Fergus Falls Optometric Center
"Family Eyecare from the Eyecare Family."
Dr. Mark D. Olmsted and Dr. Christine A. Olmsted
117 E. Lincoln Ave.
Fergus Falls, MN 56537
Appointments: 218-736-7555

Optometry Changes Since Happy Days

Optometry Changes Since “Happy Days”

By Dr. Mark D. Olmsted

I had the pleasure of attending the recent Doo-Wop show at the Center for the Arts. It had a running skit within the first half with a ‘Happy Days’ theme. Fonzie, Potsie, Ritchie, and Ralph were at their Class of 1961’s 50th reunion. What a hoot. At the break, I chatted briefly with Rev. Curt Deterding, who played Ralph Malph. I ‘reminded’ him that on the old TV show Ralph’s dad was an optometrist. He told me that later in the series, Ralph went to optometry school. That was news to me as I had stopped watching the show after Fonzie jumped the shark (Google it, if you don’t understand.)

The field of optometry has changed tremendously over the years. If we merge fact with fiction, 1950s optometrist Dr. Mickey Malph would have primarily checked eyes for refractive error and prescribed glasses. Contacts would have been hard lenses only and somewhat of a luxury. Vision therapy would have been available. All detected eye disease would have been referred out.

His son, the fictional Dr. Ralph Malph, would have received his Doctor of Optometry (O.D.) degree in the late 1960s. Early in his career, he would have seen the addition of soft contacts in the 70s. Over time he would have witnessed an explosion of optometric training, starting with an added year of optometry school in the late 60s making it a four year post-college program. Later, an increased number of undergrad courses would be required for acceptance into optometry school. The optometrists trained since the 80s had years of pharmacology plus more eye and systemic disease courses added to the curriculum.

Dr. Ralph would have had a front row seat to the updates of state laws around the country, catching up to the profession’s level of training. These law changes granted current O.D.s the privilege of prescribing both topical and oral medications for eye diseases. Both Dr. Malphs would have had the opportunity to upgrade their training and take pharmacology-based national board exams to receive these prescribing privileges. Optometrists trained in the mid-80s to present have had this training at professional school. . Dr. Mickey Malph would have likely retired prior to this training but would be amazed at what his son and other younger colleagues were doing during their workday.

I’m going to now switch to a non-fictional “character”…ME! (As Ralph Malph used to say, “I still got it!”) I decided to take some highlights from one week in my exam room for duties that were not routine, but are a big part of current optometric practice. I’ve purposely left out identifying details to protect privacy. Here we go…

A patient came in for a follow-up due to having trouble seeing with 3 month old glasses. Things were fine when they were first picked up, but a rather sudden vision drop was noticed. A re-check shows a large change in a short time. Other symptoms for my suspicion of diabetes were noted. The person was referred to a clinic for blood work. I requested that the results be sent to me and patient’s primary family doctor. Diabetes was in fact found and the GP started the patient on meds.

A person was worked into the schedule due to sudden, distorted blur to one eye while walking the day before. A dilated fundus exam (DFE) revealed a retinal detachment for which I set up an emergency consult and surgery with an area retinal surgeon.

A comprehensive exam of one of my glaucoma patients took place one day. The person was doing well with one eye medication only. The intra-ocular pressure (IOP), optic nerves, and visual field analysis (VF) were all stable. I sent refills to pharmacy on the medication.

Someone arrived for an office call having a recurrence of herpes simplex keratitis, a very serious corneal infection. The visit was early in the condition’s course, so the discomfort will be less intense by treating the problem early. This also decreases the amount of scarring that can take place. An Rx for anti-viral eye drops was sent electronically to a pharmacy.

A woman with a history of breast cancer was in for a full exam. A DFE revealed healthy eyes and no cancer in the eye. Lung and breast cancers are more prone to spreading to the eye than other malignant tumors.

An individual who works with machinery and cuts wood arrived with a red, swollen, light sensitive eye. A small foreign body was seen under high magnification, which I removed. I instilled eye drops in the office for inflammation, congestion, and to prevent infection. An Rx was sent to a pharmacy for antibiotic/steroid combo drop.

Somebody arrived with sudden flashes of light and a large new spot in the vision. A DFE to rule-out a retinal detachment revealed the less serious and more common posterior vitreal detachment (PVD). I explained that it can be a risk factor for a later retinal tear and described the symptoms.

Late one afternoon a patient presented to the office with severe headaches to the point where the head could hardly be moved. The person had trouble seeing peripherally. A computerized VF screening showed defects, but the central vision was okay. The IOP was normal. A DFE showed swollen optic nerve heads in both eyes, suggesting high intracranial pressure. Suspicion of a brain tumor or a condition called pseudo-tumor cerebri was in my differential diagnosis. I referred the person to an ER where the internist on call ordered an MRI of the brain. There was no tumor but it was pseudo-tumor cerebri, which required several spinal taps by the internist to relieve the pressure within the skull and special medication to keep that pressure normal.

On a follow-up for a secondary cataract laser treatment from one of my referrals revealed an excellent result from the surgeon and no complications. The procedure improved the patient’s vision.

I had someone in their middle-years with a relatively routine exam. A very early form of cataract was found. I explained that it didn’t need attention yet and might not for a long time, but that I needed to watch it.

I saw a patient who hadn’t had a physical in many years. There was a white ring around the cornea (corneal arcus), which can suggest high blood cholesterol. I suggested that he get a physical plus blood work with a lipid profile.

After a phone call with a patient from last month that I had told needed cataract surgery, I set up a surgical consult with a cataract surgeon and wrote a referral report.

A cataract surgeon sent a different referred patient back for follow-up. At one week things look good. Some mild (expected) inflammation still existed, but the IOP is normal and the eye was healing well. The person was told to return to me in 2 weeks.

Somebody with a sudden swollen eye from the night before came in with a green-yellow discharge and a foreign body sensation. The eyelids were stuck together in the morning. There was no foreign body, but I rinsed out the eye well anyway. Under biomicroscopy there was a mixed appearance for bacterial and allergic conjunctivitis. I instilled an anti-inflammatory drop and sent an Rx for an antibiotic/steroid med to a pharmacy.

A person returned for a DFE when his/her glasses arrived. A choroidal nevus (a mole inside the eye) was noted. I explained that I must monitor it to watch for the rare instance of melanoma development.

A full exam for a patient with rheumatoid arthritis, who controls it with plaquinil, required monitoring for a specific retinal pigment change (unique to that med) that affects the macula. No problems were present. I sent a letter sent to the treating rheumatologist.

I saw a person for a LASIK post-op follow-up per a referral from the surgeon. The result was very good. There was minimal discomfort or post-op glare. There was no need for a distance correction, but I recommended reading glasses due to age and work environment.

During a full exam for a new patient with a history of styes and lid inflammation, the only remarkable thing about the visit is red, irritated, eyelids with crust and flakes indicative of low grade staph infection seen in blepharitis. I recommended a strong commercially available lid scrub for aggressive management.

As you can see, there is much more to a modern eye doc’s work-life than, ‘Which is better…One or Two?” Of course, a large part of our day involves contact lens work and prescribing, dispensing, and repairing eyeglasses, just like the older Dr. Malph in the 50s. The traditional backbone of optometry is still there, but please don’t lock the profession in the ‘little-box’ that once was 50 years ago. Optometrists are a vital part of the healthcare system. The evolution of eyecare continues to this day.