Article Date: 8/1/2001

Lessons Learned
The Choral Director's Problem
Don't let an important part of your practice go by the wayside.
By Jack Runninger, O.D.

"Dogs must be carried on escalator," read the sign at the Irish store. "Where on earth . . ." complained O'Reilly, as he contemplated how he was going to get to the next floor, "am I ever gonna find a dog at this time of day?"

Just as O'Reilly misunderstood the sign, I can't help but wonder if some O.D.s, with their increasing interest in eye pathology, may misunderstand the importance of vocational lens prescribing.

Heckuva time

"I'm having a heckuva time getting glasses I can see with while conducting," a 50-year-old college choral director told me.

I recommended that he inquire about the possibility of monovision contact lenses to use when conducting, with the near lens focused for his music stand distance, or try bifocals with a large lower segment focused at his music stand distance.

Solving problems such as these was one of the most interesting parts of practice for me. And it was one of my best practice builders. Here are a few examples of how solving these problems can benefit patients and build your reputation.

Astronaut problems

Dr. Jack Bridwell wrote an article for OM years ago describing care for a presbyopic astronaut.

With zero gravity during space walks, the astronaut would approach near visual tasks from many angles, so that a regular bifocal wouldn't work properly. Dr. Bridwell solved his predicament with a vertical Executive-style bifocal, with the outer part of the lenses focused for distance. The 15-mm nasal portion of each lens had the appropriate near prescription.

A Golf Digest published an article I wrote a while back describing bifocal segment placements and powers for presbyopic golfers. One idea used an Executive-style bifocal focused at the ball to eliminate awkward head positions.

Patients from as far as Ohio and Michigan came to me for exams after reading that article. Plus, I got many letters requesting referrals to O.D.s who knew how to do this prescribing.

She was embarrassed

The late Dr. Louie Jacques told of fitting a Hollywood still photographer who needed to see at 40" through the bottom of his lenses, at infinity through the middle and at 12" overhead. Dr. Jacques solved his dilemma with appropriately focused top and bottom segments.

"He's doing fine," the man's wife reported. "Except I get so embarrassed when we go to a restaurant, and he reads the menu while holding it above his head."

A Popular Mechanics recognized the importance of occupational prescribing when it published an article I wrote about upper seg prescribing for electricians, cabinet makers and others who need to see at close range above eye level.

Too little, too late

"I went to Dr. Mack Ulopathy because I was having a little trouble reading," a new patient told me. "I can read better with the new bifocals he prescribed, but now I can't see at arm's length, which I need to do for my job.

"I went back, and he told me I needed trifocals, after he'd just sold me an expensive pair of bifocals!"

After we'd solved his dilemma by prescribing progressive lenses, he made an enlightening comment that every O.D. should ponder:

"Dr. Ulopathy may be a good ophthalmologist, but he sure isn't a very good optometrist!"


Optometric Management, Issue: August 2001