[AMA] I Am a Young Optometrist Working in a Childrens Clinic. Ask Me Anything

LKappaPasterino on 01/06/2018 - 13:57
Last edited 05/06/2018 - 19:34 by 1 other user

How's it going. I'm an Optometrist that's been out working for a couple of years.

I'm currently working in a clinic that is primarily for children, but we do see patients of all ages as well. I also visit primary schools where we perform free eye examinations to see whether children are able to see well in class.

I have been very fortunate to work in a clinic which that co-manages patients from other medical and ophthalmology clinics. Hence, we often get referred interesting cases for us to assess. I would be happy to answer any questions, clear up any possible misconceptions about eyes (within reason of course). I also have knowledge about spectacles, but that's far from being anywhere near comfortable knowledge.

Ask me Anything

Edit: Thanks for the overwhelming response! I'll try to answer as many as I can. Because there are so many questions, please search through the post to make sure your own question hasn't been answered. Please also take my answers with a grain of salt (particular your own ocular health questions), it's best that you ask your own optometrist about them, as I know very little about you and your background.

Introduce Yourself

closed Comments

  • Pornboy69er on 04/06/2018 - 20:55

    Can I ask what your salary is? I'm looking to become an optometrist

    • oztite on 04/06/2018 - 21:52
      +1

      "Really depends.

      80-140k"

      Answered earlier. Should've gone to specsavers!

  • Meganinja on 04/06/2018 - 21:49

    Hi
    I went to a Optometrist last year in Asia holliday , with the symptom in my left eye , it has a little cloud in the middle , he said that because old age and give the eye drop name Kary uni and one normal eye drop , can I use this Kary Uni more than one bottle ( 5ml ) , and is it safe , thanks for your time .

    • KappaPasterino on 04/06/2018 - 22:10
      +1

      It's a new drop that's been marketed to slow cataract development.

      It's not available in Australia, so I can't comment on how its suppose to be used.

      I will just advise caution in using this, as this drop seems to be out recently and more importantly there are very little studies on it, so long term effects are unknown at this moment.

      • Meganinja on 05/06/2018 - 09:45

        Thanks alot for the advise , I will stop using it , it does clear up a little .

  • oztite on 04/06/2018 - 21:58

    Hi, I have two questions:

    1. Where are optometrists older than 40 y.o.? I see an optometrist once a year, from Specsaver to OPSM to Optical Superstore and they have ALWAYS been fairly good looking under 30's - is that a criteria to work in a corporate store? Where do they go when they get older?! After a few years they seem to just get replaced by a new younger optometrist… I seriously have never ever seen someone that is older than say 40…

    2. I understand it is now OD - Doctor of Optometry, 4 years post grad (at least Melb U.) following potentially 3-4 years undergrad study. My question is, for a pay that is $70k to $140k per year, is it worth the 8 years of study? Personally I feel like for the amount of study required, it should be at least above $100k… $70k seems too little…

    • KappaPasterino on 05/06/2018 - 19:58

      1. Same way McDonalds hires teens to work for them. Frankly its cheap labor. Older optometrist often demand hire salaries since they're often more skilled and perhaps over-qualified. You'll tend to find older optoms in more specialised clinics. Some older optoms also begin to take managerial positions, so you'll never have them test you.

      2. It really depends on what you want out of live. If I said some schools offer a 4 year course to make a starting salary of 70k, I think you might consider. Because Mel U is an post-grad degree, you'll find these students to be more passionate about the course. Give that context, would you consider a job that pays 70k salary which you'll reasonably enjoy? It all comes down to personal preference I guess

  • worldwidehappiness on 04/06/2018 - 22:03

    Is there anywhere that does just eye pressure tests? My ophthalmologist put me on drops, saying high eye pressure is probably genetic, but there's nothing in my family. The drops are making my eyes sore, and I've experimented with all the different brands. I want to taper off and experiment with diet because high eye pressure can be caused by diet and things like Rhinocort. But every optometrist wants to do the whole annual Medicare multiple eye tests. I just want the eye pressure test - every few days for a week or two. Eye pressure test machines cost too much to buy. I'm surprised this isn't readily available. After all, we should find the cause before jumping straight to the prescription.

    • KappaPasterino on 08/06/2018 - 00:45
      +1

      I'd personally advise you listen to your ophthals advice. Yes certainly diet and steroid medication can increase your pressure, but it's best to keep using your prescribed drops even though they do make your eyes red.

      If the optometrists wanted money, the last thing they'd want you to do is to make you go through the annual checkup. To make it short, its our job to make sure the health of your eyes are fine. Pressure is just a small part in the whole test, and by no means is it a strong indicator of the health of your eyes.

      I'd suggest you see the same optometrist regularly to develop rapport with them, so that they know your background. Then will they be comfortable doing shorter examinations, or even just pressures. Frankly no good optometrist will measure your pressure and let you be on your way.

  • Turbonetics on 04/06/2018 - 22:11

    Sometimes I get a female optometrist and during an eye exam (with the microscope machine where they sit on the other side of the table and look into your eye), they would tell me to look down and looking down means awkwardly looking down at her chest… Do optometrists know this happens?

  • Wh33lerDealer on 04/06/2018 - 22:40

    What are your thoughts on a career in optical dispensing working alongside an optometrist? Is this a worthwhile career financially or would you hit a salary ceiling quite early on as I see alot of optical shops in shopping centres.

    • KappaPasterino on 08/06/2018 - 00:38

      Financially, the ceiling varies depending on who you work for.

      If you work as a store dispensing manager say for a big store, you can get 150k easily or even more.

  • MelbournianBoy on 04/06/2018 - 22:43

    Whats your best advice on finding a job? Specsavers>OPSM>Bupa?

  • vicccta on 04/06/2018 - 23:21

    Hi thanks for the AMA, do you know much about posner schlossman or come across this much?

    • KappaPasterino on 05/06/2018 - 20:00

      What would you like to know.

      Its frankly quite rare, I've only had a few cases, but they've been interesting.

  • babolimp on 05/06/2018 - 00:00

    what's the best treatment for red eyes? mainly from screen staring too much.

    • KappaPasterino on 08/06/2018 - 00:35

      General Recommendation is ocular lubricants and relaxing your eyes to give them a break

  • bigticket on 05/06/2018 - 01:53

    Great AMA.

    Just a quick question about PD. How accurate does the PD need to be for reading and normal vision specs. I had an optometrist once quickly put a ruler over my nose and gave me my two PD's. Is this normal or should this be done using equipment? and it seems that he measured one and estimated the other.

    • KappaPasterino on 05/06/2018 - 19:59

      PDs are most important for multifocal. Not so much for single vision. SO margin of error is different.

      If you're experienced, you can definitely do it with a ruler.

  • Keraswarl on 05/06/2018 - 01:58

    When I wake up I usually get 'eye booger'that is wet and slimy. The colour is clear but can be a faint yellow at times. What is the cause for this?

    Some info:
    - I use eye drops every night before I sleep because I generally have dry eyes.
    - I'm short sighted -550 each eye
    - Use computer all day

    Thanks

  • blitzzbargain on 05/06/2018 - 09:01

    My son has a very high index of myopia for his age (probably it is genetic), -2.75 and -1.75. He is 11 years old. Could you advise how to slow down the progression of myopia?
    Thanks

    • KappaPasterino on 05/06/2018 - 20:18
      +1

      If his prescription does progress, I would advise you ask your optometrist if they offer myopia control options such as OrthoK lenses and atropine drops, which have clinically been shown to reduce myopic progression.

      • blitzzbargain on 06/06/2018 - 16:28

        Thanks Ops for the info.

        I am just wondering whether too much screen time (e.g. iPad, TV etc.) can increase the progression of his prescription? What is the rule of thumb (a.k.a practical things) that he can do daily to reduce the progression of his myopia?
        Thanks

        • KappaPasterino on 06/06/2018 - 18:18
          +1

          Please look at my other comments about digital devices, but in short, there is no evidence to suggest that they increase prescriptioon.

          My everyday advise is to get your kids outside of the house and less time indoors.

  • goodbuy on 05/06/2018 - 10:08

    What are your thoughts on myopia in East Asian countries as high as 80-90% in 18 year olds? Good for business or alarming epidemic?

    Also, do any optometrists go into the profession with 20/20? Or are most people already familiar with the profession from needing glasses growing up?

    • KappaPasterino on 06/06/2018 - 18:42

      It's certainly an alarming statistic isn't it. I am however quite sad as I feel many of these patient's don't get the most optimal treatment for their eyes. In most East Asian countries, most of the examinations and treatments that Australian Optoms do are only performed by Ophthalmologists in Asia. Because of this there is on immense undersupply of qualified practitioners to take care of these patients, specifically treatments too reduce myopic progression.

      I guess in terms of business (since its ozbargain), the economies of scale are severely underoptimised, ophthals in those countries get overworked seeing patients.

      Yes many optoms have 20/20 vision. I mean you don't have to have bad vision to see your optometrist.

  • yida on 05/06/2018 - 10:52

    As a uni student who is thinking about doing medicine, and having optometry as a back up plan, are there a lot of job opportunities for optometrists now? I've heard a lot about how there is too many optometrists now, and it's difficult to find a job.
    Also, seems like a silly question but, are you enjoying your job?
    Thanks

    • KappaPasterino on 05/06/2018 - 20:04
      +2

      Hi and good luck in your studies.

      Yes, yes, yes there will be plenty of opportunities to work. I honestly don't think there are too many optometrists considering the ageing population, and the fact that some optoms see +20 patients a day. And this goes for all medical courses too. Medicine has an oversupply of medical interns in the surburbs and CBD, but vast undersupply in regional areas.

      The question instead you need to ask yourself is: What kind of job do you want, what kind of pay, and where to work at? You might not be able to get what you want with all 3.

      I personally enjoy my job, because I don't feel overworked, see a wide variety of patients and cases.

  • buckster on 05/06/2018 - 13:08
    +1

    What are your thoughts on Maurice Brumer's theory of myopization?

  • CryssieJade on 05/06/2018 - 13:17

    Question!

    In the past 12 months, I noticed a shift in my vision. I went from 20/20 to not being able to read signs at a distance. I had an eye test recently, and I now wear glasses for driving at night, and when my eyes are fatigued after work (I'm a Photographer).

    Within the past 18 months, I have had a very bad case of conjuctivitis (where the entire white lining (?) of the inside of my eyelids was covering my eyes and I had to wash/remove it 10 times a day over the course of two weeks). And 12 months ago, I had to take a course of Ciprofloxacin to treat very severe travel illness.

    Could those two medical conditions have contributed to my shortsightedness? It seemed to come on quite suddenly.

    • KappaPasterino on 05/06/2018 - 20:16

      Given your background, I am doubtful it may, unless the conjunctivitis significantly altered the front surface of your eye.

      I would say no.

  • Godric on 05/06/2018 - 13:23

    Are beer goggles real?

  • otaku on 05/06/2018 - 15:27

    Hi i'm a teen with blepharitis and ocular rosacea my eye has been constantly bloodshot for a year now i was prescribe doxycycline and FML eye drops my doc wants me to use doxy for 3 months is it necessary to take it and would the eye go back to bloodshot after stopping the medication? and they also want me to take FML eye drops for life is that dangerous as my other opthamologist was hesitant to prescribe it? and lastly does lack of sleep cause purple eye bags and bloodshot eyes i only sleep after 4am due to mental health issues? thanks you alot.

    • KappaPasterino on 05/06/2018 - 20:14

      As you may know yourself Ocular Rosacea is a nasty inflammatory disease of the skin.

      Doxy and FML are great because they're anti-inflammatory medications. I'd personally be concerned about using FML long term, because its a cortico-steroid (although low potency) and can have long term adverse effects if used frequently, and this is most likley why your ophthal is hesitant.

      I'd personally had great success with several patients with severe ocular rosacea using Intense Pulse Light (IPL), which not only reduces dry eye symptoms but can also sometimes reduce surrounding redness too. That can possibly be an option for you. Many dermatologist will have access to this treatment, a few optometrist clinics also have it too.

      Finally yes lack of sleep does contribute to blood shot eyes.

      • otaku on 05/06/2018 - 20:45

        Thank you very much for your answer i appreciate it a lot.

  • juln on 05/06/2018 - 15:31

    Does letting a child at a young age use the tablet / phone impact their eyes? Is it true that it could cause issues with their vision in the future?

    • fozzie on 05/06/2018 - 17:02
      +1

      Read beginning of the post he has answered already

  • lddv04 on 05/06/2018 - 16:09
    -1

    At first read I read "I'm a young optimist"….I thought all young people were optimistic :-)

  • Keef on 05/06/2018 - 18:04

    Will the clouds and black spots from my Epiretinal Membrane increase over time?

    • KappaPasterino on 05/06/2018 - 20:15

      Possibly depending on severity, please always have follow-up exams to check for any progression.

  • chumlee on 05/06/2018 - 18:07

    Is it true too much masturbating causes blindness?

    My vision is deteriorating but could be with age

  • tyb1987 on 05/06/2018 - 19:22

    Is there any cons to use mobile phone in dark?

  • qwerty132 on 05/06/2018 - 20:58

    Hi,
    Thanks for the AMA.
    Have you seen many cases of CFEOM?

    • KappaPasterino on 06/06/2018 - 18:18

      Sorry, none in my clinical experience, but I still may be able to answer your questions about it

  • MarsTitan on 05/06/2018 - 23:33

    Have you heard of Pixl based eye correction? Any experience with it?

    • KappaPasterino on 06/06/2018 - 18:19

      From my understanding, its a branch of refractive treatment that was based on keratoconic treatment.

      Frankly I have no experience with it, I've never heard of an Australian Refractive Surgeons adopting it, but Australia always tends to be a bit slow in adopting new treatment techniques

  • BubbLeT on 06/06/2018 - 10:01

    Hi. I've never had an eye test and have always thought my eyesight was pretty good. Working in an office and always looking at electronic screens, I have noticed that it takes quite a while for me to regain distanced vision being up to a few minutes after staring at screens for an extended period of time.

    It hasn't become worse but I am a little worried. I think I should get this checked out?

    • KappaPasterino on 06/06/2018 - 18:22

      This is quite normal for office workers particularly those who spend a lot of time in front of your screens.

      In the simplest sense, what your experiencing is your eyes changing its focus (in the same way that your phone camera changes focus from something close to far away). Continuous office work may strain your eyes and thus increase the time it takes for you to make things in the distance clear. If you are experiencing these symptoms increasingly, I'd suggest you talk to an optometrist. This is most likely caused by presbyopia (age-related changes in the eye)

      What they may offer are anti-fatigue lenses or computer based spectacles specifically for your work and nothing else.

  • JTTheMan on 06/06/2018 - 10:23

    Any tips/advice for me?
    I'm in my 40's and starting to notice quite a bit of eye strain due to worsening presbyopia.
    This is on top of a background of hypermetropia that I've had since teenage years. The hypermetropia was gradually getting a little worse over 20 years and requiring stronger prescriptions, In addition to correcting my Astigmatism. In the last couple of years that part of my vision is stable but now the presbyopia is taking over as the main problem obviously due to ageing.
    My optometrist says the next step is multifocals but in the short term I should be able to use reading glasses on top of my contact lenses. I'm just wondering if you may have any ideas as I guess I can't stop ageing?

    • KappaPasterino on 06/06/2018 - 18:25

      I'm afraid there's currently no treatments in presbyopia hahaha I don't think there'll be any medical advances that will stop ageing anytime in our lifetime.

      If you haven't already, talk to your optometrist about possible multifocal contact lenses, but not all optoms will offer that treatment.

      I would advise you talk regular breaks from looking at things up close.

    • buckster on 07/06/2018 - 12:20

      Embrace middle age!

  • exit on 06/06/2018 - 11:11

    Hey. Is it normal for OrthoK lenses to not work for everyone? I got perfect vision on my right eye but the optometrists can't get me great vision on my left, even after trying multiple OrthoK lenses. I've been using OrthoK for 5 years and I never got my vision on my left as good as my right. At best, I usually just end up with double vision where some of my eye can see things clearly but there is tons of blur on other parts of the eye. One of the reasons suggested is that my eye is similar in various places so the lens can't lock on properly. In this case, I'd rather just wear soft contacts on my left and OrthoK on the right.

    • KappaPasterino on 06/06/2018 - 18:36

      Hi Shot, look its quite rare that we get OrthoKs don't work.

      Various factors may come into play which may affect how your vision works, aka sleep, the position you sleep, and of course the shape of your eye.

      For me personally, wearing one contact lens in one eye and an OrthoK in the other defeats the purpose of wearing OrthoKs in the first place

  • raytriplej on 06/06/2018 - 16:34

    My 10 yr old son appears to have a colour blindness issue. I have been reluctant to get this medically diagnosed due to restrictions this might have on his future. Is there any benefit in having this diagnoses or am I being alarmist by worrying about his long term future?
    Thanks
    Ray

    • KappaPasterino on 06/06/2018 - 18:32
      +2

      Hi Ray, colour deficiency can certainly create some limitations in your son's life but it certainly will not be the end of everything.

      I'd personally you get that this deficiency formally diagnosed by an optometrist or the UNSW colour vision clinic.
      Frankly you will save your son and yourself a lot of time in the future by doing this, as it will show which pathways he may undergo.

      I've have many experiences screening adults who have spent considerable effort and thousands of dollars learning in police academies, pilot training and railwork. And in their final part of their courses they get medical check ups only to be failed by us because they were not aware they had a colour deficiency.

      I know its not the answer that you wanted, but it will save your son a lot of hardship in the future.

      • raytriplej on 07/06/2018 - 11:58

        Thanks for your reply. You raise some very valid points.

        • KappaPasterino on 08/06/2018 - 00:33

          I'd also like to add another point that having a colour vision deficiency will not mean that your son will have no change in getting a certain job. But it makes it a lot harder to do so.

          As I've mentioned before, we've had to fail some candidates in their colour vision test, but they still made it into the force because they passed a practical examination. So there is certainly a chance for your son to get into his force should he try hard enough.

          The main reason why they do it is to protect both the candidate and possibly the people they working with (eg pilot and their passengers).

  • rendo on 06/06/2018 - 22:05

    Hello,

    Thanks for all your advice.
    I suspected my daughter was short sighted, like myself, as she was having trouble focussing on the board, the TV when far away, etc. So one day I put my glasses on her and …."WOW DADDY!!! Everything is sooo clear". This was about 2 years ago, she is now 8.

    We went to an Opto and they confirmed she was short sighted, but said not to give her glasses as she was too young. I wasnt there, as I would have pushed to know exactly why and challenged it until I was satisfied. Anyway, no glasses. Then a year later my daughter still has sight issues and is getting really upset she cant see the board in class. Even though we got her moved to the front row. So enough was enough. I demanded glasses. She got them and can now see the board. The same opto only gave her a weaker script than she needs, but at least it works.She also gave strict instructions not to wear the glasses unless looking at the board.
    Her script is LEFT (Sphere -0.50; Add +0.75) RIGHT (Sphere -0.75, Add +0.75), nothing else noted on the script.

    Can you help me out here, is it true the glasses are "bad" for her eyes? I would have thought it would be better to get glasses, so that she can see the board, learn properly and not be stressed out and upset that she cant read what was trying to be taught? I also would have thought that without wearing any glasses then this could worsen her sight even further if the eyes are continually under strain.

    Anyway, hope you can help. I am also wondering should I encourage her to use the glasses when she is at home, say in front of the TV (which isnt often at all) and is sitting a few metres away.

    • [Deactivated] on 07/06/2018 - 00:32
      +1

      Please see a different optom. I mean, imagine how well you would've studied if you couldn't even see what the teacher is talking about?

      Also as previously mentioned glasses don't physically change the eyes.

    • kawinuyo on 07/06/2018 - 09:59
      +1

      She is not too young to get glasses. Glasses are not going to make things worse, if she does get worse she was going to get worse anyway without the glasses. Don't let them under prescribe the script cause this can lead to further progression in fact… Spend more time outdoors in bright sunlight.

    • buckster on 07/06/2018 - 12:23
      +1

      There is no evidence that conclusively states that not wearing glasses will be at all helpful for vision.

      She won't necessarily worsen her vision limiting the use of glasses either.

      Encourage her to spend ~2 hours outside daily

      • rendo on 07/06/2018 - 22:34

        thank you all.

        @KappaPasterino

        any thoughts or advice here?

        • KappaPasterino on 08/06/2018 - 00:28

          Hmmm this is certainly an interesting scenario you've presented.

          As Bucker has mentioned wearing spectacles doesn't accelerate the prescription from getting worse. In fact, undercorrecting can lead to accelerated myopic progression (please let me know if you want paper on this evidence). There may be one reason why the optometrist made those recommendations though, and that's if she has noticed a near focus problem. This is also most likely why she has prescribed the ADD. As a result of this, if your daughter looks at things up close it may induce some strain. In the most ideal situation, I would have prescribed Multi-focal lenses which reduces the strain when looking up things up close.

          Overall, it sounds like you're frankly quite unsatisfied. I'd personally suggest you talk to the same optometrist to clarify things out.

          Finally, spend more time outside as recommended.

          Please let me know if there are any uncertainties or queries you'd like to know.

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