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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

We are approaching the Holiday Seasons, perhaps, the happiest time of the year for most of my readers. HAPPY THANKSGIVING! This is the season to gather with friends & family to munch of goodies and share whatever we are grateful for. Don’t forget to reach out and lend a helping hand to someone less fortunate than us. CXL for KERATOCONUS: We are beginning to see more and more OMD’s offering this service to help curtail keratoconus. This procedure involves a simple procedure that can dramatically improve the quality of life for many keratoconus and ectasia patients. This procedure can halt the corneal shape change. This has in turn enabled the patients to achieve improved vision and avoid corneal transplantation. Most likely this procedure will be receiving FDA approval in the not too distant future. So what will be our role as O.D.’s to becoming involved with patient care? We refer the more advanced cones to local OMD’s that offer this service. We then provide contact lenses about 3 months after the procedure. It can be done on both eyes at the same time or one eye at a time. CXL utilizes Riboflavin (Vitamin B2) and UV-A radiation to improve the corneal rigidity by increasing...
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Optometrist Prespective by Harvey Yamamoto, OD

Optometrist Prespective by Harvey Yamamoto, OD

I’m a huge fan of remodeling one’s office very 3-5 years. Anyone can swing a paint brush or roller for beginners. A new coat of paint can spruce up the old walls. Two years ago my staff talked me into remodeling the office. I listened to their plans and upon hearing their complete makeover – I honestly balked at the idea. They wanted to retile the waiting room for starters. Then take out the flooring in 3 exam rooms and the kitchen. What? Are they nuts? The expense of installing wood flooring was more than what I had budgeted for. What they did not know was that I knew we had been laying one tile floor on top of one another for the past 3 upgrades. Our floors were high enough which made this project a major one to tackle. The staff then volunteered their husbands to do the work at night after their work was done. They would work for $10/hr. Hey, I couldn’t resist. My wife and I went shopping and purchased a large truckload of tiles, grouting, wood flooring materials, tools, etc. The boys came after work on day #1 and began to chisel out the flooring in the waiting room. Hours later, very little progress was being made. I went home and brought back a small air operated flooring...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

Hello to summer. Once again, I watch my electric bill climb through the roof. If only my bottom line would climb as quickly as our electric bill then I would be content for another year. As promised, I feel that glaucoma is a very important aspect of any optometrist’s daily practice. If we miss it then we can be held for negligence and can be in court trying to defend ourselves before a jury. So, why not prepare ourselves with proper equipment and knowledge about the disease? I found perhaps one of the most interesting articles on the subject matter pertaining to glaucoma in the Optometry Times that I will share with my readers. The article was written by Dr. Benjamin P. Casella and I could not have said it any better. He starts by calling his article: “7 Pearls to guide glaucoma treatment.” At this point, I will excuse myself and sit back and listen to his choice words. “It’s a tough diagnosis to make…and take away once made. We hear about structure vs. function in glaucoma. We hear that structural damage should correspond with functional damage (as evidenced by visual field studies). We go to weekend lectures and see tidy cases of inferior neuroretinal rim notches with...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

A giant “Hello” to all of you. March is now here and we are dealing with windy days in my neck of the woods. Trees are tumbling down with many branches falling on the road to work. Some folks have had an entire tree limb fall on their car. Very scary stuff. Hope all is well with my readers. Stay well my friends and most of all, eat healthy and live a long life. New stuff is here. During November of 2013, GP Specialists began their study on their new small iSight Scleral lenses. Many of our doctors have been inquiring about smaller scleral lenses. Our R&D department began to conduct in-house R&D over several months until they came up with the new and exciting 13.4mm scleral lens to go along with their 16.4mm sclerals which have been performing exceptionally well. Never one to be caught sleeping, GP Specialists decided to formulate a smaller version based upon the polynomials of the original design. They incorporated several large scleral experts across the country to evaluate the smaller version. After 4 months of extensive testing, the new sclerals performed flawlessly. New patients have found that the new smaller sclerals were easier to insert/remove and not as intimidating...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

HAPPY THANKSGIVING to all my readers. This year has been fleeting very quickly for me and my family. The C&E Family would like to reach out to each of you with Holiday Cheers as we are now approaching into the Holiday season which signals the end of 2013. I pray that each of our members have had a good year in spite of the ongoing economic slump that we have been mired in for so many years. It is now the end of my 2 year effort to move our practice into more highly specialized fitting of the difficult to fit contact lens patients. Yes, I must admit that these patients do consume a lot of chair time but the rewards have been there both emotionally and financially. YamaKone IC: Many of my readers have inquired about this lens. Several colleagues have asked that I write more details about this lens. The YamaKone IC is a byproduct of my lifelong dream of having a soft lens for our cone patients who have become gas perm intolerant. The most important ingredient for me was that this lens must be simple to fit. During the initial R&D phase of developing this lens into which it is today was time consuming. I would spend upwards of 4 hours per patient putting my practice in a huge backlog....
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

In our neck of the woods, summer is bearing down hard on us and we do whatever it takes to avoid the heat. Hopefully all of our members throughout the country are doing alright. Something unusual happened to me in our office. First one computer lost its hard drive. I had taken that one to Best Buy to have the Geek Squad replace the hard drive. That computer was fairly new with 8 MB of memory and 750 gigs of HD. They asked if I had the restore media discs but I had forgotten, (actually too lazy to make any restore discs.) They asked that I call HP to purchase the hard drives. After spending what seemed like an eternity talking with various techs from India, I finally got one who told me what I had to do. I went online and with my limited computer skills, I plodded for what seemed like several hours before I hit the jackpot. I crawled into bed close to 1 a.m. so I wouldn’t wake the wife and dozed off to sleep. When we woke in the a.m., I could hardly contain my happiness by announcing to the wife that I finally figured out how to order the recovery discs. I answered all the questions: S/N/ Product, code, name of computer, how many bytes, etc, etc, etc. The place that had the recovery...
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Optometrist Perspective By Harvey Yamamoto, OD

Optometrist Perspective By Harvey Yamamoto, OD

Ahhhh, the fresh smell of spring is now upon us.  Spring is one of my favorite times of the year.  I extend a very happy spring season for my readers. SOFT CONTACT LENSES:  GP Specialists launched a new lens which is called YamaKone™ IC at the Global Specialty Meeting in Las Vegas during the last week of January.  The YamaKone™ lens is a family of specialty lenses with the keratoconic patients in mind.  My long time readers will know that fitting specialty contact lenses is one of my passions in life.  I find them stimulating and challenging.  Yes, they do take some chair time but the end results often bring about very happy patients who become very loyal and great for referrals. Every GP lab around the country has focused their attention to the development of their own brand of scleral lenses.  Some say that the growth of GP lenses can be directly linked to the rebirth of scleral lenses. By now, I’m sure that I’ve whetted the appetite of most of my readers about soft cone lenses.  What? Why? For what reason?   I have a very large Keratoconus practice which grew over a period of 49 years.  I have run into patients that eventually became so advanced that they no longer...
Filed in: Contact Lens, Editorial
Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

2013 is starting out of the gate on a solid note for our practice and we hope that all of our members are doing likewise. KERATOCONUS:  In my last editorial, I promised to report more on our clinical studies with soft contact lenses.   My passion for contact lenses began in 1959 and continues to this day.  Working with PMMA lenses taught me a great deal on edge designs.  I quickly learned that the comfort of the lenses depended on how nicely I made the edge’s. Keratoconus found me soon after I was discharged from the military service in 1964.  An OMD whom I had befriended while at Ft. Ord began to send me young cone patients to evaluate.  They were in their early teens and some as young as 9 years of age.  Thus my entrance into pediatric contact lenses began with fitting young cone patients.  I found that the young patients adapted quickly to the PMMA lenses and before I had gotten my feet wet, my calendar became filled with similar cases from around the country.  Word of mouth began to spread amongst practitioners that I was very good at fitting their cone patients. Those were the days when we were dependent on keratometry to weed out these cone patients.  The mires were...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

HAPPY NEW YEAR TO EVERYONE! As we begin a new year – ALL of us at C&E sends our best wishes to each and all of you. May 2014 be a wonderful and prosperous year to us all. It is my customary editorial to begin the New Year with some reflecting on the previous year. 2013 was filled with a lot of new happenings and perhaps more excitement than we could have ever fathomed happening to us. First of all, our goal for 2013 was to continue expanding upon our contact lens skills by fitting more and more difficult but interesting cases. Did we accomplish our goal? I’m pleased to announce that we actually met all of our goals. It’s good to set goals during January and then evaluate how well you did in accomplishing those goals. For whatever spirit drives me, I’ve always been goal oriented. In college, my goal was to find an avocation that excited me. I drove myself deep in my studies to accomplish those goals early in my collegiate life and I must admit that Optometry found me. Actually it was my college roommate who introduced me to Optometry and once I felt comfortable in pursuing Optometry my future was set for the rest of my life. So, here I am some 5 decades later and still deeply...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

Many of my readers have known my personal quest to uncover the hidden secrets of scleral lenses.  I can break it further down to 3 different classifications.  First, there is the corneal-scleral lens.  These lenses are anywhere from 13.0 to 15mm.  I began fitting these lenses about 3 years ago.  I soon ran into problems with these lenses clinging to the sclera creating a suction like effect. Fitting sclerals is very similar to fitting gas perm lenses.  Sclerals are like gas perm on steroids.  These lenses presented a steep learning curve for me.  Patients are able to adapt much quicker to these larger diameter gas perm lenses than they are to corneal lenses.  These lenses come to a rest over the sclera which makes them much less aware for the patient. I progressed from fitting the corneal-scleral diameter to the full scleral lenses that equal 18.0mm in size.  Although these lenses were quite comfortable to wear, we found that our patients had difficulty in learning how to insert these larger diameter sclerals. We then migrated to what we call:  mini-sclerals which equal 16.4mm.   Finally, we found the size that our patients could learn to handle. We found these to be very...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

At the beginning of 2012, I told my staff and friends that this was going to be a special year for us.  Last year, I had let it slip that my 50th year since I graduated had slip by unnoticed thus I promised myself that I would do something special during 2012 as some sort of private celebration. I had thought that it was time to do a “makeover” of my practice. I began by retiling the front entrance to our waiting room.  That is when an article by Dr. Gerber appeared:  “You cannot afford Not to do it.”  His first two points rang loudly in my ear.  Point #1: He stated that we should move our location.  Since we own our own building that made point #1 moot.  Point #2 stated that we should remodel.   Now that made a lot of sense.   My retired dentist noticed the change of the new tiling in our office and he remarked, “While attending CE lectures, they are told to do something to their practice every 5 years. “  He remarked on how nice the new tiles had made our practice look.   That was very inspiring and I wanted to do a bit more. I began to discuss my thoughts about remodeling.  One suggestion that I considered was wood flooring in the exam rooms.  My first...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

I’m a bit late on writing about my reflections of the previous year. 2011 was a very special year for me. For one thing, the year went too quickly. Working on 3 exciting seminars at the same time does take a lot of my personal time but whenever I see the finished product it makes me feel somewhat accomplished. We will be having 3 more fabulous seminars in Southern California hosted at the Doubletree hotel in Orange. In fact we will be having one this month on the 20th. Hopefully many of my readers can make this one. Our staff has listened to our attending colleagues and we are doing our best to provide at least 6 hours a year on glaucoma. I believe that 2012 will have closer to 12 hrs on glaucoma. Unlike most other states, California received permission to begin allowing optometrists to become glaucoma certified via the new rules. Attendance at both Berkeley and SCCO has been at an all time high in attendance. I was fortunate to have completed all my requirements at SCCO with my final class completed in September. Many of my close colleagues have decided to forgo the certification process.  I can’t say that I really blame them for their decision. For those, like me who have gone...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

One of the first things that I do is to look for my long time friend’s editorial in the Optometric Physician.  Art is a world traveler and lecturer and I tend to glean words of wisdom from the words that flow from his pen. In one of his editorials during October of last year, Art titled his editorial:  “Do it until it hurts…” Among the many things that have interested me during my career, meibomian gland dysfunction has fascinated me more than most.  I first learned about MGD from Eric Donnenfeld, then a young ophthalmologist fresh out of a cornea fellowship at Wills Eye. Knee deep in problem contact lens patients back then, this early understanding of MGD was a revelation.  I later learned that it was Donald Korb, a well-known optometrist in Boston and who has since become a mentor and a friend, who discovered MGD and first reported it in the literature. I became almost evangelical about meibomian gland disease. Some of my earliest dry eye lectures, old enough to pre-date PowerPoint, explored MGD.  Warm Compresses and lid massage were routinely prescribed in my office and if patients didn’t improve they were admonished to apply compresses longer, make them warmer or...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

The entire staff at C&E extends the best of the Holidays to you, your family and to your staff. I have been saving this article which I would love to share with my readers as the first editorial of 2012.  The story was written by John M. Glionna from Tokyo.  As I read the story from the beginning to the end, the words touched my heart and I hope that you will enjoy and benefit from this story. “They Felt It In Their Core”:  They were two old friends catching up over coffee. Retiree’s swapping stories and gasping at the unfolding nuclear nightmare at the Fukushima Daiichi power plant.  But instead of merely throwing their hands up over the disaster that shook the plant in the wake of the March 11 earthquake and tsunami, Nobuhiro Shiotani and Yasuteru Yamada, both 72 year old scientists, decided they could do something to help.  They devised a plan that some have called heroic, others misguided and suicidal.  They would enlist a small army of researchers and other skilled workers to come out of retirement to venture inside the radioactive plant and use their expertise to help stabilize its stricken reactors. In early April, Yamada got on the phone to former colleagues...
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Optometrist Perspective by Harvey Yamamoto, OD

Optometrist Perspective by Harvey Yamamoto, OD

Just a few days ago, my wife and I was listening to the radio on the way to work when we heard a very interesting story.  Some professor began to collect data on 1,500 of the smartest kids who graduated from a college in California in 1921.  He followed their careers until he passed away in 1956 then some one else took over.  Then in 1999, that person died and then the person being interviewed on the radio took over for the last 11 years.  The interviewer asked one question that caught my attention:  “Did you discover the secret to long life?”  The gentleman said, “Yes”.   We turned up the volume at this point and continued to listen.  He said, “Those who worked very hard non-stop lived the longest.”  Those who retired early died shortly after retirement.  Men died shortly after losing their spouse while women went on living without their spouse for many years.  Mental dementia occurred in people who stopped working.  My wife looked at me and said, “No worries. You are never going to retire.”  End of story. Just the other day, I received a fax from one of our healthcare vendors with this note on the “Importance of Diabetes Tests”.  The message stated...
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