A day in the life of an OptStudent

OptStudent Blog on hiatus

Sat, 27 Sep 2008 18:26:55 -0700

Below is the current the dwelling of your beloved blog author and the rest of the SCCO class of 2010:

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Due to all the craziness going on right now, the OptStudent.com blog will be on a short hiatus, but please do come by in the near future to get updates on the "craziness" including our upcoming Strabismus & Amblyopia and OHP II proficiencies, and of course, 12 Station!

The hill is getting steeper

Sun, 21 Sep 2008 13:03:06 -0700

This week is going to be one of the busiest yet this quarter. I have two exams and two quizzes, plus one community service event that I'm running and a Student Association Board meeting. There is barely any time to study this week, let alone any time for practicing for 12 Station, which is coming up way faster than I'd hope. I really feel like as if I'm just barely trying to stay afloat in the water and I'm taking huge gulps of water every now and then. Seriously, this quarter is just horrible for our class...! Hopefully everything will turn out fine.

Lastly, I just wanted to update you from the last blog, and I did indeed get VAOC as my Spring Quarter pick...yeahhh! I barely got it since I filled the last slot and people were taking the other three slots pretty much like one after the other. Well that's all for now, especially since there was nothing really exciting this past week...but just hang on tight, I'll be giving you more updates on this super busy quarter when I can!

4th year rotations selection

Sun, 14 Sep 2008 10:58:24 -0700

This past Thursday was the first of two days for choosing which 4th year rotation. The selection process is pretty complicated, but if you're familiar with professional basketball, it's similar to the NBA Draft lottery process. SCCO has a vast rotation site selection to choose from, including such exotic places like Hawaii and Japan. I decided to stay local for my first two picks (and my next two as well, which will be decided on this coming Thursday) since I want to enjoy Southern California as much as possible before I get sent out to wherever the Army takes me when I graduate. My summer quarter pick was the Veterans Affairs hospital in West Los Angeles. Supposedly it's a great site, since VA hospitals have a lot of older folks, which means more pathology to see. Also, the location is pretty nice...it's around the UCLA area and somewhat close to Beverly Hills; BUT the commute from Fullerton is horrible since lots of people head in that general direction, towards Los Angeles. I heard the commute takes about 1.5 hours!!!

My fall quarter pick is the Center for the Partially Sighted (CPS); this rotation also involves some days in school vision screenings plus one day in the Optometric Center of Los Angeles, aka OCLA. Unfortunately, CPS is near VA West LA so the commute will be pretty much the same. CPS is a Low Vision rotation, which will involve working with people who have poor vision even with the best regular (spectacle or glasses) correction available. Although I have no experience with low vision as of yet, I am open to learning more about it and I do like ocular disease a lot - these folks at CPS are most likely afflicted with some type of visually debilitating disease so I know I'll enjoy this site a lot. OCLA is a remote site of SCCO, and it is just south of LA, which has a lot of minorities and lower income folks (although unfortunately, there is a higher percentage of pathology). This commute is not as far as VA West LA/CPS but I hear a lot of great things about this site. Lastly, once a week I will be working at various locations for school vision screenings; these events are very important since many school aged kids cope with visual problems by avoiding tasks at that distance, i.e. if they have trouble reading the board they will just wander off or fool around, etc.

My winter pick will be here at the SCCO Eye Care Center. I decided to stay here for the winter since I wanted to guarantee that I will be staying here during the two breaks during winter (Thanksgiving and Christmas). Also, the 2nd part of our board exams will be in December. My last pick hasn't been determined yet, but my lottery number for that quarter is somewhat high so I will be choosing either OCLA or most likely VA Outpatient Clinic Los Angeles. I also heard great things about the latter site, and after all, it is a VA site which means a great deal of pathology. Also, you have the option of taking the metro train to there so you don't have to deal with LA traffic. I haven't made my decision yet, but until the next blog, I'll update you all on this soon!

This past week

Sun, 7 Sep 2008 22:41:46 -0700

This past week was my Ocular Disease II exam. It was all about glaucoma, which I found very interesting. It was a fair test, but unfortunately I made some silly mistakes...ah what can I say, although I have decent grades, I'm not very consistent with lecture exams. I have been doing fine with proficiencies (I have yet to fail one, but that will probably change in 12 Station!) and I have been doing pretty well in clinic. So overall I have been pretty happy with my performance in optometry school since I know that my performance with hands on tasks (i.e. clinical skills) are what matters the most to me. This coming Tuesday is our Strabismus and Amblyopia Diagnosis exam, which I heard is going to be challenging in a sense that it involves a lot of analysis.I have two labs this quarter - Strab and OHP II. In Strab, we have been learning techniques that help optometrists diagnose and quantify strabismus and amblyopia - all I can say is that there are TONS of tests and many of them will be assessed in our proficiency, which is in the beginning of October. In OHP II, we learned several ocular disease procedures, including foreign body removal, dilation and irrigation, and punctal occlusion with punctal plug implants.

Dilation and irrigation serves as both a diagnostic and therapeutic procedure for blockage of the tear drainage. Dilation involves sticking a pointed metal instrument into the punctum, which is a hole where the tears drain; this is done to widen the hole so that a syringe can be inserted to irrigate the canal within. The syringe is filled with saline solution, which is passed through the canal to determine the location of blockage. It also can serve as a way to push the drainage out. If the patient tastes the salty saline solution in the back of the throat, then you know that the drainage is clear (due to the anatomy). That was a really weird feeling, having that syringe jammed in my eyelid then all of a sudden tasting a salty solution in the back of my throat!

Here is a picture of the dilation part of the procedure (yeah, it basically involves jamming and twisting a pointy instrument into the lid - of course, the patient will be anesthetized locally!):

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Punctal occlusion is a technique used to intentionally block the punctum, thus blocking the drainage of the tears. Why do this? Some people have a problem retaining their tears (thus causing dry eyes) so blocking the drainage may help. Like dilation and irrigation, it can also serve as both a diagnostic and therapeutic purpose. Diagnostically, optometrists block the punctum with a dissolvable plug; the patient returns to the optometrist after the plug dissolves, and if the plug worked, then the optometrist will know that therapeutically, permanent punctal occlusion will indeed work (whether thru non-dissolving, removable silicone plugs or surgical closure by cautery).

Here is a picture to get an idea of how it works - it's basically a tiny little plug that is inserted with forceps:

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As far as 12 Station, three other classmates and I have formed a study group. We have started practicing already this past week, and we have set a schedule where we work on 2 stations per session. Hopefully with early preparation, we will minimize station failures!

And lastly, clinic this past Saturday was pretty awesome. On my schedule was a 33 year-old female; I tried to review the chart but unfortunately it was put away since it was being scanned. I was thinking, yeah this patient is young so it should be straightforward. At the appointment time, I went to pick up the patient at the reception area and saw her - she looked pretty normal at first. Then I noticed that she was wearing hearing aids. Right as I was taking autorefraction readings, she told me she has Usher's syndrome and that I need to speak up louder. I was thinking, that syndrome sounds familiar but it didn't ring any bells. I then sat her down in my exam lane and she told me that she has Retinitis Pigmentosa (RP) and Cataracts. Whoa! So yeah, it turns out that Usher's Syndrome involves this triad (RP, Posterior Subcapsular Cataracts, and hearing loss). Her color vision was poor since her cones were abnormal due to the RP. I also did confrontation visual fields, which checks for her peripheral vision - that was totally shot and she did not see any of my fingers off to the side. When I checked out her dilated eyes in the slit lamp, I saw massive cataracts that looked like stars. Then when I looked at her retina with my BIO, there were black "bone spicules" all over...it was AMAZING! It was definitely the most exciting case I've had to date.

Her field of vision was as if she was looking through a small tunnel:

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Here is what her retina looked like - basically the entire peripheral retina is compromised, which caused the tunnel vision above:

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Here is an idea of what the cataract looked like - it was a cool looking star shape (this picture is with retroillumination, where the light is bouncing off the retina; when viewed with the light on the side, it looks like ground glass):

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Glaucoma - an interesting eye disease

Sun, 31 Aug 2008 01:24:09 -0700

In Ocular Disease II we are learning about glaucoma, which is a disease of the optic nerve that creeps up on people without them expecting it since it's often asymptomatic. The most interesting and unique thing about this disease is that it affects both the front and back part of the eye (the posterior and anterior chambers). Many ocular diseases require only a small set of instruments - for example, conjunctivitis ("pink eye") pretty much requires only the use of a slit lamp to diagnose. However, glaucoma requires a whole spectrum of instruments along with the many things to watch out for (of course, this is not totally inclusive of all instruments and things to look for):- Slit lamp: check anterior chamber depth, watch for pigment in the anterior chamber, uveitis, ocular trauma, iris neovascularization, etc
- Visual fields: this requires a lot of knowledge on several visual field defect patterns, in other words, the pattern in which a patient misses a light shown in a certain location in their peripheral vision
- BIO: check for retinal neovascularization or any other vessel disease in the fundus (to help differentiate the cause)
- Fundus lens: check for changes in the structure of the optic nerve head, missing retinal nerve fibers
- Tonometry: check for increased intraocular pressure (a significant risk factor for glaucoma)
- Gonioscopy: check the anterior chamber angles
- There are many more instruments, including the HRT, SLOCT, etc.

Glaucoma in itself is such a complex disease to the extent that most of our Ocular Disease II class will be involved with glaucoma. Also, at our clinic we designate a special kind of exam for glaucoma patients, called a "Glaucoma Workup". This is a battery of tests that is done to diagnose and help determine the prognosis and treatment of a patient's glaucoma (there are many types). It's no wonder that there are so many things to look at with glaucoma, since it's such an elusive disease!

The upcoming onslaught

Sat, 23 Aug 2008 19:57:13 -0700

Sometimes I wish school had a difficulty level selection...

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This quarter has historically been the most stressful quarter of all quarters in SCCO. However, due to the recent changes in the curriculum, I think it's going to be even harder than what past classes had to deal with. That's because a difficult class that was normally in the Winter was pushed back to this quarter (Strabismus and Amblyopia Diagnosis). Furthermore, we expect that the ocular disease portion of Geriatrics will be challenging too. These two tough classes are on top of two other tough classes - Ocular Health Procedures (OHP) II and Ocular Disease II. Here is a summary of the challenges ahead:- Our research proposal is due this coming Thursday, Aug 28. This is the proposal of the research project that all students are required to complete by the end of their 4th year. This proposal was originally due in December of this year, but the research committee decided to push it up to August! This caused a lot of scrambling and last minute decisions on what to conduct research on.

- We have 12-16 (ish) hours of clinic each week. Clinic in itself is like having a 3-4 hour proficiency since there can be any kind of condition walking through our exam door, whether it is a simple 20 year-old female myope with no complaints to a 85-year old non-english speaking, illiterate hispanic male with no prior eye exam (thus no history to work with) and with uncontrolled diabetes and hulking cataracts. Yeah, it's like a proficiency because the staff docs will quiz you on everything you've ever learned regarding your patient. Clinic can be pretty stressful but at the same time I enjoy the challenge and seeing the things we learned about in class in real life makes it even more interesting.

- Every week until Sep 26th we have a quiz in both Strab/Amb Dx lab and OHP II

- As usual, we will have one lecture exam every week until finals, starting the day after Labor Day (yeah, there goes enjoying Labor Day BBQ); also, there will be one week on the Sep 22 that will have two exams.

- For those who had the 2nd rotation of Contact Lenses in Clinic (which includes myself), we have to audit two contact lens charts by the end of this week. Auditing is basically the review of patient charts to for quality assurance and thoroughness.

- The Primary Care chart audit is due by Sep 12 - this is a relatively quick and simple audit but it's just another thing to add onto the already heaps of stuff we're involved in right now...

- Oct 3 = Strabismus Proficiency...this one is gonna be hard I heard. We have several techniques to practice on top of lecture exams and practicing for the dreaded 12 Station Proficiency (more on the latter below).

- Oct 3 = yes, another proficiency on the same day - this one's for OHP II. Basically there will be a grab bag of different ocular health techniques and one will be drawn out randomly - and that is the procedure we'll have to demonstrate proficiency in. It just so happens that my lab section has both the Strab and OHP labs on the same day!

- Sometime around the end of the quarter will be our OHP II final proficiency (gonioscopy, fundus lens, and extended BIO; see the last blog). I heard that extended BIO is what fails most people since it's very challenging to go way out in the far edges of the inside of the eye. I tried it for the first time this past Friday and yeah it's definitely hard but I know I'll pick it up somewhat quickly since I can already reach the Ora Serrata (the farthest edges of the retina) in a couple of the quadrants of the eye. Well um then again that depends on the patient, but I was doing this on a patient with small fissures (eye openings), which is challenging anyway.

- Oct 10 and 13 = 12 STATION (dun dun dunnnnn)! Here is a summary of what we are being tested on in this ridiculously ginormous proficiency:

1) Subjective Refraction/Phorometry/Entrance Testing
2) Posterior Segment Evaluation/Binocular Indirect Ophthalmoscopy/Volk Lens
3) Bifocal/Trifocal/PAL Dispensing
4) Rigid Contact Lens Skills
5) Patient History
6) Contact Lens Care Products
7) Anterior Segment Evaluation/Slit Lamp Biomicroscopy/Goldmann Applanation Tonometry
8) Contact Lens Design Knowledge
9) Soft Contact Lens Skills
10) Visual Efficiency Evaluation
11) Visual Efficiency Therapy/Home VT
12) Visual Efficiency Therapy/In-Office VT

To basically sum it up, the 12 Station Proficiency is a combination of EVERY SINGLE proficiency we have ever taken here in optometry school. Historically, most people have failed at least one station (which means you have to retake that one station). Failure to pass all stations with a 75% average means you have to remediate one extra quarter of clinic after graduation, and failure to pass with a 80% average means you have to take a special tutorial session in clinic the following quarter to enhance your clinical skills. Failure on the retake also means remediating one extra quarter after graduation. Yeah, this proficiency is seriously stressing us all out here!!! So basically we will be practicing for 12 Station on top of all of the stuff above. Wish us luck!

End of summer, beginning of fall quarter

Fri, 15 Aug 2008 17:20:44 -0700

It's been a while since my last post, but it's been incredibly busy here (yeah, nothing new right) - basically what happened over the past week were my finals for the summer. I had four finals over three days, and basically only a weekend to study for all four. The Contact Lenses III final was super long and covered probably among the most material we've had in a single test. This happened because due to the recent curriculum changes, CL III became a combination of two classes and the material was very compressed - oftentimes the lectures would go over time. It was a three hour long test...I took a little over two hours myself though but most people finished at almost two hours into the exam.

Next quarter is just around the corner - it's going to start this coming Monday. Here is a quick breakdown of my classes:- Geriatric Optometry: this class covers the special considerations when examining older patients, including ocular diseases related to age.
- Ocular Health Procedures II: we will be learning more advanced procedures such as gonioscopy, Extended Binocular Indirect Ophthalmoscopy (basically advanced BIO), and fundus lens ophthalmoscopy.
- Strabismus/Amblyopia diagnosis: the name says it all - this class will cover strabismus (eye turns) and amblyopia ("lazy eye")
- Ocular Disease II: this is a continuation from our last ocular disease class, and we will be covering mainly the retina, including glaucoma, a significant ocular condition where the optic nerve is damaged.

Of course, all third years will be doing something like 12-16 hours of clinic per week on top of classes. However, the most stressful thing about this quarter, as I've mentioned in past blogs, is the dreaded 12 station...we will be starting to practice for that pretty soon, and throughout the quarter until it takes place mid October. I'll be talking more and more about this very important, comprehensive proficiency in the near future.

Also, just today was the first year orientation - since I am part of the Student Association Board (I'm one of the chairs in the Department of Community Health), I came to help out with the tours and other orientation stuff. It was nice to meet a bunch of new people and get to show them around our nice campus. I was also really happy to see that some of the students are familiar with OptStudent.com - the came up to me and told me about how the website helped them through the application process. I'm so glad to meet the people I've impacted in person, and it makes the time I put into this website totally worthwhile. So please, if you run into me on campus, feel free to introduce yourself..I am more than happy to help you out with anything i.e. advice or questions. I really do take pleasure in helping others so please don't hesitate to say hi! Alright, stay tuned for more Fall quarter excitement (and stress)!!!

Learn Something New #6: Adaptive Eyewear

Wed, 6 Aug 2008 08:28:01 -0700

It seems to be that there is a solution for easy to make glasses for third world countries, and it has been in existence for a couple of years now...it's called Adaptive Eyewear! Basically, clear bags within the frame are filled with water, and the amount of water adjusts the amount of power the lens will give. Although they probably look a little awkward, the makers claim that they are functional and have helped thousands of people in third world nations...check out the links and the video below for more info:

Adaptive Eyewear Homepage

How it works

The strongest earthquake I've experienced

Tue, 29 Jul 2008 15:01:08 -0700

I keep talking about all the great things about living here in California - but of course, any place has its downsides too. Minor earthquakes are a part of life here in California due to the San Andreas Fault. But
this morning I experienced the strongest earthquake I've ever felt (see an article about it in the NY Times here). It was about 5.4 on the Richter Scale, which fell into the Moderate Earthquake category. Luckily my friends and family were okay through the ordeal, and everything was alright in my apartment (only my box of Grape Nuts fell from the top of my fridge). I was basically just sitting in my apartment during my lunch break, and all of a sudden I hear things dropping really hard and loud in the apartment above me, then I felt the ground moving around, almost as if several rolling waves just passed by. The whole apartment was shaking and all of the loose items (e.g. glassware, cups, etc.) were rattling. It didn't occur to me that there was an earthquake right away, but as soon as I realized it I ran outside. I just read in this article from FEMA that you're supposed to stay indoors actually (oh well). When I was outside, my neighbor from upstairs came down and told me about how he had to stay in the apartment to hold down the fish tank, which would have tipped over and potentially cause a leak down to my apartment through the ceiling!

What can I say, I'm so used to living in La-La land here, thinking that nothing can go wrong, but it's crazy to know that because of the seismic activity here in California, within a few moments, all of your things can be buried in rubble. Now I'm thinking, geez all of this stuff that I have related to optometry school could be buried just like that, and not to mention all of my work in my computer!!! It reminds me of what Forrest Gump said: "life is like a box of chocolates, you'll never know what you're gonna get."

No midterm this coming week!

Sun, 20 Jul 2008 00:25:11 -0700

Normally, during the weekend, I hang out on Friday evening and Saturday (either the day or evening), then all the other times I'm not out (including all day Sunday), I study for the upcoming exam that Tuesday. Since I don't have an exam this coming week, I was able to truly relax for the weekend.

On Friday evening, I watched The Dark Knight, which is the new Batman movie. I came in the theater knowing that the movie had excellent ratings, so I was hoping that it would not be one of those typical Hollywood films, with cliche lines and predictable plots and endings. However, I must say that I was truly blown away! It was very interesting to see how the plot twisted a couple times throughout the movie, instead of the typical single twist at the end. Definitely an unpredictable plot. And I must say Heath Ledger's rendition of The Joker was creepy as heck!!! So yeah, I highly recommend it! Check out the ratings all over the internet and you'll see what I mean, but even better, go watch it!

On Saturday, my fiancee and I spent the day around some of the Orange County beaches (yes, we got engaged - sorry I didn't mention anything until now, but yeah I popped the question in May). We went to Laguna Beach and ate at a very popular restaurant called Las Brisas, which serves excellent Mexican food; I heard that it's known to have celebrity sightings there. I highly recommend the calamari if you ever stop by there! We walked around the beach there and enjoyed the waves crashing against the rocks and cliffs. The surrounding area is definitely a great place to stop by to relax and walk around for a scenic stroll. Next, we went to Sprinkles Cupcakes in Newport Beach; this place has been very popular in the LA area, and so a location was opened in Newport. It's a very simple bakery that specializes in cupcakes, and what makes them so special is the icing. My fiancee had the strawberry and I had coconut - both were good but the strawberry was awesome!

Here's a sample of what they looked like - don't they look delicious???

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This weekend was definitely a well needed boost, especially since I keep hearing about how horrible fall quarter is going to be (and it's coming up faster than I would like to)! I'm just trying to do as much fun stuff as I can before I go back to hermit status...!