,,FACT ,,& ,,FIC;N ,,( ,,H1L?Y ,,VI.N ,EYE ,C>E = ,ADULTS & ,*N ,,CLYDE ,K4 ,,KIT*51 ,M4,D4 ,PUBLI%$ 0,PRAEG] ,PUBLI%]S1 ,WE/PORT1 ,3NECTICUT ,COPY"R ^C #BJJG 0,CLYDE ,K4 ,KIT*5 ,FUR!R REPRODUC;N OR 4TRIBU;N 9 O!R ?AN A SPECIALIZ$ =MAT IS PROHIBIT$4 ,TRANSCRIP;N ( ,,ISBN-#AJ3 #J-BGE-IICDE-J ,,ISBN-#AC3 #IGH-J-BGE-IICDE-J ,TRANSCRIB$1 #BJJH1 BY ,C>OL ,/UD] ,"EGRE5 ,BRL ,S]VICE ,WA%+TON ,TALK+ ,BOOK @& ,BRL ,LIBR>Y ,S1TTLE1 ,WA%+TON ,9 #E ,VOLUMES ,VOLUME #D ,BRL ,PAGES P#A-P#F & #BII-DAB ,PR9T ,PAGES #ABC-C#AFI P#A ,,TRANSCRIB]'S ,,NOTES ,! ILLU/R,NS 9 ? BOOK >E ALL S*EMATIC CROSS-SEC;NS (! EYE OR "PS (! EYE4 ,!Y >E N NUMB]$ OR O!RWISE ID5TIFI$4 ,CAP;NS 6! ILLU/R,NS >E BRLD ": !Y APPE> 9 PR9T4 ,]RORS 9 SPELL+1 PUNCTU,N1 GRAMM>1 & SYNTAX H1 =! MO/ "P1 BE5 TRANSCRIB$ Z !Y APPE> 9 PR9T4 P#B ,,SPECIAL ,,SYMBOLS ,,US$ ,,9 ,,? ,,VOLUME @& 7#D1 #ABCDF7 AMP]S& SYMBOL _/ 7#DEF1 #CD7 SLA% ,' 7#F1 #C7 T]M9,N SIGN ,MA!MATICAL ,SYMBOLS @+ 7#D1 #CDF7 PLUS SIGN @- 7#D1 #CF7 M9US SIGN P#C P#D ,,3T5TS ,PAGE #AF4 ,"S ,UNUSUAL ,EYE ,PRO#MS & ,EYE ,9JURIES """"""""""""""""" #ABC ,EYE ,PRO#MS """""""""""""""""""" #ABC ,EYE ,9JURIES """""""""""""""""" A#ABG #AG4 ,?+S 6,"K AB ,EYE ,SURG]Y """" #ACD ,CAT>ACT ,SURG]Y """""""""""""""" #ACD ,GLAUCOMA ,SURG]Y """"""""""""""" #ACF ,RET9AL ,DETA*;T ,SURG]Y """"""" A#ACH ,/RABISMUS ,SURG]Y """""""""""""" #ADJ ,CORN1L ,TRANSPLANT """""""""""" B#ADA ,ENUCLE,N """""""""""""""""""""" A#ADB ,"P ,V4 ,3SUM] ,9=M,N #AH4 ,DEF9I;NS ( ,C>EGIV]S """""""" #ADG ,C>EGIV]S """"""""""""""""""""""" #ADG #AI4 ,M ,?+S ,Y ,NE$ 6"K """""""""" #AEB ,-MON ,EYE ,DROP ,M$IC,NS """"""" #AEB ,:O ,PAYS & ,H[ """"""""""""""""" #AEH #BJ4 ,EYE ,C>E--,! ,WAY ,X ,0 &! ,WAY ,X ,W ,2 """"""""""""""""" #AFJ ,ORIG9 (! ,OPH?ALMOLOGI/ """""""" #AFJ P#E ,! ,ORIG9 ( AN ,OPTOMETRI/ """""" #AFC ,9T]AC;N ( ,OPH?ALMOLOGY & ,OPTOMETRY """"""""""""""""" B#AFD ,! ,WAY ,?+S ,C ,2 7,Z ,I ,SEE ,X7 """"""""""""""""""" A#AFF P#F #AF #ABC ,"S ,UNUSUAL ,EYE ,PRO#MS & ,EYE ,9JURIES ,EYE ,PRO#MS ,C.ER (! ,EYE ,=TUNATELY C.ER DOES N (T5 A6ECT ! EYE4 ,PRIM>Y C.ERS 9CLUDE RET9OBLA/OMA 7O3URS 9 *N AT AN E>LY AGE71 OCUL> MELANOMAS1 & EYELID TUMORS4 ,RET9OBLA/OMA MAY 2 PRES5T AT BIR? B USU,Y IS N DIAGNOS$ UNTIL EIE1 "S"TS FAMILIAL4 ,DIAGNOSIS IS TOO (T5 DELAY$ UNTIL ! *'S PUPIL IS NOT$ 6BE :ITE OR ! EYE TURNS \TW>D4 ,X C 2 BILAT- ]AL1 & TR1T;T ( *OICE IS ENUCLE,N 7RE- MOVAL (! EYE71 : C 2 CURATIVE IF P]=M$ E>LY 5\<4 ,NEW] TR1T;TS MAY PRES]VE VI.N & LIFE4 ,MELANOMAS (! EYE >E ! MO/ -MON PRIM>Y MALIGNANT TUMORS (! EYEBALL4 ,! USUAL SITE IS 9 ! 8*OROID10 ! PIG;T #BII 3TA9+ VASCUL> LAY] 2N ! RET9A1 9 A#ABC ! BACK (! EYE4 ,DIAGNOSIS IS USU,Y A RE- SULT ( EYE EXAM9,N1 &( C\RSE DIAGNO/IC BIOPSY IS DI6ICULT1 B N[ N IMPOSSI#4 ,A BIOPSY SPECIM5 C 2 OBTA9$ VIA A #BE- GAUGE NE$LE1 & NEW G5ETIC TYP+ PROC$URE C PREDICT ! LIKELIHOOD ( META/ASIS4 ,TR1T;T HAS USU,Y BE5 ENUCLE,N1 B O!R LOCALIZ$ RADI,N TR1T;TS >E 2+ P]=M$4 ,CL9IC,Y "! >E SIGNS T MAY HELP DI6]5TI- ATE A MALIGNANT MELANOMA F A 2NIGN MELA- NOMA 7NEVUS74 ,META/ASIS1 OR SPR1D (! TUMOR ELSE": 9 ! BODY1 MAY L1D 6D1?1 L ) O!R MELANOMAS4 ,IRIS MELANOMAS >E LESS -MON1 & S9CE "! IS A DI6]5TIAL DIAGNOSIS ( 2NIGN MEL- ANOMA1 OBS]V,N MAY 2 9ITI,Y ! C\RSE ( MANAGE;T4 ,EYELID MELANOMAS >E Q R>E1 & 3JUNCTIVAL MELANOMAS C AL O3UR4 ,BIOPSY (! 3JUNCTIVA OR ! EYELID IS POSSI# S Z 6DI6]5TIATE 2NIGN NEVI1 : >E Q -MON1 F MALIGNANT TUMORS4 ------------------------------------#ABD ,BASAL CELL C>C9OMAS & SQUAM\S CELL C>- C9OMAS O3UR ON ! EYELIDS4 ,!Y C 2 #CJJ LOC,Y EXCIS$4 A#ABD ,! MO/ -MON META/ATIC TUMOR (! EYE IS F BR1/ C.ER 6! *OROID1 & ? IS Q UNUSUAL4 ,CORN1L ,DYSTROPHY ,! ANATOMY (! CORNEA HAS BE5 DESCRIB$ Z V UNIQUE4 ,REMA9+ P]FECTLY CLE>1 L A W9D[1 X AL IS UNIQUE 9 T X HAS NO BLOOD VESSELS 6PROVIDE N\RI%;T4 ,ON ! \TSIDE1 ! CORN1L EPI!LIUM &A SPECIAL LAY] CALL$ ,BRU*'S MEMBRANE PROVIDE PROTEC;N4 ,ON ! 9SIDE1 A SPECIAL LAY] ( CELLS CALL$ ! 5DO!LIUM HELPS KEEP ! CORNEA F 2COM+ SWOLL5 0FLUIDS BA?+ ! 9T]IOR1 & YET AL SELECTIVELY ALL[S P5ETR,N ( NE$$ NUTRI- 5TS F ^! FLUIDS CALL$ AQUE\S4 ,) AGE1 ! NUMB] ( H1L?Y 5DO!LIAL CELLS DIM9I%ES NATUR,Y4 ,? M1NS T ANY TRAUMA OR SURG]Y A6ECT+ ? TISSUE1 9CLUD+ CATA- RACT SURG]Y1 IS LESS WELL TOL]AT$4 ,IN- VASIVE SURG]Y1 S* Z CAT>ACT SURG]Y1 CAUSES ! 5DO!LIAL CELL C.T 6G D[N FUR!R4 ,IF ! 5DO!LIAL CELL C.T 2COMES TOO L[1 !N ! PROTECTIVE ABIL;Y (! 5DO!LIUM 6KEEP FLUID \ (! CORNEA DIM9I%ES1 &! #CJA CORNEA 2COMES SWOLL5 & LESS B#ABD CLE>4 ,"! IS A 3DI;N CALL$ 5DO!LIAL CORN1L DYSTROPHY1 : C SPONTANE\SLY REDUCE ! EN- DO!LIAL H1L? DRAMATIC,Y4 ,Z A RESULT1 TYPICAL SPOTS1 CALL$ GUTTATA1 C 2 SE5 ) MICROSCOPIC EXAM9,N1 L1D+ 6DIAGNOSIS (A 3DI;N CALL$ ,FU*'S 5DO!LIAL DYSTROPHY1 A 3DI;N PREDOM9AT+ 9 WOM5 & (T5 FAMILIAL4 ,9 ! E>LIE/ /AGES1 ! DIAGNOSIS IS "O MA9LY ( POT5TIAL1 IF GUTTATA >E EVID5T4 ,H["E1 ) "T1 EVID;E ( CORN1L SWELL+ RE- SULTS1 : CAUSES BLURR+ ( VI.N4 ,TYPIC,Y1 ? IS1 9 ! E>LY /AGES1 E>LY 9 ! "D4 ,? IS 2C ! NORMAL ACTIV;Y ( WAKE;L H\RS RE- SULTS 9 EVAPOR,N-TYPE REDUC;N ( FLUID F ! W9D[LIKE CORNEA4 ,EV5TU,Y1 ! SWELL+ C 2 ID5TIFI$ 0REDUC$ VI.N & MICROSCOPIC EXAM9,N EVID;E ( SWELL+ (! CORNEA4 ,! SWELL+ (! CORNEA C 2 A3URATELY M1SUR$ 0A SPECIAL 9/RU;T CALL$ A PA*YMET]1 : M1S- URES ! ?ICK;S (! CORNEA4 ,TR1T;T C IN- VOLVE USE ( HYP]TONIC SOLU;NS OR O9T;TS 6DRAW WAT] \ (! CORNEA1 ALL[+ BETT] VI- .N4 ,LAT] /AGES ( CORN1L SWELL+ #CJB RESULT 9 FLUID EXT5D+ 6! SURFACE C#ABD (! EYE1 CAUS+ BLI/]S1 OR BULLAE1 & ? IS CALL$ BULL\S K]ATOPA?Y4 ,:5 "O ( ^! BUL- LAE RUPTURES 6ALL[ DRA9AGE (! WAT]LIKE FLUID1 PA9 RESULTS SIMIL> 6ANY CORN1L ABRA.N4 ,H["E1 S9CE ! CORNEA IS N H1L?Y1 H1L+ USU,Y TAKES L;G]4 ,S* WORS5+ MAY L1D 6A NE$ =A CORN1L TRANSPLANT OP],N1 B X IS N 9EVITA# T ALL PATI5TS R1* ? /AGE4 ,A CORN1L TRANSPLANT AM.TS 6REPLAC+ ! C5TRAL POR;NS (! CORNEA )A DONOR CORNEA1 F "S"O :O REC5TLY DI$ & ^: CORN1S 7 DO- NAT$4 ,? FULL ?ICK;S GRAFT "!=E C>IES ) X A H1L?I] 5DO!LIUM4 ,X IS N NEC 6MAT* BLOOD CELL TYPES 2T DONOR ------------------------------------#ABE & RECIPI5T4 ,! RESULTS C 2 Q GD1 :5 CON- SID]+ RE/OR,N ( VI.N1 B SURVIVAL (! GRAFT IS N GU>ANTE$1 &A REP1T PROC$URE MAY 2 REQUIR$4 ,A/IGMATISM ( SIGNIFICANT DEGREE (T5 -PLICATES VI.N CORREC;N4 ,"! >E S"EAL M R>E TYPES ( CORN1L DYS- TROPHY1 MO/ ( : D N SIGNIFICANTLY A6ECT VI.N1 & REPRES5T V>I\S TYPES ( OPACITIES (! CORNEA1 : MAY N 2 EVID5T )\T #CJC MICROSCOPIC 7SLIT LAMP7 EXAM9,N4 A#ABE ,A V -MON CORN1L V>I,N1 L A DYSTROPHY1 IS ! GREY R+ T =MS >.D ! P]IPH]AL COR- NEA1 MAK+ ! EYE COLOR LESS 4T9CTIVE4 ,? 3DI;N IS CALL$ >CUS3 >CUS S5ILIS =! OLD] P1 & >CUS JUV5ILIS =! "Y] P4 ,! GREY- COLOR$ MAT]IAL IS MA9LY *OLE/]OL1 & MAY REPRES5T A HI< LEVEL ( S]UM *OLE/]OL1 B MO/ (! "T1 X IS N RELAT$ 6HI< *OLE/]OL LEVELS4 ,N"E!.S1 X C 2 Q NOTICEA#1 ESPE- CI,Y 9 BR[N-EY$ P1 & ^! P NE$ 6BE ASSUR$ T X IS N ?R1T5+ 6VI.N 2C X IS LIMIT$ 6! P]IPH]AL CORNEA ": X DOES N OB/RUCT ! VISUAL AXIS4 ,(T5 X IS H]$IT>Y4 ,*ORIORET9ITIS ,! *OROID IS A LAY] ( TISSUE 2N ! RET- 9A1 3TA9+ BLOOD VESSELS & PIG;T1 & IS ! MO/ PO/]IOR "P (! UV1L LAY]1 2+ 3TIGU\S )! IRIS 9 FRONT1 &! CILI>Y BODY 9 ! MID- DLE (! EYE4 ,BLOOD-BORNE 41SES C A6ECT ? LAY]1 CAUS+ VISUAL PRO#MS "S"TS1 OR =M+ SC>S1 : C SU7E/ T "S =M ( *ORIORET9ITIS 79FLAMM,N (! *OROID & ADJAC5T RET9A7 0 PRES5T1 :5 4COV]$ 9 ! C\RSE ( #CJD FUNDUS EYE EXAM9,N1 USU,Y Z "P ( B#ABE A R\T9E EXAM9,N4 ,HI/OPLASMOSIS IS A FLULIKE ILL;S DUE 6A SOIL FUNGUS MO/ -MON 9 ! ,MIDWE/ "P ( ? C.TRY4 ,9 MO/ CASES1 SIGNS ( H[ ? IN- VOLV$ ! EYE >E PRES5T 9 ! =M ( T9Y R.D SC>S 9 ! RET9A1 & "S"TS A HALO ( MILD SC>R+ >.D ! OPTIC N]VE4 ,F9D+ ^! SIGNS SU7E/S ,,POH1 OR PRESUM$ OCUL> HI/OPLAS- MOSIS4 ,"S"TS1 H["E1 "! C 2 NEOVASCUL> MEMBRANE 7NEW BLOOD VESSELS7 =M,N 9 ! MACUL> REGION1 & BLE$+ F ^! VESSELS C CAUSE WET-TYPE MACUL> DEG5],N1 EV5 9 A "Y] P]SON4 ,DIAGNOSIS C 2 3FIRM$ 0FL\R- ESCE9 ANGIOGRAPHY1 & TR1T;T C 2 ATTEMPT$ Z P]=M$ )! WET =M ( AGE-RELAT$ MACUL> DEG5],N4 ,TOXOPLASMOSIS IS ANO!R FLULIKE ILL;S1 : C L1VE XS M>K ON ! EYES4 ,X IS CAUS$ 0P>ASITIC ORGANISMS C>RI$ 0ANIMALS1 S* Z CATS4 ,LL CY/S SPR1D >.D ! BODY1 9CLUD+ ! EYES1 & ^! MAY REMA9 DORMANT = YE>S4 ,RUPTURE ( ^! CY/S MAY CAUSE SYMPTOMS ( 9FLAMM,N F FLOAT]S 9 VI.N 6ACTUAL REDUC- ;N ( VI.N1 ESPECI,Y IF ! MACULA1 #CJE ! S5SITIVE R1D+ VI.N "P (! EYE1 C#ABE IS 9VOLV$4 ,MO/ S]I\S IS ! 3G5ITAL =M1 ":9 ! 9FEC;N IS TRANSMITT$ DUR+ PREGNAN- CY 6! FETUS1 &! EYE 9VOLVE;T MAY 2 SE- V]E4 ,! "M1 H["E1 WD ------------------------------------#ABF N TRANSMIT ? PRO#M 6SUBSEQU5T EV5TUAL PREGNANCIES4 ,TR1T;T ) M$IC,N IS AVAILA- #1 B "! C 2 SIDE E6ECTS4 ,RET9ITIS ,PIG;TOSA ,? PRO#M1 "S"TS CALL$ ,,RP1 IS A 41SE PRIM>ILY 9VOLV+ ! RODS (! RET9A1 ! PE- RIPH]AL RET9AL CELLS NE$$ = NIY1 )! ONSET ( SYMP- TOMS ( NI AT NID\S4 ,?\< VI.N MAY 3T9UE 6BE #BJ_/BJ = "S "T1 TYPICAL PIG;T,N (! RET9A ( 8B"O CORPUSCUL>0 NATURE TIPS (F ! PRO#M DUR+ EYE EXAM9,N4 ,A VISUAL FIELD TE/ ( SIDE VI.N %[S 3/RIC;N1 & X MAY 2 S BAD Z 6GIVE ! IMPRES.N ( 8TUNNEL VI.N10 AN 9CORRECT T]M1 B "O : CORRECTLY IMPLIES SEV]E RE/RIC;N ( P]IPH]AL #CJF VI.N4 A#ABF ,EV5TU,Y ! PRO#M MAY 2COME S BAD S Z 6A6ECT ! C"OS (! MACULA AL1 L1D+ 6POT5- TIAL LEGAL BL;S1 OR R>ELY1 ALM -PLETE BL;S4 ,X %D 2 PO9T$ \ T A P]SON MAY 2 3SID]$ LEG,Y BL DUE 6VISUAL FIELD LIMI- T,N AL"O1 EV5 IF !Y CD R1D ! #BJ_/DJ L9E ON ! ,SNELL5 *>T4 ,"! IS NO TR1T;T1 SUR- GIC,Y OR M$IC,Y4 ,G5ETIC C\NSEL+ MAY DE- TECT IF A P]SON IS LIKELY 6PASS ON ! TRAIT1 & FAMILY MEMB]S MAY NE$ 6BE TE/$1 EV5 IF APP>5TLY UNA6ECT$4 ,SPECIAL L[- VI.N AIDS MAY 2 HELP;L1 & REHABILIT,N S]VICES >E AVAILA# = ^? SEV]ELY A6ECT$1 USU,Y N UNTIL MIDLIFE4 ,IF HE>+ IS AL A6ECT$1 ! 3DI;N IS CALL$ ,U%]'S SYN- DROME4 ,K]ATOCONUS ,! CORN1L W9D[ TISSUE (! EYE IS IDE,Y SPH]ICAL 9 CURVATURE1 L A SMOO?-SURFAC$ R.D BASKETBALL4 ,A/IGMATISM IS AN IRREG- UL> CURVATURE (! CORNEA1 S* T "! IS A L;G AXIS &A %ORT AXIS (! CORNEA1 L A SPOON OR ! SIDE (A FOOTBALL4 #CJG ,K]ATOCONUS M1NS T ! CORNEA 7K]- B#ABF ATO7 2COMES C"O %AP$ 7CONUS71 M L ! PO9T$ 5D (A FOOTBALL4 ,! SIGNS ( K]ATOCONUS USU,Y 2G9 9 ! LATE TE5S 6! E>LY TW5TIES1 M -MONLY 9 MALES1 & >E REPRES5T$ 9 ! ONSET Z AN IN- CR1SE 9 NE>SID 3TACT L5SES MAY GIVE Q GD VI.N4 ,FITT+ ( S* 3TACT L5SES IS DIF- FICULT B IS ACTU,Y 3SID]$ A TR1T;T (! 41SE1 S* T X IS AB ! ONLY M$ICAL JU/IFI- C,N = FITT+ 3TACT L5SES1 & 9 ? CASE !Y M/ 2 H>D 3TACT L5SES4 ,= ? R1SON1 )! DOCTOR'S 3FIRM,N ( ? 9DIC,N1 M$ICAL IN- SUR.E MAY COV] ! CO/4 ,! SURFACE IRREGU- L>;Y C 2 M1SUR$ 0A TOPOGRAPHY 9/RU;T1 & ? C 2 US$ 6FOLL[ PROGRESS4 ,! R1SON H>D 3TACT L5SES "W IS T A H>D 3TACT L5S HAS XS [N SPH]ICAL CURVATURE1 & ?US ! FRONT 3TACT L5S SURFACE B5DS OR FOCUSES LI LAY] IS J ( DI6]5T ?ICK;S AG/ ! BACK SURFACE (! 3TACT L5S4 ,H>D 3TACT L5SES H ?US ALW D"O A BETT] JOB ( CORRECT+ A/IGMATISM1 S9CE A S(T 3TACT L5S J LAYS ON ! CORNEA & TAKES UP ! SAME \-(-R.D CURVATURE (! CORNEA4 ,"!=E1 ! A/IGMATISM IS / PRES5T :5 A S(T 3TACT L5S IS WORN4 ,= -=T R1SONS1 H["E1 9 ! TR1T;T ( K]ATOCONUS1 "S"TS A PI7YBACK FITT+ IS CR1T$1 ":BY A H>D 3TACT L5S IS FIT OV] ! TOP (A S(T 3TACT L5S4 ,_M P ) K]ATOCONUS >E ALR WE>+ 3TACT L5SES :5 ! DIAGNOSIS IS MADE1 ESPECI,Y IF NE>SID 3TACT L5S WE>] IS "S"TS SUSPECT$ Z 2+ DUE 6W>PAGE (! CORNEA .CAUS$ 0! 3TACT L5S1 S X IS "S"TS H>D 6TELL : CAME F/4 ,S9CE ! 3DI;N IS SUPPOS$ 6BE M -MON 9 MALES1 ! SUSPICION ( 3TACT L5S CAUSE ( K]ATOCONUS IS GRT] 9 A FEMALE 3TACT L5S WE>] :O DEVELOPS SIGNS ( IRREGUL> A/IG- MATISM S* Z NOT$ ) K]ATOCONUS4 ,2C ! NATURAL C\RSE ( #CJI K]ATOCONUS IS 6/OP GETT+ WORSE A#ABG EV5TU,Y1 SAY 2T AGES TW5TY-FIVE & =TY1 ! SU3ESS;L TR1T;T ) 3TACT L5SES USU,Y P]- SI/S4 ,H["E1 9 "S CASES1 9ADEQUATE COR- REC;N ( VI.N1 -PLIC,NS 9 FITT+ 3TACT L5SES -=TABLY1 OR DECOMP5S,N (! CORNEA MAY L1D 6! NE$ = CORN1L TRANSPLANT,N4 ,REMOV+ ! C"O-%AP$ C5TRAL CORNEA & RE- PLAC+ X )A H1L?Y DONOR CORNEA IS USU,Y Q SU3ESS;L4 ,"! / MAY 2 SIGNIFICANT A/IG- MATISM PO/OP]ATIVELY S* T H>D 3TACT L5S- ES AG MAY 2 NE$$4 ,! MO/ IMPORTANT RE- SULT1 ( C\RSE1 IS 6RE/ORE GD VI.N1 & Z HAS BE5 M5;N$1 MO/ K]ATOCONUS PATI5TS D N R1* ! /AGE ( SURG]Y4 ,EYE ,9JURIES ,BL[ 6! ,EYE ,HYPHEMA ,? 3CUS.N 9JURY IS ! MO/ -MON TRAUMAT- IC EYE 9JURY NE$+ ATT5;N4 ,! 9JURY MAY RESULT F A F+] 6! EYE1 9 SPORTS1 A T5NIS BALL1 OR EV5 A *AMPAGNE CORK4 #CAJ ,BLOOD1 APP>5TLY DUE 6A BROK5 B#ABG BLOOD VESSEL 9 ! IRIS TISSUE1 FL[S 9 FRONT (! PUPIL & COV]S "P (! COLOR$ IRIS "P (! EYE4 ,DUE 6GRAV;Y1 NATUR,Y ! BLOOD %IFTS 6! L[] "P (! EYE4 ,IF1 H["E1 ! LEVEL ( BLOOD IS GRT 5\<1 ! PUPIL IS COV]$1 &A -PLETE HYPHEMA IS POSSI#1 M1N+ NEI ! PUPIL NOR ! IRIS IS VISI#4 ,A -PLETE HYPHEMA WD 2 ( M 3C]N1 S9CE FILL+ (! ANT]IOR *AMB] ) BLOOD M1NS T ! 9TRAOCUL> PRESSURE WD PROBABLY 2 9CR1S$4 ,BLOOD1 L AQUE\S FLUID1 C DRA9 VIA ! AN- T]IOR *AMB] ANGLE1 B PLU7+ (! SY/EM ) ?ICK] BLOOD MAY RESULT 9 9CR1S$ 9TRAOCU- L> ------------------------------------#ABH PRESSURE1 EV5 HI< 5 6CAUSE PA94 ,DEP5D+ ON H[ HI< ! PRESSURE HAS RIS5 DET]M9ES :E!R ! TR1T;T 9VOLVES PRESSURE-L[]+ M$I- C,N OR SURGICAL DRA9AGE (! BLOOD F ! AN- T]IOR *AMB]4 ,TR1T;T = HYPHEMA 0 TRADI;N,Y B$ RE/1 ) B9OCUL> O3LU.N = FIVE "DS4 ,RECURR5T BLE$+ USU,Y O3URS )9 FIVE "DS1 DUR+ ! /AGE (! S-CALL$ CAPILL>Y FRAGIL;Y #CAA DUR+ : ! BLOOD VESSELS H1L !MVS4 A#ABH ,CO/ ( HOSPITALIZ,N V]SUS LL DI6];E 9 RESULTS1 HAS RESULT$ 9 CURR5TLY MA9LY \TPATI5T TR1T;T4 ,O!R ?AN B$RE/1 : C 2 V>I$ P] PATI5T1 TOPICAL EYE DROPS 6REDUCE ! 9FLAMM,N CAUS$ 0! BLOOD 9 ! EYE1 &A M$IC,N CALL$ ,AMIC> C 2 US$ 6REDUCE ! LIKELIHOOD ( RECURR5T HEMORRHAGE4 ,DAILY (FICE EXAMS MAY 2 RECOMM5D$4 ,R>ELY1 SURGICAL DRA9- AGE (! BLOOD F ! ANT]IOR *AMB] (! EYE MAY 2 NE$$1 IF ! BLOOD IS N GO+ AWAY & POT5TIAL -PLIC,NS1 S* Z BLOOD /A9+ (! CORNEA1 EXI/4 ,BLACK ,EYE ,ANY 9JURY >.D ! EYE1 S* Z A FI/ IN- JURY1 CAUSES BLE$+ "U ! SK9 & BRUIS+ CALL$ EC*YMOSIS4 ,! TISSUES >.D ! EYE >E S(T & SWELL EASILY4 ,"!=E1 A BLACK EYE1 BLOOD 2N ! SK9 >.D ! EYE1 MAY SEEM TO SPR1D4 ,(T51 6"O'S SURPRISE1 A BLACK EYE ON "O SIDE (! NOSE C RESULT 9 A BLACK EYE ON ! O!R SIDE (! NOSE1 2C ! SK9 ON ! NOSE IS S TI IS 9 ! BA7Y "P AT ! BOTTOM (! L[] EYELID4 ,Z BLOOD SL[LY ABSORBS1 A YELL[I% 4COLOR,N O3URS4 ,! MA9 3C]N1 NATUR,Y1 IS T A BLACK EYE MAY SIGNIFY M S]I\S 9JURY 6! EYE XF1 OR ! B"OS >.D ! EYE1 SU7E/+ NE$ = AN EYE EX- AM9,N4 ,RUPTUR$ ,GLOBE ,? IS ! MO/ S]I\S 9JURY & RESULTS F S* ?+S Z A ,,BB GUN1 ROCK1 F+]S1 H& BALL1 OR GOLF BALL4 ,RECOGNI;N ( SEV];Y C 2 NOT$ 0SWELL+ (! TISSUES >.D ! EYE1 DE- CR1S$ VI.N1 4TOR;N (! PUPIL1 & PA94 ,A SEV]E HYPHEMA MAY SIGNIFY S]I\S 9JURY1 9CLUD+ LAC],N OR RUPTURE (! 8GLOBE10 M1N+ A W.D "? ! FULL ?ICK;S (! SCL]AL COV] OR CORNEA1 ALL[+ 9TRAOCUL> FLUIDS 6L1K \1 & POT5TIAL 9FEC;N4 ,EM]G5CY REPAIR 0AN OPH?ALMOLOGI/ IS REQUIR$1 USU,Y AVAILA# 6! CALL ( AN EM]- G5CY ROOM PHYSICIAN4 ,9JURIES MAY 2 S SEV]E T AU?ORIZ,N = REMOVAL (! #CAC 9JUR$ EYE %D 2 OBTA9$ PRIOR TO C#ABH SURG]Y1 R ?AN REQUIR+ A SECOND SURG]Y4 ,2LIEVE ME1 ? IS ! LA/ ?+ ! OPH?ALMOLO- GI/ W WANT 6D IF HE OR %E C AVOID X4 ------------------------------------#ABI ,BL[-,\ ,FRACTURE ,? ORBITAL FRACTURE RESULTS F A L>G] =CE S* Z A FI/4 ,A BLACK EYE1 D\# VI.N1 LIMIT,N ( UPW>D EYE MOVE;T1 & NUMB;S (! SK9 (! UPP] LIP SU7E/ S* A FRACTURE4 ,! EYEBALL XF MAY 2 UN9JUR$4 ,REPAIR1 IF X IS AN ISOLAT$ 9JURY1 MAY 2 P]=M$ 0AN OPH?ALMOLOGI/4 ,IF A3OMPANI$ 0FRACTURES ( O!R B"OS (! FACE1 X C 2 REPAIR$ 0AN E>1 NOSE1 & ?ROAT DOCTOR1 A PLA/IC SUR- GEON1 OR AN ORAL SURGEON4 ,RET9AL ,9JURY A4 ,RET9AL DETA*;T C O3UR F 3CUS.N IN- JURY1 Z SE5 ) BOX]S4 ,H["E1 MO/ RET9AL DETA*;TS >E SPONTANE\S4 ,SURGICAL RE- PAIR IS USU,Y URG5T4 B4 ,-MOTIO RET9AE IS A T]M =! 3CUS.N IN- JURY (! RET9A1 SIGNIFI$ 0RET9AL HEMOR- RHAGES & TRANSI5T OR P]MAN5T #CAD LOSS ( VI.N4 ,L ANY LOSS ( VI- A#ABI .N FOLL[+ 9JURY1 ? DIAGNOSIS REQUIRES EXAM9,N 0AN EYE DOCTOR4 ,EYELID ,LAC],NS ,? TYPE 9JURY C RESULT F BLUNT OR %>P 9/RU;T TRAUMA4 ,W.DS >.D ! EYE1 EYELIDS1 & BR[ C FREQU5TLY 2 REPAIR$ 0AN EM]G5CY ROOM PHYSICIAN4 ,LAC],NS 9VOLV+ ! EYELID M>G9 REQUIRE REPAIR 0AN OPH?ALMOLOGI/4 ,X IS IMPORTANT 6RECOGNIZE ! POT5TIAL SEV];Y ( LAC],NS1 9CLUD+ DOG BITES1 IN- VOLV+ ! "P (! EYELID T[>D ! NOSE4 ,? IS 2C S* AN 9JURY MAY CUT ACR ! TE> DUCT TISSUES & REQUIRE SPECIAL REPAIR4 ,? IS 6PRES]VE ! TE> FUNC;N1 S T TE>S MAY DRA9 NORM,Y F ! EYE4 ,A P$IATRIC OR PLA/IC SURGICAL OPH?ALMOLOGI/ MAY 2 REQUIR$1 & ? IS "S?+ T C USU,Y WAIT UNTIL ! NEXT MORN+1 OR UP 6#DH H\RS 6OBTA9 S* SPECIAL S]VICES4 #CAE ,=EIGN ,BODIES B#ABI ,A =EIGN OBJECT MAY 2 Q SMALL B1 IF LODG$ "U ! UPP] EYELID1 MAY 2 Q IRRITAT+4 ,USU,Y ! TE>+ (! EYE W WA% \ MO/ SMALL =EIGN BODIES UN.S EMB$D$ OR HELD TI5T T X IS DI6ICULT 6SEE1 EV5 )A SLIT LAMP4 ,:5 OBS]V+ )\T MAGNIFIC,N1 X MAY 2 A GD IDEA 6SWAB ACR ! "USURFACE (! EYELID )! HOPE ( 4LODG+ A =EIGN BODY N VISI#4 ,IRRIG,N MAY AL HELP 0HAV+ ! PATI5T LOOK D[N :ILE IRRIGAT+ "U ! UPP] EYELID4 ,RELIEF IS USU,Y PROMPT1 SIGNIFY+ SU3ESS1 B "! MAY 2 RESIDUAL IRRIT,N TEMPOR>ILY F SCRAT*ES CAUS$ 0RU2+ ON ! CORNEA4 ,A CORN1L =EIGN BODY IS -MON1 ESPECI,Y 9VOLV+ A PIECE ( IRON1 Z ASSOCIAT$ 0P.D+ OR GR9D+ ON METAL 7=K-LIFT OP]ATORS >E AL GD C&IDATES74 ,! PIECE ( METAL1 ESPE- CI,Y IF HOT1 C /ICK 6! CORNEA1 &1 #CAF IF IRON1 C CAUSE A RU/ R+ REAC;N #ACJ 6! CORN1L TISSUE4 ,SYMPTOMATIC,Y1 ^? )A CORN1L =EIGN BODY ID5TIFY ! PRO#M Z "S?+ "U ! UPP] EYELID1 S9CE BL9K+ CAUSES ? REF];E4 ,! DOCTOR1 F EXP]I;E1 "KS T ! F/ PLACE 6LOOK IS ON ! CORNEA1 )A SLIT LAMP4 ,CORN1L =EIGN BODIES1 ESPECI,Y IF A PIECE ( HOT IRON EMB$D$ 9 ! SURFACE (! CORNEA1 REQUIRE REMOVAL )A RELATIVELY %>P 9/RU;T CALL$ A SPUD4 ,IF PRES5T = M ?AN A FEW H\RS1 A RU/ R+ RESULTS F F]R\S 7IRON7 =EIGN BODIES1 & ? M/ AL 2 REMOV$ Z WELL Z POSSI#4 ,"S"TS ! EM]G5CY ROOM DOCTOR C REMOVE ! =EIGN BODY1 B1 RECOG- NIZ+ ! PRES;E (A RU/ R+1 REF]S ! PATI5T 6AN OPH?ALMOLOGI/ = DEF9ITIVE TR1T;T4 ,IF N REMOV$ ADEQUATELY1 A RU/ R+ MAY CAUSE SWELL+ 6! PO9T T ! =EIGN BODY MAY SEEM 6H -E BACK4 ,S* TR1T;T NE$ N 2 S SC>Y1 S9CE TOPICAL EYE DROP M$IC,N C NUMB ! EYE S T ONLY "S R1SONA# COOP],N ALL[S TR1T;T )! SLIT LAMP4 ,FOLL[+ REMOVAL (! CORN1L OBJECT1 "! NE$S 6BE TR1T;T (! RESULTANT #CAG CORN1L ABRA.N4 ,! SURFACE (! A#ACJ CORNEA HAS 6H1L & W D S 9 A MATT] ( H\RS4 ,EYE DROPS MAY 2 PRESCRIB$ 6SPE$ RECOV]Y )\T 9FEC;N4 ,A T9Y SC> MAY RE- SULT1 SELDOM A6ECT+ ! VI.N IF PROP]LY TR1T$4 ,AN 9TRAOCUL> =EIGN BODY C O3UR1 & ? IS AL USU,Y METAL4 ,"S"TS A SMALL PIECE ( METAL RESULT+ F AN EXPLO.N OR SIMIL> =CE C P5ETRATE ! CORNEA OR SCL]AL COAT ( ! EYE & LODGE 9SIDE ! EYE1 9 ! RET9A4 ,SEE+ X "? A DILAT$ PUPIL C 2 HELP;L4 ,AL1 SPECIAL ;,X-RAY TE*NIQUES C HELP LOCALIZE ! OBJECT4 ,SURGIC,Y1 ONCE LO- CALIZ$1 ! OBJECT C 2 APPROA*$ PO/]IORLY 0AN 9CI.N MADE 9 ! SCL]A OV]LY+ ! OB- JECT4 ,IF MAGNETIC1 A MAGNET C 2 APPLI$ OV] ! 9CI.N &! MAGNETIC =EIGN BODY C CUT XF \ "? ! S(T TISSUES (! RET9A & *OROID 6ATTA* XF 6! MAGNETIC TIP4 ,IF O!R POR- ;NS (! EYE >E N 9JUR$1 VI.N MAY 2 RE- /OR$4 ,UNTR1T$1 H["E1 MO/ METALLIC =EIGN BODIES WD D DAMAGE 6! EYE 9 ! PROCESS ( DEGRAD,N4 #CAH ,*EMICAL ,9JURIES B#ACJ ,S* 9JURIES >E Q -MON1 & SEV];Y V>IES F M9OR 64A/R\S4 ,! WOR/ >E DUE 6ALKAL9E 9JURY1 ESPECI,Y ) "S?+ L P[D]$ LYE OR LIME4 ,! MA9 TR1T;T IS PROMPT IRRIG,N1 & 9 _M CASES ? IS ALL T IS NEC4 ,A %[]1 G>D5 HOSE1 OR "S (! N[ -MON BOTTLES ( WAT] 7SQUEEZ$ S Z 6CAUSE A /R1M7 C 2 V HELP;L4 ,M DEF9ITIVE TR1T;T 9 ! =M ( EYE DROPS W 2 PRESCRIB$ 0! EYE DOCTOR4 ,SE- V]E ALKAL9E BURNS MAY REQUIRE HOSPITALI- Z,N1 & "S"TS EV5 A CORN1L TRANSPLANT4 ,/RANGELY 5\<1 GLUE IS N S UNCOMMONLY A S\RCE ( 9JURY4 ,! CRAZY-GLUE-L ADHE- SIVE US$ = F+]NAILS -ES 9 A SMALL BOTTLE SIMIL> 6T ( EYE DROPS4 ,I C RECALL AT L1/ TWO PATI5TS :O UNWITT+LY R1*$ 96_! PURSE & PUT :AT !Y ?"\ 7 EYE DROPS 96_! EYE4 ,! ------------------------------------#ACA GLUE USU,Y DIDN'T 9JURE ! EYE XF S M*1 DUE 6BL9K+1 B SURE DID GLUE ! EYELA%ES TGR4 ,! /R;G] UPP]-LID LA%ES OV]P[] ! L[] LA%ES & PULL !M \1 S T ! EYE #CAI C AT L1/ OP54 ,H["E1 ! L[] LA%ES A#ACA /ICK D[N1 L F;E PO/S HANG+ F ! UPP] EYE- LA%ES4 ,2+ FEMALE1 & EMB>RASS$1 NEI PA- TI5T RETURN$ = FOLL[-UP1 & APP>5TLY TOOK C>E (! PRO#M H]F4 ,EYE O9T;TS C HELP LOOS5 GLUE4 ,F/ ,AID & ,PREV5;N ,Z M5;N$1 IRRIG,N (! EYE1 ) CAU;N1 IS 9DICAT$ :5 X APPE>S T DU/ OR LIQUID *EM- ICAL HAS SPLA%$ 96! EYE4 ,C>E;L EXAM9,N )A FLA%LI+ (! EYE W WA% \ SMALL "PICLES1 UN.S EMB$D$ 9 ! CORNEA OR TRAPP$ "U ! UPP] LID4 ,"S"TS1 0G5TLE TRAC;N D[NW>D1 0PULL+ D[N ! LA%ES (! UP- P] LID OV] ! L[] LID1 ! LA%ES (! L[] EYELID MAY HELP 4LODGE A "PICLE /UCK 6! 9N] SURFACE (! UPP] EYELID4 ,! 9JUR$ P]- SON W 2 A# 6TELL RELIEF PROMPTLY4 ,IF "! APPE>S 6BE A LAC],N T MAY IN- VOLVE ! EYEBALL1 !N ! EYE %D 2 C>E;LLY COV]$ &! PATI5T TRANSPORT$ 6A HOSPITAL EM]G5CY ROOM4 #CBJ ,PREV5;N ( 9JURY USU,Y 9VOLVES B#ACA ! USE ( SAFETY GLASSES1 GO7LES1 OR %IELD4 ,SAFETY GLASSES REQUIR$ 0"S TYPES ( "W >E H1VI] S Z 6PROVIDE M PROTEC;N & C 2 PRESCRIP;N 7"S"TS PD = 0! EMPLOY]74 ,S* GLASSES >E USU,Y S H1VY T A P]SON HAS ANO!R PAIR = REGUL> USE4 ,ORD9>Y GLASSES1 ( C\RSE1 PROVIDE "S PROTEC;N1 C]TA9LY -P>$ 6^? :O WE> NO GLASSES4 ,3TACT L5SES >E AL "S:AT PROTECTIVE1 = EXAMPLE1 AG/ =EIGN BODIES1 : MI ,9JURY 6! ,EYES ,ULTRAVIOLET 7,%ORT ,WAVEL5G?7 OR ,,UV ,9JURY ,,UV 9JURY 6! EYES IS -MON1 = EXAMPLE1 9 >C WELD+1 9 SUNTAN P>LORS1 OR Z A COM- PLIC,N ( SKI+ 7ACT9IC K]ATITIS74 ,A WELD] USU,Y "KS BETT] ?AN 6WELD )\T A PROTECTIVE %IELD1 B "S"TS OBS]V]S ?9K !Y >E SAFE IF N TOO CLOSE & N LOOK+ AT ! "W4 ,TANN+ BOO?S 9SI/ ON PROTECTIVE EYE- WE>4 ,A SKI] MAY 2 TOT,Y SURPRIS$ #CBA T ! 9JURY IS DUE 6SUNLIE WORN4 ,! SURPRISE -ES LAT]1 S9CE "! IS NO IMM 4COM=T S Z 6W>N T AN 9JURY HAS O3URR$4 ,AF AN 9T]VAL ( H\RS1 USU,Y #F-AB1 & "!=E FREQU5TLY DUR+ ! MI4LE (! NIE SWOLL5 & TIS (F4 ,A PA- TI5T NATUR,Y WANTS "S M ( T GD /UFF1 B UN=TUNATELY1 REP1T$ USE (! ANES!TIC DE- LAYS H1L+4 ,A /R;G S$ATIVE SLEEP+ PILL W HELP GET "? ! NIE NO LA/+ AFT]E6ECTS1 : MAY 2 H>D = "S"O 62LIEVE AF S M* 4COM=T4 ,X IS N UNUSUAL =A P]SON 6BLAME A SUBSEQU5T EYE PRO#M ON ? EPISODE4 ,! PA9 IS DUE 6TEMPOR>Y SWELL+ (! CORNEA1 "!=E A K]ATITIS1 & HELPS 3FIRM T ! CORNEA IS ! MO/ PA9- S5SITIVE TISSUE 9 ! BODY4 ,! NORMAL L5S (! EYE ABSORBS ,,UV S WELL T ! RET9A IS PROTECT$4 ,ATTEMPTS H BE5 MADE 6DUPLICATE ? FILTR,N ABIL;Y BY A4+ ,,UV PROTEC;N 6! 9TRAOCUL> L5S IM- PLANTS1 ) ONLY LIMIT$ SU3ESS4 ,FOLL[+ CAT>ACT SURG]Y1 X IS ! EXTRA ULTRAVIOLET R1*+ ! RET9A T IS RESPONSI# =! %IFT ( COLOR RECOGNI;N Z MAK+ "EY?+ LOOK BLU]1 A %ADE T IS USU,Y N (F5SIVE1 ESPECI,Y -P>$ 6! DIMM+ ( COLOR RECOGNI;N CAUS$ 0! CAT>ACT T 0 REMOV$4 ,EXPOSURE 6TOO M* SUN HAS BE5 FELT 6BE A POSSI# CAUSE ( CAT>ACTS1 & S* EXPOSURE 6,,UV HAS EXP]I- ;T,Y PRODUC$ CAT>ACTS 9 LAB ANIMALS4 ,"! >E R>E 9DIVIDUALS :O SEEM 6DEVELOP CORN1L SWELL+ AF :AT WD ORD9>ILY #CBC 2 3SID]$ RELATIVELY M9OR SUN EX- B#ACB POSURE1 S* T RELATIVELY LIMIT$ ATTACKS >E REPORT$4 ,^! P NE$ 2 EXTRA C>E;L 9 WE>+ SUNGLASS PROTEC;N4 ,AL1 ANY"O :O HAS _H CAT>ACT SURG]Y NE$S 6WE> PROTEC- TIVE SUNGLASSES1 & USU,Y IS AW>E ( M LIK5 AUTOMATIC,Y1 C 2 A GD *OICE 9 EYEWE>4 ,GRAY SUNGLASSES SEEM 6BE PREF]A# Z A *OICE ( T9T DUE 6! PRES]V,N ( NORMAL COLOR APPRECI,N4 ,PO- L>OID SUNGLASSES >E ! BE/ 9 PROTEC;N & >E N[ AVAILA# 9 PRESCRIP;N4 ,WRAP>.D SUNGLASSES >E POPUL> B >E N AVAILA# 9 PRESCRIP;N L5SES4 ,SOL> ,RET9OPA?Y ,? IS MO/ -MONLY A RESULT ( AN ECLIPSE BURN F LOOK+ DIRECTLY AT ! SUN4 ,9FRAR$ 7L;G WAVEL5G?7 OR ,,IR LIE1 & X IS DEBATA# Z 6:E!R X IS IN- FRAR$ ,,IR OR ULTRAVIOLET 7%ORT WAVE- L5G?7 ,,UV RADI,N T CAUSES SOL> RET9OPA- ?Y1 OR BO?4 ,ORD9>ILY1 ! RET9A IS PRO- TECT$ F SOL> 9JURY 2C A P]SON #CBD REFLEXIVELY LOOKS AWAY F ! SUN C#ACB :5 X IS TOO B"R4 ,"! >E REPORTS ( DRUG- GIES S SPAC$ \ T !Y LOOK$ AT ! SUN TOO L;G1 OR ( RELIGI\S FANATICS DO+ S ON PURPOSE4 ,! DANG] ) AN ECLIPSE IS T ! MOON COV]S 5 (! SUN S* T ------------------------------------#ACC "O C LOOK M DIRECTLY AT ! SOL> S\RCE1 P]H L;G 5 6CR1TE A BURN 9 ! RET9A4 ,S9CE ! MACULA IS ! FOCAL PO9T ( VI.N1 ? DAM- AGE RESULTS 9 LOSS ( R1D+ VI.N4 ,"! >E REPORTS ( SOL> RET9OPA?Y ) LESS] EXPO- SURE1 & "! >E AL REPORTS ( SPONTANE\S RECOV]Y4 ,H["E1 X IS TOO M* (A RISK TO LOOK AT AN ECLIPSE1 EV5 ) PROTECTIVE %IELD+4 ,"! IS AL ! /ORY (! SOLDI] 9VOLV$ 9 NUCLE> EXP]I;T,N 9 ! E>LY /AGES4 ,SUP- POS$LY1 8 UNIT 0 6HIDE 9 A TR5* AT A 4T.E ?"\ P]H SAFE F RADI,N 9JURY4 ,?\< TOLD 6COV] 8 EYES1 ? MAN REPORT$LY /OOD UP1 OP5$ "O EYE1 & SAW ! MU%ROOM CL\D (! BLA/4 ,8 RET9A %[$ AN UPSIDE-D[N MU%ROOM SC> (! MACULA1 2C1 ( C\RSE1 ?+S >E RE- V]S$ UPSIDE D[N 9 ! EYE1 & #CBE EXPLA9+ :Y HE LO/ VI.N 9 T EYE4 A#ACC #CBF #AG #ACD ,?+S 6,"K AB ,EYE ,SURG]Y ,EYE SURG]Y HAS BE5 4CUSS$ 9 A 4CUS.N ( 41SES REQUIR+ SURG]Y1 B P]H "S DETAILS ( EYE SURG]Y WD 2 9T]E/+4 ,= EXAMPLE1 J :AT HAPP5S1 & :AT C Y EXPECT IF Y >E ! PATI5T4 ,& NO1 WE D N TAKE ! EYE \1 OP]- ATE ON X1 & PUT X BACK 9 PLACE4 ,CAT>ACT ,SURG]Y ,CAT>ACT SURG]Y1 Z M5;N$1 IS ! MO/ -MON SURGICAL PROC$URE P]=M$ 9 ! ,UNIT$ ,/ATES1 & P]H ALL C.TRIES4 ,! SURGICAL PROC$URE HAS 5JOY$ _M IMPROVE;TS 9 REC5T YE>S4 ,REMOVAL (! L5S (! EYE 0 P]=M$ 0R RELATIVELY GROSS TE*NIQUES YE>S AGO1 &! 9TRODUC;N ( SUTURES M1NT BETT] & M RAPID PO/OP]ATIVE IMPROVE;T4 ,0! #AIDJ;S TO #AIEJ;S1 ! L5S (! EYE 0 REMOV$ 9 "O PIECE 79TRACAPSUL> CAT>ACT EXTRAC;N74 ,!N A TE*NIQUE CALL$ ,KELMAN PHACOEMUL- SIFIC,N >OSE 9 ! #AIGJ;S1 UTILIZ+ A V SMALL 9CI.N4 ,? IS A =M ( #CBG 8EXTRACAPSUL>0 CAT>ACT EXTRAC;N1 A#ACD M1N+ T ALL ! L5S IS REMOV$1 EXCEPT =! CAPSUL> 5VELOPE T SURR.DS ! S(T 9T]NAL POR;N (! L5S1 A TISSUE L CELLOPHANE4 ,? ALL[S AN 5VELOPE SORT ( >RANGE;T 96: ! 9TRAOCUL> L5S 7,,IOL7 IMPLANT CD FIT 9TO PROP] POSI;N4 ,3TR>Y 6-MON 2LIEF1 ? PHACOEMULSIFIC,N DOES N 9VOLVE LAS]1 B 9/1D 9VOLVES ULTRAS.D4 ,"! >E DI6]5T TE*NIQUES1 & Y MAY WI% 64CUSS ) YR SURGEON J :AT HE DOES4 ,0! WAY1 ,I USE ! MALE G5D] :5 4CUSS+ EYE DOCTORS1 R1LIZ+ T ALM HALF (! EYE DOC- TORS 2+ TRA9$ >E FEMALE4 ,CAT>ACT SURG]Y IS AN \TPATI5T PROC$URE4 ,"! IS NO S* ?+ Z 2+ TOO OLD 6H ! SURG]Y1 & ALM NO S* ?+ Z 2+ TOO SICK4 ,X TAKES AB #B H\RS 9 ! \TPATI5T SURGIC5T]4 ,X AL IS N A R1SON 6PO/P"O SURG]Y1 2C ( FE> (! UN"KN4 ,? FE> C USU,Y 2 LESS5$ 0GD 9=M,N4 ,! PRO- C$URE ALM ALW IS D"O "U LOCAL ANES!SIA1 M1N+ AN ANES!SIOLOGI/ IS "! 6HELP1 B X IS N ------------------------------------#ACE NEC 6BE PUT 6SLEEP4 ,Y PROBABLY W #CBH N EV5 REMEMB] :AT HAPP5S1 EV5 A#ACE ?\< IF ASK$ A "Q DUR+ ! SURG]Y1 Y MAY 2 A# 6RESPOND4 ,ONCE1 :5 ,I 0 /&+ NEXT 6MY PATI5T PO/OP]ATIVELY 9 ! RECOV]Y ROOM1 H] DAUTS "W+4 ,! EYE IS NUMB$1 B N[ "DS ? C 2 D"O TOPIC,Y1 M1N+ ) EYE DROPS & AN 9JEC;N ( NUMB+ M$IC9E ONCE ! EYE IS OP54 ,A SMALL 9CI.N IS MADE 9 ! CORNEA1 "O S SMALL T USU,Y NO SUTURES >E NE$$4 ,SMALL TUBUL> 9/RU;TS >E 9S]T$1 &A R.D 9CI.N IS MADE 9 ! FRONT SURFACE (! L5S1 A CAPSULOTOMY4 ,!N ALL ! L5S CORTEX & NUCLEUS IS RE- MOV$1 0ULTRAS.D1 IRRIG,N1 & ASPIR,N 7SUC;N74 ,A FLEXI# FOLDA# 9TRAOCUL> L5S IS IMPLANT$ 79S]T$7 96! CAPSUL> SPACE1 L 96AN 5VELOPE1 )! OP5+ 2+ 7! CAPSULOTOMY7 9 ! FRONT ( :AT 0 ! L5S (! EYE4 ,:5 AWAK5$1 ! RELAX+ M$IC9E HAV+ WORN (F1 ! PATI5T C SOON G HOME4 ,AT HOME1 "O IS N 3F9$ 6B$ B C SIT & WAT* #CBI ,,TV4 ,"! MAY 2 AN EYE PAD OV] ! B#ACE EYE &_/OR A PROTECTIVE %IELD1 B IF ONLY A %IELD1 "O C SEE "R AWAY "? ! HOLES (! %IELD4 ,EYE DROPS ( ANTI-9FLAMMATORY NA- TURE >E TAK51 & USU,Y ! NEXT "D 9 ! DOC- TOR'S (FICE1 PATI5TS C GET AN E>LY IDEA ( H[ WELL !Y >E GO+ 6SEE4 ,?+S LOOK B"R] & :IT]1 ACTU,Y DUE 6! ,PURK9JE %IFT1 M1N+ T M (! BLUE 5D (! LI L5S IMPLANT1 B X'S ,,OK1 "EY?+ LOOKS B"R]4 ,RE/RIC;NS ( ACTIV;Y >E M9IMAL1 &! DOCTOR MAY ALL[ RETURN 6"W SOON1 DEP5D+ ON ! NATURE ( "W4 ,S9CE MO/ PATI5TS >E S5IORS1 REGUL> ACTIVITIES >E USU,Y AL- L[$1 & ANY NE$$ GLASSES C 2 PRESCRIB$ 9 AB ?REE WEEKS4 ,IF TEMPOR>Y R1D+ GLASSES >E NE$$1 ! DOCTOR C SU7E/ :AT 6GET AT ! DRUG /ORE4 ,IF AN A3OMMODATIVE OR PSEU- DOA3OMMODATIVE IMPLANT IS US$1 ! PROCE- DURE & FOLL[-UP IS PRETTY M* ! SAME4 ,I ACTU,Y HE>D AN AD OV] ! RADIO ONCE = "S VITAM9S T 7 6PREV5T #CCJ CAT>ACTS1 ( C\RSE1 : IS RIDICU- C#ACE L\S4 ,! FUNNIE/ "P 0 A /ATE;T T IF Y H CAT>ACT SURG]Y1 X J MIY CAT>ACT40 ,! BACK SURFACE (! CAPSULE1 ! MEMBRANE LEFT 9TACT1 : 0 ! ORIG9AL CELLOPHANE-L WRAPP] (! ORIG9AL L5S (! EYE1 MAY 2COME CL\D$ AT "S PO9T AF SURG]Y4 ,Z X 2COMES CL\D$1 X REPRES5TS A BLUR 6! EYE 2C LESS LIACT 0 DEVELOP+4 ,? MAY GIVE ! IMPRES.N T ! CAT>ACT IS -+ BACK4 ,IF 5 (A NUIS.E1 ! TR1T;T IS SIMPLE & PA9.S4 ,? IS ": A LAS] IS ACTU,Y US$ 9 CAT>ACT TR1T;T4 ,A 8,YAG0 LAS]1 ATTA*$ 6A SLIT LAMP MICRO- SCOPE1 C 2 FOCUS$ ONTO ? MEMBRANE &A HOLE POPP$ "? ! CL\D$ CAPSULE1 K9D ( L A PUPIL 2H ! ------------------------------------#ACF PUPIL1 & LILY4 ,9/ANT RETURN 6GD VI.N RESULTS4 ,! "Q -ES UP Z 6": "O %D G 6H CAT>ACT SURG]Y & :E!R 6G 6A SURGEON :O "O HAS HE>D DOES A :OLE LOT ( CAT>ACTS1 #CCA & IS A CAT>ACT SPECIALI/4 ,C]- A#ACF TA9LY 9 \R FIELD1 "S HI<-VOLUME CAT>ACT SURGEONS H EVOLV$4 ,I WD SU7E/ T IF Y H A LOCAL OPH?ALMOLOGI/ ) :OM Y H DEVELOP$ A GD REL,N%IP1 & Y "K ( PATI5TS :O H RCVD GD RESULTS & C>E F ? DOCTOR1 T X WD PROBABLY 2 BETT] 6/AY ) YR DOCTOR =! SURG]Y4 ,A DI6]5T DOCTOR1 DEP5D+ ON LO- C,N & O!R FACTORS1 MAY 2 GLAD 6OBLIGE DO+ ! SURG]Y1 B N WI% OR 2 A# 6GIVE Y ! K9D ( 3T9U$ FOLL[-UP C>E Y %D H4 ,(T51 AF GO+ \ ( T[N =! SURG]Y1 PATI5TS >E EM- B>RASS$ 6RETURN 6! C>E ( _! ORIG9AL DOC- TOR4 ,Z A RESULT1 !Y MAY N GET EXAM9,NS Z FREQU5TLY Z SU7E/$ & MAY EV5 RESORT TO 9ADEQUATE GLASSES S* Z DRUG /ORE GLASS- ES1 OR G 6"S O!R /RANG] = C>E4 ,A G5]AL RULE IS T ANY"O HAV+ "UG"O CAT>ACT SUR- G]Y %D 2 EXAM9$ AT L1/ ONCE A YE>4 ,"! MAY N 2 ANY -PLIC,NS (! CAT>ACT SURG]Y1 B O!R PRO#MS AL NE$ POSSI# DETEC;N4 ,( C\RSE1 ! SECOND EYE IS A "Q REG>D+ H1L? & CAT>ACT4 #CCB ,GLAUCOMA ,SURG]Y B#ACF ,9 4CUSS+ ! TR1T;T ( GLAUCOMA1 SURG]Y 0 M5;N$ Z ! TR1T;T "O SEEKS :5 TR1T;T ( PRESSURE-L[]+ EYE DROPS OR LAS] TR1T;T HAS N PROVID$ ADEQUATE 3TROL (! 9TRAOCU- L> PRESSURE4 ,! SIMPLE/ SURG]Y IS ! IRIDECTOMY P]- =M$ = ANGLE CLOSURE GLAUCOMA4 ,? 0 ONCE D"O SURGIC,Y Z AN \TPATI5T PROC$URE4 ,9 REC5T YE>S1 ? HAS BE5 D"O )A LAS]1 & RE,Y N AN 9VASIVE SURGICAL PROC$URE1 2+ R QK & SAFE4 ,! 9DIC,N WD 2 AN ATTACK ( ANGLE CLOSURE GLAUCOMA1 OR RECOGNI;N (! SAME POT5TIAL = AN ATTACK 9 ! O!R EYE4 ,! R1L ISSUE IS PROPHYLACTIC OR PREV5- TIVE TR1T;T (A PATI5T ^: ANT]IOR *AMB] ANGLES SEEM N>R[ VIA MICROSCOPIC GONI- OSCOPY4 ,! ANT]IOR *AMB] DEP? IS E/IMAT$ F/ BY SLIT LAMP MICROSCOPIC EXAM9,N1 & IS EX- PECT$LY M N>R[ 9 ! F>SIY BODY1 #CCC R L LOOK+ >.D ! CORN]4 ,IF ! C#ACF SPACE SEEMS Q N>R[1 !N "! IS 3C]N T AN ATTACK ( ANGLE CLOSURE GLAUCOMA MAY OC- CUR4 ,? /IMULATES ! IDEA ( PREV5TIVE !R- APY1 EI ) PILOC>P9E DROPS1 : %R9K ! PU- PIL S Z 6WID5 ! ANT]IOR *AMB] ANGLE1 OR ) LAS] IRIDOTOMY 6MAKE AN EXTRA PUPIL = EASY A3ESS ( FLUID 6! ANT]IOR *AMB] AN- GLE DRA9AGE >EA4 ,P >E ATTRACT$ 6A QK FIX1 S* T ! LAS] ALT]NATIVE SEEMS BE/4 ,N"E!.S1 EYE DOCTORS FREQU5TLY PLACE _! PATI5TS ON PILOC>P9E EV5 AF LAS] IRIDO- TOMY4 ,9 SPITE ( ALL ? 3C]N1 ------------------------------------#ACG ,I AM N P]SON,Y AW>E ( ANY"O :O SU6]$ AN ATTACK ( ANGLE CLOSURE GLAUCOMA AF EI M1NS ( PREV5TIVE TR1T;T4 ,AN 9T]M$IATE TR1T;T ( OP5-ANGLE GLAU- -A1 :5 EYE DROP !RAPY HAS FAIL$1 OR 2C1 AG1 P >E 9T]E/$ 9 A QK FIX1 IS LAS] TRA- BECULOPLA/Y4 ,"S DEBATE :E!R ? IS RE,Y SURG]Y1 B X IS RELATIVELY SIMPLE & )\T M* -PLIC,N4 ,! BI7E/ -PLIC,N IS T X MAY N "W 63T9U$ SATISFAC;N OR = V L;G4 ,:AT IS 9VOLV$ IS A LAS] BURN PLAC$ 9 #CCD ! *AMB] ANGLE TISSUE CALL$ ! A#ACG TRABECUL> ME%"W1 : IS ! FILT]+ >EA "? : FLUID DRA9S F ! EYE 96VE9S4 ,X IS R A PLUMB+ APPROA* 6IMPROVE ! \TFL[4 ,IF ? DOES N "W1 X C 2 REP1T$4 ,H["E1 X IS N UNUSUAL 6H 6RESORT 6! USE ( GLAUCOMA EYE DROPS 6SUPPLE;T FUTURE TR1T;T4 ,NEW] LA- S]S H BETT] POT5TIAL RESULTS & ALL[ LESS LIMIT$ REP1T$ PROC$URES IF NEC4 ,GLAUCOMA SURG]Y AM.TS 6ME?ODS 6DRA9 FLUID F ! EYE1 9 A 3TROLL$ FA%ION1 S Z 6L[] ! 9TRAOCUL> PRESSURE 6SAFE RANGES4 ,"! >E DI6]5T ME?ODS BAS$ ON MAK+ AN IM- PROVE;T ( FLUID REL1SE F ! EYE4 ,TRABEC- ULECTOMY AM.TS 6MAK+ A SURGICAL W$GE OP5+ 96! ANT]IOR *AMB] ANGLE1 & PURPOSE- LY CR1T+ R1SONS :Y ? OP5+ %D REMA9 OP51 S* Z TAK+ \ "S TISSUE4 ,9 O!R ^WS1 CR1T+ A W.D T DOES N H1L -PLETELY4 ,FILTR,N IS 5C\RAG$ "? ! SCL]A & "U ! 3JUNCTIVA1 CR1T+ :AT IS CALL$ A BLEB1 : IS L A BLI/] 3TA9+ AQUE\S FLUID1 : C EV5TU,Y 2 DRA9$ 9 A 3TROLL$ FA%ION 0VE9S F ! EYE4 ,-PLIC,NS 9CLUDE POSSI# 9FEC;N1 FAIL- URE 6FILT] 5 FLUID1 OR EV5 FILT]+ #CCE TOO M* FLUID4 ,FAILURES C "S"TS B#ACG 2 SALVAG$ 0NE$L+ ! BLEB1 OR REOP],NS4 ,! USE ( GLAUCOMA DROPS MAY AL 2 NE$$ EV5- TU,Y 6MAXIMIZE E6ECT4 ,APP>5T E>LY SUC- CESS MAY 2 -PLICAT$ 0EV5TUAL SC>R+ D[N ( ! BLEB4 ,O!R SURGICAL APPROA*ES 9VOLVE A /9T1 TUBE1 OR %UNT ) >TIFICIAL IMPLANT$ MATE- RIAL1 : 5C\RAGES FILTR,N ( FLUID1 L A WICK "U ! 3JUNCTIVA1 6=M A BLEB1 OR A DIRECT DRA9AGE 96A SPACE 9SIDE ! *OROID4 ,^! PROC$URES MAY 2 NEC IF ! 3JUNCTIVA IS SC>R$ F PREVI\S SURG]Y S* Z A CAT>ACT OP],N4 ,F ! PATI5T /&PO9T1 ! EXP]I;E WD 2 SIMIL> 6\TPATI5T CAT>ACT SURG]Y4 ,AN AN- ES!SIOLOGI/ MAKES ! EXP]I;E =GET;L1 & PO/OP]ATIVE 4COM=T IS EXPECT$ 6BE M9I- MAL4 ,( C\RSE FOLL[-UP IS V IMPORTANT TO SEE IF ! TR1T;T IS SU3ESS;L OR IF FUR!R TR1T;T IS NE$$4 ,Z F> Z ": 6G = SURG]Y1 ? IS "S?+ YR G5]AL OPH?ALMOLOGI/ W HELP DECIDE ) Y4 ,GLAUCOMA SPECIALI/S H EVOLV$1 HAV+ _H SPECIAL TRA9+ 9 TR1T+ GLAUCOMA4 #CCF ,MO/ G5]AL OPH?ALMOLOGI/S D N D C#ACG ! FILT]+-TYPE SURGICAL PROC$URES = GLAU- -A1 ?\< "S MAY D LAS] TR1T;TS4 ,Z A RULE1 :5 X IS DET]M9$ T EYE DROP TOPICAL !RAPY IS N SU3ESS;L1 !N 0MUTUAL DECI.N1 REF]RAL 6A GLAUCOMA SPECIALI/ IS RECOM- M5D$1 IF AVAILA#4 ,! PATI5T IS !N REF]R$ BACK 6! G5]AL PRIM>Y OPH?ALMOLOGI/ EV5- TU,Y = 3T9U$ FOLL[-UP1 & "S"TS ------------------------------------#ACH FUR!R USE ( TOPICAL EYE DROP !RAPY IS NE$$4 ,X SEEMS 6BE TRUE T GLAUCOMA SPE- CIALI/S >E MA9LY 9T]E/$ 9 PROC$URES & >E N LIKELY 6WANT 63DUCT ! 9DEF9ITELY L;G FOLL[-UP REQUIR$ = GLAUCOMA PATI5TS1 IN- CLUD+ *ECK+ VI.N & DETECT+ O!R PRO#MS 9 ! C\RSE ( R\T9E -PREH5SIVE EXAM9,NS4 ,"S PATI5TS >E 9T]E/$ 9 A 8QK FIX0 & MAY 2 TOO IMPATI5T 6TAKE L;G-T]M TOPICAL !RA- PY4 ,!Y MAY SEEK \ A GLAUCOMA SPECIALI/ :O W P]=M A LAS] PROC$URE1 OR FILT]+ SURG]Y1 S Z 6AVOID ! NE$ 6USE EYE DROPS4 ,H["E1 E>LY GD RESULTS >E "S"TS ONLY TEMPOR>Y1 & IF ! PATI5TS >E TOO EMB>- RASS$ 6RETURN 6_! ORIG9AL PRIM>Y #CCG OPH?ALMOLOGI/1 !Y MAY ACTU,Y A#ACH LOSE VI.N F AN UNDIAGNOS$ RETURN ( HI< PRESSURE1 9ADEQUATE VISUAL CORREC;N1 OR UNDETECT$ EYE 41SE4 ,PROBABLY1 IF S* PA- TI5TS WD 4CLOSE _! 9T5T1 6%ORTCUT ! USE ( ANNOY+ EYE DROPS1 _! EYE DOCTOR WD PROBABLY SUPPORT !M 9 _! DECI.N1 & AGREE 6TAKE OV] _! C>E ^U -PLE;N ( TR1T;T 0! GLAUCOMA SPECIALI/4 ,RET9AL ,DETA*;T ,SURG]Y ,A RET9AL DETA*;T C 2 S]I\S & C RE- QUIRE "S"TS EM]G5CY TR1T;T SURGIC,Y4 ,! 9CID;E IS REPORT$ Z "O = E #AJ1JJJ P P] YE>4 ,?\< ? SEEMS A SMALL 9CID;E1 ! 3SE- QU;ES C 2 DEVA/AT+4 ,DETA*;T (! RET9A IS M -MON 9 HI<] DEGREES ( MYOPIA 7NE>SIACT EXTRAC;N4 ,! RET9A L9ES ! BACK (! EYE & HAS BE5 LIK5$ 6! FILM 9 ! BACK (A CAM]A4 ,X IS DELI- CATE N]VE TISSUE & IS L WALLPAP] 9 H[ X L9ES ! BACK (! EYE4 ,A HOLE 9 ! RET9A C O3UR1 "S"TS F TRAUMA1 B USU,Y SPONTANE- \SLY4 ,?9K+ (! EYE L A ROOM FILL$ #CCH ) FLUIDS1 IF A HOLE =MS 9 ! RET- B#ACH 9A1 X IS L A HOLE 9 WALLPAP]4 ,! FLUID C GET 96! HOLE & WA% AWAY ! RET9A1 L WALL- PAP] /RIPP+ F ! SIDE (A ROOM4 ,GRAV;Y PLAYS A ROLE S* T A HOLE HI< UP 9 ! EYE IS M LIKELY 6ALL[ FLUID 65T] & /RIP AWAY ! RET9A4 ,H["E1 A HOLE L[] 9 ! EYE IS SL[] 9 PROGRESS 6/RIP AWAY ! RET9A1 L WD 2 UNLIKELY )! ANTIGRAVIT,NAL E6ECT (A HOLE 9 WALLPAP] NE> ! BOTTOM (A ROOM4 ,! MACULA1 Z HAS BE5 DESCRIB$1 IS V SPECIAL & DELICATE4 ,IF ! MACULA IS DE- TA*$1 OR /RIPP$ AWAY F XS USUAL LOC,N1 ! PROGNOSIS IS POOR = RECOV]Y ( GD VI.N4 ,X IS L HAV+ ?\S&S ( LL ELECTRICAL PLUGS UNPLU7$ & TRY+ 6REALIGN ^! T9Y PLUGS ) REPAIR (! RET9AL DETA*;T4 ,?US :AT MAY APPE> 6BE A GD ANATOMICAL RESULT MAY N 2 A GD FUNC;NAL RESULT1 IF ! MACULA IS DE- TA*$ 9 ! PROCESS4 ,SURGICAL REPAIR (A RET9AL DETA*;T IS MAJOR SURG]Y 9 MO/ CASES4 ,A G5]AL ANES- !TIC IS USU,Y REQUIR$1 ?\< ! PROC$URE C 2 D"O "U LOCAL ANES!SIA4 ,AL1 X IS M LIKELY 6BE AN 9PATI5T PROC$URE1 #CCI REQUIR+ OV]NI.D ! EYE S Z 6ELEVATE ! TISSUE 2N ! HOLE4 ,!N1 :5 ! FLUID IS DRA9$ F 2N ! RET9A1 X DRAPES ONTO ! BUCKLE Z X FALLS BACK 9 PLACE4 ,TR1T;T 6! TISSUE =M+ ! BUCKLE 9 ! =M ( H1T OR LAS] CR1TES A /ICKY REAC;N T HELPS S1L ! RET9A 9 PLACE4 ,IF ALL GOES WELL1 !N ! RET9A /AYS 9 PLACE1 & DEP5D+ ON :E!R ! MACULA 0 9VOLV$1 VI.N MAY 2 FULLY RE/OR$4 ,H[- "E1 ! BUCKLE IS L A BELT >.D ! EYE1 & X T5DS 6MAKE ! EYE L;G] ?AN ORIG9,Y1 & "!- =E M RELATIVELY NE>SISIE M LIKELY 6DEVELOP A RET9AL DETA*;T4 ,? IS 2C ! NE>SIG] ?AN AV]AGE1 &1 IF HISI- SIACT SURG]Y 9CR1SES ! LIKELIHOOD ( RET9AL DETA*;T1 & "!=E ! IDEA ( P]=M+ 8PRESBYOPIA SURG]Y0 ON A HISIACT RAISES AL]T;S 6POSSI# RET9AL DE- TA*;T -PLIC,N4 ,"! >E O!R ME?ODS ( TR1T+ A RET9AL DE- TA*;T4 ,"S"TS 9JEC;N (A GAS 96! VITRE\S C =CE ! RET9A BACK 9 PLACE1 A PNEUMATIC RET9OPEXY4 ,TR1T;T L S* Z SPOT WELD+1 ) LAS]1 C !N HELP HOLD ! RET9A 9 PLACE4 ,"S"TS ? SORT ( TR1T;T C 2 P]=M$ 9 ! (- FICE4 ,IF ! VITRE\S IS FILL$ ) BLOOD1 OR IF ! VITRE\S SEEMS 6BE A FACTOR 9 PULL+ (F ! RET9A1 A SURGICAL VITRECTOMY MAY NE$ 6BE P]=M$ ) AN OP]AT+ MICROSCOPE4 ,AL VITRECTOMY C 2 EMPLOY$ 9 /RIPP+ (F A MEMBRANE CAUS+ PRERET9AL MACUL> FIBRO- SIS4 ,LAS] TR1T;T C AL 2 APPLI$ 6NE$$ >1S 6HELP /ICK ! RET9A 9 PLACE 5DOSCOP- IC,Y 7F ! 9SIDE VIA ! USE (! OP]AT+ MI- CROSCOPE74 ,! O!R EYE ( C\RSE NE$S 6BE #CDA CLOSELY WAT*$1 S9CE X AL HAS IN- B#ACI CR1S$ LIKELIHOOD ( RET9AL DETA*;T4 ,AL1 O!R MEMB]S (! FAMILY1 ESPECI,Y IF AL NE>SIE;LLY = SIGNS ( RET9AL DETA*;T4 ,>1S ( RET9AL ?9N+ OR DEG5],N1 S* Z 8LATTICE DEG5],N10 MAY 2 TR1T$ PROPHYLACTIC,Y ) LAS]4 ,SYMPTOMS1 Z M5;N$ 9 ! 4CUS.N ( FLOAT]S & FLA%ES1 %D 2 ATT5D$ 60C>E;L RET9AL EXAM9,N4 ,EV5 IF ! EXAM IS NORMAL1 FUR!R SYMPTOMS (A %[] ( FLOAT]S1 OR A %AD[ 9 ANY FIELD ( VI.N1 %D 9DICATE A NE$ = FUR!R EXAM4 ,RET9AL DETA*;TS >E USU,Y DETECT$ BY PRIM>Y OPH?ALMOLOGI/S OR OPTOMETRI/S1 )A REF]RAL 6A RET9AL SPECIALI/ OPH?ALMOLO- GI/4 ,X IS N NEC 6SEE A RET9AL SPECIALI/ = R\T9E EXAMS IF Y >E A DIABETIC1 OR = SYMPTOMS ( FLOAT]S OR FLA%ES4 ,A SCRE5+ EXAM C 2 P]=M$ 0YR PRIM>Y EYE DOCTOR1 & !N A REF]RAL W 2 RECOMM5D$ DEP5D+ ON ! NE$4 ,AF RET9AL SURG]Y OR TR1T;T1 A P]I- OD ( FOLL[-UP W 2 SU7E/$ 0! RET9AL DOC- TOR1 B ! PATI5T W 2 REF]R$ BACK 6! PRI- M>Y EYE DOCTOR = L;G-T]M FOLL[-UP4 #CDB ,/RABISMUS ,SURG]Y #ADJ ,SURG]Y ON EYE MUSCLES IS USU,Y P]=M$ ON *N :O >E CROSS-EY$4 ,! SURG]Y IS N Z DI6ICULT Z 9TRAOCUL> SURG]Y S* Z CAT>ACT SURG]Y4 ,PREOP]ATIVE RECOGNI;N ( :AT NE$S 6BE D"O & DESIGN+ ! SURG]Y = EA* PATI5T IS :AT IS M DI6ICULT4 ,"O ( MY PROFESSORS1 ,DR4 ,FR$ ,BLODI1 US$ 6SAY1 8,I C T1* A MONKEY 6OP]ATE4 ,! "Q IS :540 ,O!R ME?ODS ( TR1T+ CROSS$ EYES NE$ 6BE EMPLOY$ F/1 GLASSES IF 9DICAT$ 7USU- ,Y71 & ELIM9,N ( AMBLYOPIA 7LAZY EYE7 IF POSSI#4 ,I 2LIEVE1 & "S AGREE ) ME1 T ! 9CID;E ( SURG]Y = CROSS-EY$ *N IS LESS ?AN X WAS1 2C "! >E FEW] CROSS-EY$ *N4 ,:Y1 ,I DON'T "K4 ,MO/ G5]AL OPH?ALMOLOGI/S ONCE P]=M$ S* 8MUSCLE0 SURG]Y4 ,CURR5TLY1 ? TYPE ( SURG]Y IS ALM ALW D"O 0P$IATRIC OPH?ALMOLOGI/S :O H SPECIALIZ$ TRA9+4 ,? IS TRUE = ADULTS :O NE$ /RABISMUS SURG]Y AL1 S9CE G5]AL OPH?ALMOLOGI/S H /OPP$ DO+ S* OP],NS4 ,I "K A PROFES.NAL FOOT- BALL PLAY] "ND ,MIKE1 :O 0 GREET$ #CDC 9 ! WAIT+ ROOM (A P$IATRIC OPH- A#ADJ ?ALMOLOGI/1 A FR ( M9E1 6:OM HE 0 RE- F]R$4 ,! NURSE CAME 96! WAIT+ ROOM1 LOOK+ >.D =A BOY & SAY+1 8,MIKEY1 ,MIK- EY1 X'S YR TURN ,MIKEY10 ONLY 6BE />TL$ 0A #F-FOOT-#C-9* MAN WEI<+ #BHE P.DS1 >IS+ & SAY+1 8,I AM ,MIKEY40 ,Z DESCRIB$1 EYE MUSCLE SURG]Y UTILIZ- ES "S:AT OR?OP$IC PR9CIPLES 7C>P5TRY7 6A NEUROLOGICAL 7ELECTRONIC7 PRO#M4 ,! REC- TUS MUSCLES1 : ROTATE ! EYES1 >E E/IMAT$ 6BE #AJJ "TS M P[];L ?AN NEC =! "W !Y D4 ,!Y "W 9 COORD9AT$ SYN*RONY4 ,:5 ! MUS- CLE T TURNS ! EYE T[>D ! NOSE IS ACTIVE1 ! M$IAL RECTUS1 ! OPPOS+ MUSCLE1 : IS TO ROTATE ! EYE T[>D ! E>1 ! LAT]AL RECTUS1 M/ RELAX & /RET*4 ,X IS R>ELY TRUE T A CROSS-EY$ * HAS ANY W1K EYE MUSCLES4 ,! EYE T CROSSES ALL ! "T1 IS FREQU5T- LY CALL$ ! 8W1K EYE10 B ? IS N TRUE1 X IS N W1K4 ,! O!R EYE HAS J 2COME ! PRE- F]R$ EYE1 & ? MAY H RESULT$ F ! FACT T ! CROSS$ EYE DOES N SEE Z WELL & IS AMBLY- OPIC4 ,:5 SURG]Y IS D"O1 X CD 2 ON EI EYE1 & ? IS DI6ICULT = P>5TS TO #CDD "U/&1 L>GELY 2C !Y L 6?9K T ! B#ADJ SURG]Y W MAKE ! 8W1K EYE0 /R;G]4 ,) ? 9 M9D1 ! EYE SURGEON R\T9ELY OP]ATES ON ! EYE T IS USU,Y CROSS$4 ,H["E1 IF REOP],N DUE 69COMPLETE SU3ESS 9 ! F/ OP],N IS 9DICAT$1 X IS C]TA9LY M LOGICAL 6"W ON ! O!R EYE1 EV5 IF X IS ! BETT]-SEE+ OR PREF]R$ EYE4 ,SC> TISSUE F ! F/ OP],N MAKES X M DI6ICULT 6E/IMATE ! RESULTS (! SECOND OP],N IF D"O ON ! SAME EYE Z ! F/ OP],N4 ,ANO!R FACTOR IS T "! IS A LIMIT 6:AT C 2 D"O 6A GIV5 MUSCLE1 & IF ! MAX- IMUM HAS BE5 D"O ALR1 !N OBVI\SLY ! O!R EYE M/ 2 US$ 9 ! SECOND SURG]Y4 ,=! CROSS-EY$ PATI5T1 ! M$IAL RECTUS1 ! MUSCLE T TURNS ! EYE 9 T[>D ! NOSE1 IS RECESS$ 7SET BACK7 OR W1K5$ 9 XS E6ECT4 ,"S"TS ------------------------------------#ADA BO? M$IAL RECTUS MUSCLES >E RECESS$1 & SELDOM IS ONLY "O MUSCLE OP]AT$ ^U4 ,USU,Y1 AL;G ) RECESS+ "O M$IAL RECTUS MUSCLE1 ! LAT]AL RECTUS 9 ! SAME EYE IS RESECT$1 OR TIE *N1 A G5]AL ANES!TIC IS USU,Y US$4 ,X / C 2 AN \TPA- TI5T PROC$URE4 ,= EXOTROPIA1 ! \-TURN+ ( "O EYE1 ! DECI.N = SURG]Y MAY N -E UNTIL 2Y *ILD- HOOD4 ,MO/ -MONLY BO? LAT]AL RECTUS MUS- CLES >E RECESS$ 7SET BACK7 OR W1K5$ 9 E6ECT4 ,"S"TS ! M$IAL RECTUS IS RESECT$ OR %ORT5$ 9 "O EYE4 ,"O (! FREQU5T 9DI- C,NS = EXOTROPIA SURG]Y IS A -PLIC,N ( PRIOR SURG]Y = ESOTROPIA1 CALL$ 3SECU- TIVE EXOTROPIA4 ,? IS ESPECI,Y ! CASE IF ! AM.T ( SURG]Y = CROSS+ (! EYES IS BAS$ ON ! AM.T ( CROSS+ PRES5T )\T GLASSES4 ,A TEMPOR>Y GD RESULT IS FOLL[$ 0LAT] RECOGNI;N (! NE$ = GLASSES1 & !N \-TURN+ ( "O EYE1 USU,Y ! EYE OP]AT$ ^U4 ,? TYPE ( REOP],N IS -PLICAT$ 0! SC> TISSUE F ! F/ OP],N4 ,/RANGELY 5\<1 ! BE/ LA/+ RE- SULT F SURG]Y = PRIM>Y EXOTROPIA1 ":BY ! PATI5T HAS ! ABIL;Y 6IGNORE ! IMAGE ( "O EYE :5 X DRIFTS \ B RETA9S A =M ( B9OCU- L> VI.N MO/ (! "T1 IS 6SEE TEMPOR>ILY D\# AF ! SURG]Y DUE 62+ A LL #CDF CROSS-EY$4 ,S9CE ! NATURAL T5D5- B#ADA CY IS 6DRIFT M \TW>D ) "T1 ? TRANSI5T D\# VI.N HELPS DEVELOP A M LA/+ B9OCUL> RESULT4 ,V]TICAL MUSCLE SURG]Y IS LESS -MON4 ,RESULTS >E LESS PREDICTA#1 & USU,Y ! AM.TS ( SURG]Y NE$$ >E RELATIVELY SMALL4 ,"O 9DIC,N IS 6REL1SE ! TID BETT]4 ,CORN1L ,TRANSPLANT ,! CORNEA IS ! ONLY "P (! EYE T C 2 TRANSPLANT$4 ,X IS AL UNUSUAL 9 T1 3TR>Y 6O!R TRANSPLANTA# ORGANS1 X IS N NEC TO CROSS-MAT* )! DONOR4 ,! DONOR IS USU,Y "S"O :O1 2F D1?1 AGRE$ 6DONATE _! EYES = ! USE ( _! CORN1S 6HELP "S"O REGA9 _! SIE TRANSPORT$ 9 RE- FRIG]AT$ /ORAGE1 (T5 0! HIE 2+ ------------------------------------#ADB DEVELOP$ 6MAKE ! DONOR & RECIPI5T GRAFT TISSUES MAT* M EXACTLY1 S Z 6GIVE BETT] VISUAL RESULT4 ,PO/OP]ATIVELY ! PATI5T M/ PROTECT ! EYE4 ,VI.N MAY 2 IMMLY IMPROV$1 DEP5D+ ON ! PREOP]ATIVE PRO#M1 B ! VISUAL RE- SULTS MAY N 2 FULLY RECOGNIZ$ = _M MON?S4 ,TOPICAL /]OID EYE DROPS MAY 2 NE$$ =A L;G "T 6AVOID REJEC;N OR FAILURE (! GRAFT4 ,A 3TACT L5S MAY 2 NE$$ 6GIVE ! BE/ VI.N AF A CORN1L TRANSPLANT4 ,! SUTURES MAY NE$ REMOVAL 9 /AGES4 ,IF ! #CDH GRAFT IS REJECT$1 X C 2 REPLAC$ A#ADB 0ANO!R TRANSPLANT4 ,! SU3ESS RATE IS HI<1 P]H #IJ P]C5T1 & NEW TE*NIQUES ( TREPH9,N & SUTUR+ >E 2+ UTILIZ$ 6GIVE EV5 BETT] RESULTS4 ,A CORN1L SPECIALI/ WD P]=M ! SURG]Y & 2 9VOLV$ 9 FOLL[-UP =A L;G "T4 ,H["E1 G5]AL EYE C>E W 2 REF]R$ BACK 6! PRIM>Y EYE DOCTOR4 ,ENUCLE,N ,"S"TS ! EYE 2COMES S SICK X NE$S 6BE REMOV$1 & ? IS CALL$ ENUCLE,N4 ,"S"TS ENUCLE,N IS 2C (A TUMOR S* Z A MELANOMA4 ,! ?"\ ( ? IS1 ( C\RSE1 Q DEPRESS+4 ,B "S"TS1 ! REMOVAL (! EYE IS PREF]A# = -=T OR COSMETIC R1SONS4 ,A BADLY 9JUR$ OR 41S$ EYE T5DS 6%R9K & 2COME ABNORMAL 9 APPE>.E4 ,Z A RULE1 IF AN EYE HAS NO SID4 ,%D ? HAPP5 9 *ILDHOOD1 X B#ADB WD CROSS & !N LAT] 9 ADULT LIFE DRIFT \TW>D4 ,9 A4I;N 6N 2+ /RAI GRAY IF ! CORNEA IS CL\D$ OR R$ IF X IS 9FLAM$ & PA9;L4 ,ONCE A DECI.N IS MADE 6REMOVE AN EYE1 "! IS R1SON = EXPECT,NS (A POSITIVE RE- SULT4 ,AN >TIFICIAL EYE IS LESS OBJEC;N- A# & C 2 MADE 6LOOK FAIRLY NORMAL4 ,! SIMPLE/ PROC$URE IS 6REMOVE ! EYE & PUT A PLA/IC BALL 9 ! SPACE LEFT EMPTY4 ,AN- O!R ME?OD1 CALL$ EVISC],N1 9VOLVES RE- MOV+ MO/1 B N ALL1 (! EYE1 & ? C GIVE GD MOTIL;Y (A PROS!SIS LAT]1 S9CE ! MUSCLES >E LEFT 9TACT4 ,REMOVAL (! EYE C 2 P]=M$ ) ORBITAL IMPLANT1 M1N+ T A PROS!TIC IM- PLANT IS PLAC$ 9 ! ORBITAL SPACE LEFT EMPTY 0EYE REMOVAL1 USU,Y ) ROT,N-CAUS+ MUSCLES 9TACT1 & GIV+ BETT] COSMETIC RE- SULT4 ,"! >E PROS!TICS T 9CLUDE FIX,N (! EX- TRAOCUL> MUSCLES S Z 6GIVE M NORMAL- APPE>+ MOVE;T (! PROS!SIS4 #CEJ ,ACTU,Y1 ! ORBITAL IMPLANT IS C#ADB BURI$ 2N ! 3JUNCTIVAL LAY]1 GIV+ A P9K LOOK 6! TISSUE4 ,! PROS!SIS IS !N FIT 96PLACE1 L A BIG 3TACT L5S1 OV] ! IM- PLANT4 ,MOVE;T (! ORBITAL IMPLANT TRANS- MITS FRIC;N 6! OV]LY+ PROS!SIS &1 DEP5D+ ON ! TYPE ( IMPLANT1 MAY GIVE RELATIVELY NORMAL ------------------------------------#ADC MOVE;T (! PROS!SIS4 ,! FITT+ (A PROS!SIS IS 0AN 8OCUL>I/10 & ? C 2 Q AN >T4 ,! COSMETIC RESULTS C 2 Q GD1 S T X MAY 2 DI6ICULT 6NOTICE IMP]FECT EYE APPE>.E OR V>I.E F MOVE;T (! O!R EYE4 ,EV5 IF IMP]- FECT1 ! APPE>.E ( AN >TIFICIAL EYE C 2 AN IMPROVE;T OV] A BL1 UNSIE1 B N 9SIGNIFICANT1 R1SON 6RE- MOVE AN EYE IS T IF A P5ETRAT+ W.D 96! EYE 9VOLVES UV1L TISSUE 7! IRIS1 CILI>Y BODY1 OR *OROID71 !N "! MAY DEVELOP AN UNUSUAL =M ( UVEITIS1 CALL$ SYMPA!TIC OPH?ALMIA4 ,= R1SONS YET UN"KN1 ! 9FLAM- M,N 9 ! 9JUR$ EYE MAY SPR1D 69VOLVE ! UN9JUR$ EYE1 ) 4A/R\S POT5TIAL E6ECTS1 & IS AN 9DIC,N 6REMOVE ! EYE AT ! #CEA "T ( 9JURY IF RECOGNIZ$ T DAMAGE A#ADC 6! EYE IS S SEV]E Z 6RAISE ? PROSPECT4 #CEB ,,"P ,V #ADD-ADG ,,3SUM] ,,9=M,N #AH ,DEF9I;NS ( ,C>EGIV]S ,IF Y NE$ ADVICE1 Y C (T5 DEP5D ON REC- OMM5D,NS ( FRS OR YR PRIM>Y PHYSICIAN4 ,:E!R Y %D G 6AN OPTOMETRI/ OR AN OPH- ?ALMOLOGI/ MIE "S DEF9I;NS3 ,C>EGIV]S ,OPH?ALMOLOGI/ ,AN OPH?ALMOLOGI/ IS A DOCTOR ( M$IC9E 7,,MD71 A PHYSICIAN :O -PLET$ A PREM$ DEGREE ( USU,Y F\R YE>S1 F\R YE>S ( M$I- CAL S*OOL1 AN 9T]N%IP YE>1 & ?REE OR F\R YE>S ( SPECIALIZ$ TRA9+ 9 OPH?ALMOLOGY1 CALL$ A RESID5CY4 ,? TOTALS TWELVE OR ?IRTE5 YE>S ( TRA9+1 & AL REQUIRES /ATE LIC5SURE 6PRACTICE M$IC9E4 #CEC ,OPH?ALMOLOGI/S SPECIALIZE 9 A#ADG TR1T+ ALL =MS ( EYE 41SE1 M$ICAL OR SUR- GICAL1 ANY?+ F PRESCRIB+ GLASSES1 TR1T+ 8P9K EYE10 OR P]=M+ SURG]Y S* Z REPAIR+ 9JUR$ EYES1 OR CAT>ACTS4 ,^U -PLE;N ( SATISFACTORY TRA9+1 OPH?ALMOLOGI/S >E C]TIFI$ 0! ,BO>D ( ,OPH?ALMOLOGY1 HAV+ -PLET$ SU3ESS;LLY WRITT5 & ORAL TE/+4 ,REC]TIFIC,N IS N[ REQUIR$1 HELP+ 6AS- SURE T PRACTIC+ OPH?ALMOLOGI/S >E CURR5T 9 9=M,N4 ,_M HOSPITALS REQUIRE BO>D C]- TIFIC,N 9 ORD] 6RCV SURGICAL PRIVILEGES4 ,^?1 L MYF1 >E CALL$ G5]AL OPH?ALMOLO- GI/S4 ,:5 ,I F/ PRACTIC$1 T M1NT T WE DID "EY?+1 9CLUD+ ALL K9DS ( SURG]Y1 F RET9AL DETA*;T 6/RABISMUS1 & PLA/IC PRO- C$URES S* Z BLEPH>OPLA/Y1 GLAUCOMA SUR- G]Y1 & S ON4 ,M REC5TLY1 SUBSPECIALTIES1 REQUIR+ AN A4I;NAL "O 6?REE YE>S ( A4I- ;NAL TRA9+ H EVOLV$4 ,^! 9CLUDE P$IAT- RIC1 RET9AL1 CORN1L & EXT]NAL 41SE1 NEURO-OPH?ALMIC1 GLAUCOMA1 ------------------------------------#ADH OCULOPLA/IC1 & N[ REFRACTIVE SURG]Y SUB- SPECIALTIES4 ,G5]AL #CED OPH?ALMOLOGI/S 3T9UE 6TR1T ALL A#ADH EYE 3DI;NS1 B SURGIC,Y MA9LY OP]ATE ON CAT>ACTS4 ,L1D]%IP IS VIA ! ,AM]ICAN ,ACADEMY ( ,OPH?ALMOLOGY1 : HAS SU7E/$ T OPH?ALMOLOGI/S REF] 6!MVS Z ,EYE ,,MD,'S1 S Z 6AVOID 3FU.N ) OPTOMETRI/S4 ,3FU.N AB ! 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TR1T;T ( _M EYE 41SES S* Z 3JUNCTIVITIS 7P9K EYE71 =EIGN BODIES1 & EV5 GLAUCOMA4 ,MO/ RE- C5TLY1 ORGANIZ$ OPTOMETRY HAS ?R1T5$ TO DEM& P]MIS.N 6P]=M EYE SURG]Y AL4 ,C]TA9 /ATES1 S* Z ,OKLAHOMA & ,NEW ,MEXICO1 H 3SID]$ APPROV+ ?1 ?\< ! ACTUAL PRACTICE ( SURG]Y 0OPTOMETRI/S SEEMS ILLOGICAL4 ,LAS] SURG]Y IS AN >EA ( 9T]E/ 2C X IS ESS5TI,Y N H&S-ON CUTT+ SURG]Y1 "S?+ = : !Y WD 2 POORLY TRA9$ 7CAT>ACT SURG]Y1 = EXAMPLE74 ,! SCOPE ( PRACTICE 7PRIVILEG- ES7 = OPTOMETRI/S IS DET]M9$ 0/ATE LEG- ISLATURES1 N A BO>D ( M$IC9E4 ,? IS SIM- IL> 6*IROPRACTORS & PODIATRI/S1 ^: SCOPE ( PRACTICE IS AL DET]M9$ 0/ATE LEGISLA- TURES4 ,= ? R1SON1 "S /ATES GRANT M PRIVILEGES ?AN O!RS1 &! SCOPE ( PRACTICE V>IES AM;G OPTOMETRI/S ( DI6]5T /ATES1 M1N+ T ! AU?ORIZ,N 6TR1T GLAUCOMA #CEF OR O!R 41SES IS N /&>DIZ$4 ,9 C#ADH G5]AL1 OPTOMETRY TRA9+ IS PROGRESSIVELY BETT] & -PREH5SIVE4 ,"S S*OOLS TRA9 _! /UD5TS 6BE A# 63=M 6! OPTOMETRY SCOPE ( PRACTICE LEVELS ( ANY /ATE 9 ! C.TRY4 ,OPTICIAN ,? P]SON IS LIC5S$ 64P5SE & FIT GLASS- ES1 UTILIZ+ A PRESCRIP;N F AN OPTOMETRI/ OR AN OPH?ALMOLOGI/4 ,TRA9+ RESULTS F A "O 6TWO YE> OPTICION>Y DEGREE1 OR A TWO- YE> APPR5TICE%IP4 ,/ATE LIC5SURE IS RE- QUIR$ 9 TW5TY-"O /ATES1 & REC]TIFIC,N VIA ! ,AM]ICAN ,BO>D ( ,OPTICIANRY IS E ?REE YE>S4 ,= P]=M+ 3TACT L5S FITT+1 A SPECIAL ------------------------------------#ADI LIC5SE IS REQUIR$4 ,OPTICIANS "W 9 AN OPTICAL %OP1 : MAY 2 FREE/&+1 B M -MONLY [N$ 0EMPLOY+ OPTOMETRI/S1 OPH?ALMOLO- GI/S1 OR *A9 OPTICAL %OPS1 S* Z ,PE>LE ,VI.N OR ,L5S ,CRAFT]S4 ,FREE/&+ OPTICAL %OPS >E N[ R>E1 S9CE X 2CAME NEC = MO/ OPH?ALMOLOGI/S 64P5SE GLASSES 9 _! (FIC- ES4 ,*A9 OPTICAL %OPS & RETAIL #CEG /ORES AL EMPLOY OPTOMETRI/S1 S* A#ADI Z ,WAL-,M>T1 ,SE>S1 OR ,CO/CO4 ,3TACT L5SES >E (T5 FIT 9 *A9 OPTICAL %OPS1 & PRICES =! REPLACE;T ( S(T 3TACT L5SES >E (T5 L[ 5 6ATTRACT PATI5T PRESCRIP;NS OB- TA9A# F _! EYE DOCTOR4 ,OPTICIANS TAKE A SPECTACLE PRESCRIP- ;N1 M1SURE ! NE$$ C5TR,N ( L5SES1 DEP5D+ ON ! 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PRESCRIP;N & SEE+ @+#B.EJ ADD MAY ?9K T ! DRUG /ORE APPROPRIATE GLASSES WD 2 A @+#B.EJ4 ,ACTU,Y1 "O M/ TAKE 96A3.T ! A/IGMATISM1 & AL ! SPH]E4 ,= EXAMPLE1 A P]SON #A DIOPT] NE>SIE4 ,H[- C#ADI "E1 OR?OPTI/S >E N ^? :O CLAIM 6BE A# TO HELP AVOID ! NE$ = GLASSES 0EX]CISES1 Z ADV]TIS$ "S"TS OV] ! RADIO4 ,!Y "W USU,Y ) AN OPH?ALMOLOGI/ 9 /RABISMUS MANAGE;T4 ,_! *IEF !RAPEUTIC SU3ESS ) EX]CISES IS )! 3DI;N CALL$ 3V]G;E 9SU6ICI5CY1 PRO#MS ) BR++ ! EYES TGR = R1D+4 ------------------------------------#AEJ ,OCUL>I/ ,? SPECIALI/ FITS >TIFICIAL EYES & C 2 Q SKILL$4 ,ONCE ! PROS!SIS IS FITT$1 HE OR %E NE$S 6BE 3SULT$ = FOLL[-UP CL1N+ & ALT],NS R\T9ELY4 ,OPH?ALMIC ,TE*NICIAN ,^! C]TIFI$ TRA9$ TE*NICIANS ASSI/ AN OPH?ALMOLOGI/ 9 EXAM9,NS & TR1T;TS 9 ! DOCTOR'S (FICE4 ,9 "S /ATES1 !Y APP>5TLY C WRITE A PRESCRIP;N = GLASSES1 Z A PHY- SICIAN ASSI/ANT4 ,9 O!R /ATES1 OPTOME- TRI/S H LEGISLAT$ REDUC$ PRIVILEGES = S* ASSI/ANTS4 #CFJ ,OPTOMETRIC ,TE*NICIAN A#AEJ ,^! TE*NICIANS >E TRA9$ 6ASSI/ AN OP- TOMETRI/ 9 EXAM9,NS & TR1T;TS ( EYE 41SE & >E USU,Y C]TIFI$ FOLL[+ APPROPRIATE TRA9+4 ,) ^! DEF9$ ROLES1 !N X %D 2 SIMPLE TO ANSW] "QS ( ": 6G = EYE C>E1 B X IS N ALW S4 ,ALL ^! PROFES.NALS >E DESIGN$ TO "W TGR1 & USU,Y D1 B "! IS A NONPUBLI- CIZ$ W> GO+ ON 2T ORGANIZ$ OPTOMETRY & ORGANIZ$ OPH?ALMOLOGY4 ,X'S A TURF W>1 & AB M"OY & P[]1 L MO/ W>S4 ,ACTU,Y1 ? IS NO L;G] S* A SECRET4 ,SEE ! ,JANU>Y #CA ISSUE ( ..,U4,S4 ,NEWS & ,_W .,REPORT 4CUSS+ NONPHYSICIAN CL9ICIANS4 ,AL DIS- CUSS$ 9 ? ISSUE >E O!R NONPHYSICIAN CLI- NICIANS1 S* Z PHYSICIAN ASSI/ANTS1 NURSE PRACTI;N]S1 ORAL SURGEONS1 PODIATRI/S1 PSY*OLOGI/S1 & *IROPRACTORS4 ,AL;G ) OP- TOMETRI/S1 ! *ANG+ ROLE ( ^! CL9ICIANS RELATIVE 6! ROLE (! PHYSICIAN IS 4CUSS$4 ,H["E1 "! IS NO "Q T ! QUALIFI$ ROLE (! OPTOMETRI/ 9 HELP+ OPH?ALMOLOGI/S 9 EYE C>E IS UNEQUAL$ 0O!R #CFA 8NONPHYSICIAN CL9ICIANS40 B#AEJ ,BACK 9 ! "TS :5 _! FUNC;NS 7 LIMIT$ 6PRESCRIB+ GLASSES & 3TACT L5SES1 OPTOM- ETRI/S 7 QK 6REF] _! PATI5TS 6OPH?ALMOL- OGI/S = EYE 41SE4 ,YE>S AGO OPH?ALMOLO- GI/S DID N 4P5SE GLASSES2 X 0 3SID]$ UN- E?ICAL1 S !Y PRESCRIB$ GLASSES 6BE 4P5S$ 0OPTICAL %OPS4 ,LAT]1 X 2CAME DESIRA#1 & EV5TU,Y REQUIR$ = OPH?ALMOLOGI/S 64P5SE GLASSES4 ,9 ! M1N"T1 PATI5TS REF]R$ 6AN OPH?ALMOLOGI/ (T5 DID N RETURN 6! REF]R+ OPTOMETRI/1 & /AY$ 9 ! C>E (! OPH?ALMOL- OGI/1 = GLASSES TOO4 ,LOSS ( PATI5TS1 ( C\RSE1 MADE OPTOMETRI/S LESS 9T]E/$ 9 REF]R+ PATI5TS 6OPH?ALMOLOGI/S4 ,OPTOME- TRY S*OOLS 2GAN 6EMPHASIZE TR1T;T ( OCU- L> 41SES1 & LEGISLATORS 7 SU3ESS;LLY RE- CRUIT$ 6VOTE 9CR1S$ !RAPEUTIC PRIVILEGES = OPTOMETRI/S 9 ALL /ATES1 "O 0"O1 B SELDOM ! SAME PRIVILEGES4 ,A CURR5T >EA ( 3FLICT 2T ! TWO GR\PS ( EYE DOCTORS IS ! ISSUE ( 8COMANAGE;T40 ,9 ! CASE ( CAT>ACT SURG]Y1 REF]R+ OP- TOMETRI/S H 9SI/$ ^U1 OR H BE5 (F]$ Z 9DUCE;T = REF]RAL1 ! APPROVAL ( #CFB ! OP]AT+ SURGEON = DELEG,N ( PO/- #AEA OP]ATIVE MANAGE;T ( CAT>ACT PATI5TS 0! REF]R+ DOCTOR4 ,9 "S CASES1 ? 0 JU/IFI$ 0ALL[+ ! 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POR;N = M1SUR+ ! VI.N1 ! 8REFRAC;N10 IS N COV]$4 ,? IS 2C ,M$IC>E LOOKS AT ? "P (! EXAM Z J = "S"O WANT+ A NEW PAIR ( GLASSES1 & DOES N RECOGNIZE T A DIAGNO- SIS ( EYE 41SE1 OR ! SEV];Y1 _C 2 M1SUR$ )\T M1SUR+ VI.N4 ,"!=E1 ! ,M$IC>E PATI5T ) CAT>ACTS OR O!R EYE PRO#M IS *>G$ A C>VE-\ FEE =! 8REFRAC;N40 ,? IS #CHA DI6ICULT = PATI5TS 6"U/&1 = GD B#AEH R1SON4 ,H1L? MA9T5.E ORGANIZ,NS 7,,HMO,'S7 H PROVID$ A SOLU;N4 ,MO/ ( ^! H1L? PLANS D 9CLUDE COV]AGE = EYE EXAM9,NS1 & "S"TS GLASSES1 Z "P (A S5IOR PLAN4 ,M$IC,NS C AL 2 9CLUD$ 6A DEGREE4 ,H["E1 9 ^! PLANS1 A PATI5T IS LIMIT$ 6! SELEC;N (A DOCTOR F ^? AVAILA# 9 ! ,,HMO1 & NO L;G] HAS 3TROL ( _! ,M$IC>E B5EFITS4 ,! EYE DOCTOR AL WD H 6BE ON ! ,,HMO,'-APPROV$ LI/4 ,M$ICAID PATI5TS USU,Y D H EYE C>E COV]AGE4 ,AN EYE EXAM9,N MAY 2 COV]$ = YE>LY OR E-O!R-YE> -PREH5SIVE EXAM9,N4 ,GLASSES MAY AL 2 A B5EFIT1 B RE/RICT$ 6E TWO YE>S OR L;G]1 AL;G ------------------------------------#AEI ) EVID;E ( *ANGE ( PRESCRIP;N4 ,AM;G ! PRO#MS1 H["E1 IS ! FACT T N ALL DOCTORS1 9CLUD+ EYE DOCTORS1 W A3EPT ,M$ICAID PA- TI5TS1 2C (! V L[ FEES PROVID$4 ,"! >E ONLY A FEW DESIGNAT$ OPTICAL %OPS T C A3EPT ,M$ICAID GLASSES PRESCRIP;NS4 ,H1L? B5EFITS1 9CLUD+ SURG]Y1 #CHB >E COV]$ 0,M$IC>E1 ,,HMO,'S1 A#AEI ,G5]AL ,9SUR.E1 OR ,M$ICAID4 ,M$IC>E USU,Y 3TROLS ! A3EPTA# FEE1 ,"P ;,A =! HOSPITAL FEE & ,"P ;,B =! PHYSICIAN FEE4 ,= EXAMPLE1 IF A USUAL & CU/OM>Y DOC- TOR'S FEE IS 4#B1JJJ1 ,M$IC>E MAY1 = EX- AMPLE1 ONLY RECOGNIZE 4#HJJ Z A3EPTA#1 & !N PAY ONLY #HJ P]C5T ( 4#HJJ1 OR 4#FDJ4 ,A SECOND>Y 9SUR.E WD !N D LIKEWISE3 RECOGNIZE ONLY ! 4#HJJ FEE1 & !N PAY ! #BJ P]C5T N PD 0,M$IC>E1 4#AFJ4 ,,HMO,'S PAY _! "PICIPANTS EV5 LESS ON ! ,M$IC>E DOLL>1 & !N1 ( C\RSE1 ,M$ICAID PAYS M* LESS YET4 ,?\< ? MAY S.D UNFAIR1 & DOC- TORS ?9K S1 !Y >E B.D 6A3EPT ^! FEES 9 FULL PAY;T4 ,! REC5T EXCEP;N1 Z M5;N$1 IS 9 8PRESBYOPIA SURG]Y40 ,! 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PRACTICE1 ORIG9AT$ 9 ,9DIA1 AM.T$ 6US+ A %>P /ICK 6P5ETRATE ! CORNEA1 & PU% A D5SE CAT>ACT BACK 96! VITRE\S S Z 6UNBLOCK ! PUPIL TO ALL[ "S VI.N4 ,AC 6,DR4 ,FR$ ,BLODI1 MY M5TOR AT ! ,UNIV]S;Y ( ,I[A1 C\*+ ( CAT>ACTS 0 ! PROC$URE ( *OICE = #B1JJJ YE>S1 SPR1D+ F ,9DIA 6! ,WE/]N _W4 ,X 0 P]=M$ 0TRAVEL+ B>B]S1 S9CE TRUE M$ICAL SURGEONS FELT X 2N _! DIGN;Y4 ,AN 9CI.NAL APPROA* 0 IN- TRODUC$ 9 #AGEJ 0,DR4 ,DAVIEL1 B #CHE ! -PLIC,N RATE 0 S HI< T C\*+ A#AFJ 3T9U$ UNTIL >.D #AHJJ1 :5 ,VON ,GRAEFE P]FECT$ A BETT] 9CI.NAL APPROA*4 ,CAT>ACT SURG]Y PROGRESS$ 6! USE ( %>P KNIVES 6MAKE AN 9CI.N 9 ! UPP] CORNEA1 L>GE 5 6PU% \ ! CAT>ACT\S L5S F 2H ! PU- PIL1 P] ,VON ,GRAEFE4 ,0? "T SPECTACLES 2CAME AVAILA# 6IMPROVE VI.N4 ,PO/OP]A- TIVE C>E1 H["E1 AM.T$ 6EXTREME LIMIT,N ( ACTIV;Y 6ALL[ ! W.D 6H1L4 ,5=C$ B$ RE/ ) S& BAGS ON EA* SIDE (! H1D 0 NEC = WEEKS4 ,PO/OP]ATIVE ACTIV;Y IMPROV$ )! 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S]VICES ( AN ANES!SIOLOGI/ >E UTILIZ$1 9CORPORAT+ M$IC,NS T MAKE A PATI5T N ONLY PA9 FREE B AMNESIC & COOP- ]ATIVE DUR+ ! \TPATI5T SURG]Y4 ,HOSPITALIZ,N (A CAT>ACT PATI5T 9 ! #AIEJ;S 0 USU,Y = F\R 6FIVE "DS1 6MAKE SURE ! PATI5T 0 ALL "R 6RETURN HOME4 ,"S"TS1 S9CE ! O!R EYE 0 AL USU,Y R1DY = SURG]Y1 ! SECOND CAT>ACT 0 AL REMOV$1 RESULT+ 9 ONLY A BIT L;G] HOSPITALIZ,N4 ,9 ! #AIGJ;S A TR5D = \TPATI5T #CHG SURG]Y = CAT>ACT PATI5TS 0 9ITI- B#AFA AT$ 0OPH?ALMOLOGI/S1 & ? SOON 2CAME ! PREF]R$ R\T9E4 ,X 0 N L;G 2F ,M$IC>E IN- SI/$ ON ONLY \TPATI5T CAT>ACT SURG]Y1 Z IF X 0 _! IDEA 9 ! F/ PLACE4 ,"O ADVAN- TAGE ( \TPATI5T SURG]Y IS T ON ! F/ "D FOLL[+ SURG]Y1 A PATI5T IS EXAM9$ 9 ! (- FICE1 &A M* BETT] EVALU,N ( AN E>LY RE- SULT IS POSSI# ?AN AT A HOSPITAL B$SIDE4 ,!N A REN[N$ OPH?ALMOLOGI/ 9V5T$ ANO!R 8/ICK0 6PUT 96! EYE 6REMOVE ! CAT>ACT4 ,DR4 ,*>LES ,KELMAN 9V5T$ ! PHACOEMULSI- FI]1 "S"TS 3FUS$ )A LAS]1 B ACTU,Y AN ULTRAS.D TE*NIQUE = BR1K+ UP ! CAT>ACT\S L5S & SUCK+ X \ 7ASPIR,N74 ,? 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T]M OPTOME- TRI/ 0 ADOPT$ 9 #AIJD1 M1N+ 8"O :O M1S- URES OPTICS40 ,MY "F 0 AN OPTOMETRI/1 TRA9$ AT ! ,ILL9OIS ,COLLEGE ( ,OPTOMETRY 9 ! #AICJ;S4 ,HE 0 AN 8E?ICAL0 OPTOMETRI/ & REQUIR$ 6BE S Z A MEMB] (! ,I[A ,/ATE ,OPTOMETRY ,ASSOCI,N4 ,? M1NT T HE CD N ADV]TISE O!R ?AN PUT 8 "N & PROFES.N 9 ! NEWSPAP] OR PH"O BOOK1 NO ADV]TIS+ ( ANY SPECIAL D1LS1 ETC4 ,MY UNCLE1 AL AN ,I[A OPTOMETRI/1 0 CRITICIZ$ = 2COM+ EMPLOY$ 0,SE>S & =M+ AN OPTICAL %OP "!4 ,SUBSE- QU5TLY1 Z A RESULT1 8 MEMB]%IP 9 ! /ATE OPTOMETRY ASSOCI,N 0 9 JEOP>DY4 #CID ,EV5TU,Y1 ADV]TIS+ AM;G OPTOME- C#AFC TRI/S 2CAME NEC1 ESPECI,Y :5 *A9 OPTICAL %OPS APPE>$1 : 7 AL EV5TU,Y A# 6EMPLOY OPTOMETRI/S4 ,MY "F DID N *>GE = AN EYE EXAM9,N1 8 F9ANCIAL REW>D 2+ 9 ! GLASSES HE PRE- SCRIB$ & 4P5S$4 ,H["E1 X 0 A GIV5 T A RECOMM5D$ PAIR ( EYEGLASSES WD 2 ! RE- SULT ( ALL ( 8 EXAM9,NS4 ,FEES = AN OP- TOMETRIC EYE EXAM9,N 2CAME A R\T9E AB ! "T T ,M$IC>E 5T]$ ! PICTURE4 ,AL1 3TACT L5SES >RIV$ 9 ! #AIFJ;S4 ------------------------------------#AFD ,IF ! PROFES.N 0 9 TR\#1 Z "S PREDICT- $1 ! >RIVAL ( CORN1L 3TACT L5SES REVIV$ & 5]GIZ$ ! FIELD ( OPTOMETRY4 ,OPTOME- TRI/S 2CAME SPECIALI/S 9 3TACT L5S FIT- T+1 ":AS OPH?ALMOLOGI/S 7 SL[ 6EMBRACE ? M1NS ( TR1T;T 96_! PRACTICES4 ,EMBOLD5$ 0SU3ESS1 &= BUSI;S R1SONS1 ORGANIZ$ OP- TOMETRY PRESS$ = M PRIVILEGES1 F/ ) DI- AGNO/IC PH>MACEUTICAL AG5TS 7,,DPA,'S74 ,? ALL[$ ! USE ( TOPICAL ANES!TIC EYE DROPS1 = EXAMPLE1 = USE 9 TE/+ = GLAU- -A ) 9TRAOCUL> PRESSURE M1SURE;T4 #CIE ,AL 9VOLV$ 7 DILAT+ DROPS & CY- A#AFD CLOPLEGIC DROPS = EXAM9,N ADVANTAGE VIA A L>GE PUPIL4 ,PRIOR 6T "T1 "O WAY ( DI6]5TIAT+ 2T AN OPH?ALMOLOGI/ & AN OP- TOMETRI/ 0 :E!R Y _H YR EYES DILAT$ DUR+ ! EXAM4 ,LAT]1 5C\RAG$ 0! RESULTS ( 9FLU5C+ /ATE LEGISLATURES1 ORGANIZ$ OPTOMETRY PU%$ = !RAPEUTIC PH>MACEUTICAL AG5TS 7,,TPA,'S74 ,S9CE ! SCOPE ( PRACTICE ( OPTOMETRI/S1 L S* Z *IROPRACTORS & PODI- ATRI/S1 IS DET]M9$ 9 MO/ /ATES 0! /ATE LEGISLATURE1 X HAS BE5 M NEC 63V9CE A LEGISLATOR ?AN A M$ICAL 3TROL BO>D Z 6! QUALIFIC,NS 6EXP& ! SCOPE ( PRACTICE = OPTOMETRY4 ,:ILE ADMITT$LY ORGANIZ$ OPH- ?ALMOLOGY RECOGNIZ$ PRO#MS POT5TIAL 6S* EXPAN.N 6,,TPA,'S = OPTOMETRY1 X 2CAME N A MATT] ( DEBATE OR -MON S5SE1 B R A BATTLE ( POLITICAL MANIPUL,N1 &! OPTOME- TRY ORGANIZ,NS SEEM$ BETT] AT ?4 ,Z A RESULT1 OPTOMETRI/S H BE5 GRANT$ !RAPEUTIC PRIVILEGES ( V>I\S DEGREE1 DE- P5D+ ON ! /ATE 9VOLV$4 ,9 "S /ATES1 ! TR1T;T ( GLAUCOMA IS ALL[$1 ) _M #CIF OR MO/ (! AVAILA# TOPICAL EYE B#AFD DROP M$IC,NS P]MITT$4 ,9 O!R /ATES1 A M RE/RICTIVE USE ( M$IC,NS = GLAUCOMA & O!R LIMIT,NS MAY 2 5C.T]$4 ,! MA9 PRO#M1 O!R ?AN GRANT+ S* PRIVILEGES 9 G5]AL1 IS T ! TR1T;T & PRESCRIB+ PR9CIPLES V>Y P] /ATE4 ,9T]AC;N ( ,OPH?ALMOLOGY & ,OPTOMETRY ,S ! ROLES ( OPH?ALMOLOGI/S & OPTOME- TRI/S H *ANG$ "? ! YE>S1 &! NE$ = COOP]- ,N SEEMS OBVI\S4 ,OPH?ALMOLOGI/S NE$ HELP 9 PROVID+ NEC EYE C>E1 &! ANSW] DOES N M1N PROVID+ M OPH?ALMOLOGI/S4 ,! ANSW] 9VOLVES BETT] USE ( OPTOMETRI/S 9 COORD9,N ) OPH?ALMOLOGI/S4 ,! ANSW] AL DOES N1 ,I 2LIEVE1 LIE 9 ! ATTEMPT 6MAKE AN OPTOMETRI/ ! EQUAL ( AN OPH?ALMOLO- GI/4 ,ADMITT$LY "! IS A TURF W> 2T OPTOME- TRY & OPH?ALMOLOGY4 ,? IS N SECRET1 Z X 0 M5;N$ 9 ! ,SEPTEMB] ISSUE (! ..,U4,S4 ,NEWS & .,REPORT1 "U ! SUBJECT ( #CIG P>AM$ICAL 9FLU;E ON ! PRACTICE ( C#AFD M$IC9E4 ,ORGANIZ$ OPTOMETRY IS ?R1T5+ DO+ EYE SURG]Y1 ) /ATE APPROVAL1 & NATU- R,Y ? HAS ORGANIZ$ OPH?ALMOLOGY V UPSET4 ,? IS 2C X IS S TOT,Y RIDICUL\S4 ,": WD ! OPTOMETRI/ :O HAS N 2COME A M$ICAL DOCTOR LE>N 6D SURG]Y8 ,:O WD 9SURE S* A P]SON8 ,"P (! 5C\RAGE;T MAY 2 9 REG>D TO LAS] SURG]Y1 S9CE X N[ HAS 2COME ------------------------------------#AFE POSSI# 6P]=M A LASIK OP],N )\T ANY SUR- GICAL 7USE (A CUTT+ KNIFE7 9T]V5;N4 ,! LAS] C CR1TE ! CORN1L FLAP & !N -PLETE ! PROC$URE4 ,"S MID 6? LOOP- HOLE 96! PRACTICE ( OPH?ALMOLOGY MAY 2 NAIVE 9 ?9K+ T X IS EASY4 ,!N "! IS ! "Q AB ! LAS] & LASIK MANUFACTUR+ -PANIES & _! ROLES 9 5C\RAG+ OPTOMETRI/S AL;G ^! L9ES4 ,:AT SEEMS 6"W BE/ IS ! COOP],N ( OPH- ?ALMOLOGI/S & OPTOMETRI/S 9 ! SAME (- FICE4 ,"U ^! CIRCUM/.ES1 ! TRUE VALUE & EXP]TISE ( AN OPTOMETRI/ 9 EYE C>E C 2 BE/ UTILIZ$4 ,"S OPH?ALMOLOGI/S1 #CIH = POLITICAL OR O!R R1SONS1 H A#AFE UTILIZ$ OPH?ALMIC TE*NICIANS 9 (FICE C>E ( PATI5TS4 ,^! TE*NICIANS C 2 ( GRT HELP1 & >E TRA9$ )! HELP (! ,ACADEMY ( ,OPH?ALMOLOGY1 B >E N (! SAME VALUE 9 PRACTICE Z AN OPTOMETRI/4 ,2C ( TRA9+1 AN OPTOMETRI/ C 2 ( USE 9 SCRE5+ NEW PA- TI5TS = PA?OLOGY1 & C 2 GIV5 RESPONSI- BILITIES 9 ! ABS;E (! OPH?ALMOLOGI/ F> 2Y T : %D 2 DELEGAT$ 6A TE*NICIAN4 ,? BR+S UP ! SUBJECT ( TRA9+ ( G5]AL DOCTORS & _! ASSI/ANTS4 ,YE>S AGO1 M$I- CAL S*OOL TRA9+ 0 FAIRLY UNIV]SAL 9 ! ,UNIT$ ,/ATES4 ,"EY"O _H BASIC,Y ! SAME CURRICULUM4 ,! F/ TWO YE>S 7 BASIC SCI- ;ES1 DUR+ : NONCL9ICAL PHYSICIAN 9/RUC- TORS SEEM$ 6D _! BE/ 6FLUNK \ M$ICAL /U- D5TS4 ,! LA/ TWO YE>S 7 ! CL9ICAL YE>S1 DUR+ : ROT,N 6V>I\S SPECIALTY S]VICES TOOK PLACE4 ,EV5TU,Y1 FAMILY PRACTICE 2CAME "O ( ^! FIELDS4 ,OPH?ALMOLOGY LEC- TURES 7 -MONLY GIV5 9 A BASIC DEGREE1 &A ROT,N "? ! OPH?ALMOLOGY DE"P;T 0 AN OP- ;N4 ,M REC5TLY1 TR5DS 9 M$ICAL #CII S*OOL TRA9+ H 5C\RAG$ E>LY DEC- B#AFE L>,N Z 6! EXPECT$ F9AL 9T5T Z F> Z ! TYPE ( PRACTICE A /UD5T PLANS4 ,? AS- SUMES1 ( C\RSE1 T S* /UD5TS H "S 9SI5TLY MODIFI$ _! CURRICULUM S* T X 0 LESS PREDICTA# Z 6! F9AL RESULT 7G5]AL $UC,N7 ^U GRADU,N4 ,OPH?ALMOLOGY1 Z A SUBJECT1 0 USU,Y N R\T9ELY COV]$1 EV5 9 M9OR DETAIL4 ,! RESULT IS T M$ICAL DOCTORS "K V LL AB ! EYE4 ,? BOOK1 = EX- AMPLE1 IS M1NT = !M Z M* Z =! G5]AL PUB- LIC4 ,FOLL[+ M$ICAL S*OOL IS ! 9T]N%IP4 ,A ROTAT+ 9T]N%IP 0 ! RULE1 M1N+ T1 L 9 M$- ICAL S*OOL1 A BROAD EXP]I;E 0 OBTA9$ 9 TR1T+ PATI5TS = ALL MANN]S ( PRO#MS DUR+ ? YE>1 F DELIV]+ BABIES 6"W+ 9 ! EM]G5CY ROOM4 ,AL;G )! *ANGES 9 M$ICAL CURRICU- LA1 X HAS 2COME R\T9E 6REPLACE ! ROTAT+ 9T]N%IP )A M SPECIALIZ$ "O4 ,= EXAMPLE1 IF Y 9T5D 62COME A SURGEON1 Y MAY ROTATE "? ANES!SIA & SURGICAL SUBSPECIALTIES 7A LA ! ,,TV %[ 8,GRAY'S ,ANATOMY071 #DJJ B N ANY NONSURGICAL FIELDS4 ,A C#AFE POT5TIAL OPH?ALMOLOGI/ WD SP5D M* (! YE> 9 ! OPH?ALMOLOGY DE"P;T1 TRY+ 6QUALIFY = A RESID5CY1 IF N ALR A3EPT$4 ------------------------------------#AFF ,! 5D RESULT HAS BE5 T ! NEW] ,,MD,'S "K EV5 LESS AB ! EYES ?AN =M] DOCTORS4 ,N"E!.S1 G5]AL PHYSICIANS 9 ,,HMO,'S >E (T5 PLAC$ 9 A SCRE5+ GATEKEEP] ROLE1 )! RESPONSIBIL;Y 6TR1T M9OR EYE PRO#MS IF POSSI#1 & LIMIT REF]RALS 6AN OPH?ALMOLO- GI/ UN.S NEC4 ,9 ! M1N"T1 "? NE$1 ! EM]- G5CY ROOM SPECIALTY PHYSICIANS H 2COME ACTU,Y BETT] 9 DIAGNOS+ & TR1T+ EYE DIS- EASE1 )9 LIMITS4 ,CURR5T TR5DS 9 M$IC9E H 9VOLV$ M$ICAL ASSI/ANTS 6AN 9CR1S+ DEGREE4 ,NURSE PRACTI;N]S OBTA9 A MA/]S DEGREE1 & >E ALL[$ 6TR1T PATI5TS1 ) OR )\T SUP]VI.N ( A M$ICAL DOCTOR4 ,PHYSICIAN ASSI/ANTS "W ) DOCTORS 9 V>Y+ LEVELS1 "S"TS A# 6EXAM- 9E1 TR1T1 & PRESCRIBE4 ,NEI ( ^! GR\PS IS A# 6HELP 9 EYE C>E 6! DEGREE ( AN OP- TOMETRI/1 ^: TRA9+ IS USU,Y 9 EXCESS ( EV5 ! G5]AL PHYSICIAN 9 ! ABIL;Y #DJA 6RECOGNIZE1 TR1T1 & DET]M9E ! A#AFF A4I;NAL NE$ = TR1T;T 0AN OPH?ALMOLOGI/4 ,:AT IS NE$$ IS N 65C\RAGE OPTOMETRI/S 6-PETE ) OPH?ALMOLOGI/S1 B ! POT5TIAL ( BETT] COOP],N )9 ! TWO GR\PS4 ,! POT5- TIAL = 9VOLVE;T 9 EYE C>E C 2 2Y EV5 ! WILDE/ DR1MS ( OPTOMETRI/S1 B ONLY 9 CO- OP],N ) OPH?ALMOLOGI/S :O C BETT] TRA9 !M 6BE E6ECTIVE4 ,"! W 2 D\BT]S Z 6:E!R S* COOP],N IS POSSI#1 L MY OPTOMETRI/ "F1 :O DI$ ) ,ALZHEIM]'S A FEW YE>S AGO4 ,9 P]H MY LA/ 3V]S,N ) HM AT 8 C>E FACIL;Y1 ,I TOLD HM T ,I 0 "W+ ON A WAY = OPTOME- TRI/S & OPH?ALMOLOGI/S 6BETT] GET AL;G4 ,9 "O ( 8 R>E COG5T MO;TS1 HE SD 8,T W 2 ! "D40 ,! ,WAY ,?+S ,C ,2 7,Z ,I ,SEE ,X7 ,"! >E LIKELY *ANGES 6BE EXPECT$ 9 ! PROVI.N ( OPH?ALMIC C>E4 ,! TR5D 6SUB- SPECIALIZ,N IS LIKELY 63T9UE4 ,! ROLE (! G5]AL OPH?ALMOLOGI/ W *ANGE AL4 #DJB ,HI<-VOLUME CAT>ACT SURGEONS W B#AFF PROBABLY MAKE ! G5]AL OPH?ALMOLOGI/ LESS 9T]E/$ 9 P]=M+ CAT>ACT SURG]Y4 ,!Y W / H PL5TY 6D MANAG+ GLAUCOMA1 MACUL> DEG5]A- ;N1 & O!R 41SES4 ,! G5]ALI/ MAY A3EPT A REF]RAL ROLE 9 CAT>ACT SURG]Y1 S5D+ ! PATI5T (F = SURG]Y & RESUM+ C>E PO/OP]A- TIVELY4 ,I AL C =ESEE A TR5D = SUBSPECIALI/S 6-B9E G5]AL OPH?ALMOLOGY C>E ) _! SUB- SPECIALTY1 S9CE X IS (T5 DI6ICULT 9 A NONACADEMIC 5VIRON;T 6PRACTICE A PURE SPECIALTY4 ,X IS AL POSSI# T "! W 2 M -B9,NS ( SUBSPECIALTIES1 S* Z P$IATRIC & NEUROOPH?ALMOLOGY4 ,A NEW SUBSPECIALTY ,I C PREDICT W 2 CAT>ACT & REFRACTIVE SURG]Y1 -B9$4 ,! WAY ?+S >E GO+1 ! CAT>ACT SURGEON1 & ES- PECI,Y ! PRESBYOPIA SURGEON1 IS EXPECT$ 6PROVIDE A NE> P]FECT RESULT1 />T+ ) 4T.E VI.N4 ,? IMPLIES ! NE$ = T\*UP OR REVI.N SURG]Y1 A LA LASIK1 6ELIM9ATE RE- SIDUAL REFRACTIVE ]ROR 7USU,Y A/IGMA- TISM7 Z "S?+ EXPECT$ & 9CLUD$ 9 ! SURGI- CAL FEE4 ,CURR5TLY1 MO/ LASIK #DJC SURGEONS H C#AFF ------------------------------------#AFG GIV5 UP O!R TYPES ( OPH?ALMIC SURG]Y1 9CLUD+ CAT>ACT SURG]Y4 ,! TRADI;NAL CAT- >ACT SURGEON IS N "O :O HAS USU,Y SP5T M* "T ) O!R REFRACTIVE SURG]Y S* Z LA- SIK4 ,! NEW -PREH5SIVE REFRACTIVE SUR- GEON W 2 REQUIR$ 6D LAMELL> & SURFACE CORN1L SURG]Y PLUS L5S PROC$URES1 S* Z CAT>ACT & CLE> L5S EXTRAC;NS4 ,! OPTOMETRY ROLE HAS GRT POT5TIAL = *ANGE4 ,I ?9K ALL OPTOMETRIC S*OOLS %D 2 ASSOCIAT$ )A M$ICAL S*OOL OPH?ALMOLOGY PROGRAM4 ,! BASIC OPTOMETRY C\RSE C 2 SIMIL> 6:AT X IS N[ &! GRADUATE A# TO PRACTICE OPTOMETRY AL;G ! L9ES (! TRADI- ;NAL NE$ 9 PROVID+ REFRACTIVE & 3TACT L5S C>E1 2+ A DOCTOR ( OPTOMETRY 7,,OD74 ,H["E1 ! CURRICULUM C 2 SUPPLE;T$ 0LEC- TURES & CL9ICAL 9CLU.N ( PATI5TS ) EYE 41SE1 Z PROVID$ 0! OPH?ALMOLOGY DE"P;T4 ,A -PLE;T>Y ROLE ) OPH?ALMOLOGY C 2 EX- P]I;ED S* T ! ROLE (! OPTOMETRI/ C 2 BETT] UTILIZ$4 ,! ISSUE ( COMANAGE;T BY #DJD OPTOMETRI/S ( CAT>ACT & REFRAC- A#AFG TIVE SURG]Y PATI5TS C 2 BETT] RESOLV$ IF OPH?ALMOLOGI/S >E 9VOLV$ 9 ! TRA9+ ( OP- TOMETRI/S4 ,! POT5TIAL ( L>GE-VOLUME SURGEONS 9CR1S+LY DOM9AT+ ! FIELD1 & G5- ]AL OPH?ALMOLOGI/S )DRAW+ F CAT>ACT SUR- G]Y1 M1NS T ! REF]RAL ROLE ( OPTOMETRI/S W 2 EV5 GRT]4 ,AL "! W 2 !N 9CR1S$ RE- SPONSIBIL;Y ( PO/OP]ATIVE C>E1 N EXPECT$ 6BE PROVID$ 0! L>GE-VOLUME SURGEON1 CO- MANAGE;T4 ,X AL %D 2 POSSI# = AN OPTOMETRI/ TO SP5D EXTRA "T "U CL9ICAL TRA9+ 9 ! OPH- ?ALMOLOGY DE"P;T4 ,M DETAIL$ & 3C5TRAT$ TRA9+ C 2 PROVID$ 9 S* 41SES Z GLAUCOMA & EXT]NAL EYE 41SE4 ,IF AN OPTOMETRI/ IS 6ASSUME RESPONSIBIL;Y ( TR1T;T ( S* ?+S Z GLAUCOMA1 Z N[ ALL[$ 9 _M /ATES1 X IS BE/ T ! OPTOMETRI/ "K Z M* Z POSSI# AB GLAUCOMA4 ,9CLUD$ 9 ! LE>N+ PROCESS W 2 ! R1LIZ,N T S* TR1T;T DECI.NS >E 0NO M1NS SIMPLE & UNCOMPLICAT$1 S Z 6RECOG- NIZE ! NE$ = EXTRA TRA9+ & 9SIE M M$I- C,Y TRA9$ ?AN A DOCTOR ( D5TAL SURG]Y ,7,,DDS7'47 ,& NO1 ! ,,OD OR ! ,,MOD W N 2 DO+ SURG]Y4 ,IF !Y WANT 6D SURG]Y1 !Y C G TO M$ICAL S*OOL4 ,H["E1 ? C 2 MADE 6BE ------------------------------------#AFH A M VIA# OP;N4 ,AF -PLET+ OPTOMETRY S*OOL TRA9+1 A GRADUATE C 2 (F]$ #DJF ! OPPORTUN;Y 6G 6M$ICAL S*OOL TO A#AFH -PLETE J ! LA/ TWO YE>S1 GRADUAT+ Z AN ,,MD4 ,! ASSUMP;N1 ( C\RSE1 IS T S* A P]SON W WANT 62COME AN OPH?ALMOLOGI/ = AN A4I;NAL ?REE OR M YE>S TRA9+1 & 9T]N- %IP C 2 A4$ 6?4 ,X IS 3CEIVA# T ! OPH- ?ALMOLOGY DE"P;T MAY 2 9FLU5TIAL 9 HELP+ ! OPTOMETRY /UD5T 2 A3EPT$ = ? A2REVIAT$ M$ICAL S*OOL EXP]I;E1 & IMPLY ! LIKELI- HOOD ( 2+ A3EPT$ 96! OPH?ALMOLOGY RESI- D5T PROGRAM4 ,X C 2 NOT$ T O/EOPA?IC PHYSICIANS H P>ALLEL1 B N ! SAME1 $UC,N Z 9 A M$ICAL S*OOL1 & >E DOCTORS ( O/E- OPA?Y 7,,DO,'S7 R ?AN ,,MD,'S4 ,YET O/E- OPA?IC S*OOL GRADUATES C 2 A3EPT$ 96ANY OPH?ALMOLOGY RESID5CY & 2COME G5]AL OR SUBSPECIALIZ$ OPH?ALMOLOGI/S4 ,IS ? UNFAIR1 6ALL[ A %ORTCUT 62COM+ AN ,,MD8 ,WELL CURR5TLY1 X 2COMES NEC = AN OPTOMETRY GRADUATE 6G F\R M YE>S 6BE- -E AN ,,MD4 ,! F/ TWO YE>S >E SP5T 9 BA- SIC SCI;ES Z USUAL4 ,?\< ! OPTOMETRY S*OOL BASIC SCI;ES >E N ! EQUIVAL5T ( M$ICAL S*OOL1 !Y CD 2 IMPROV$ ) M$ICAL S*OOL GUID.E4 ,AL ,I ?9K CR$IT %D #DJG 2 GIV5 =! "T SP5T 9 OPTOMETRY B#AFH S*OOL1 9CLUD+ PATI5T 3TACT N EXP]I;ED BY 2G9N+ M$ICAL S*OOL /UD5TS4 ,&1 Z F> Z FAIR;S IS 3C]N$1 ,I ?9K ? OPPORTUN;Y TO %ORT5 M$ICAL S*OOL TRA9+ 6TWO YE>S %D 2 AL EXT5D$ 6D5TI/S & NURSE PRACTI;N]S4 ,!Y AL H BASIC SCI;E & M$ICAL BACKGR.D1 & MAY DECIDE AL;G ! WAY T !Y WD L 6BE AN ,,MD4 ,D5TI/S H %[N 9T]E/ 9 G5]AL H1L? & M$- IC9E1 HOP+ 69CORPORATE S* K 9 ! TR1T;T ( _! PATI5TS4 ,"S >E P]H PRACTIC+ M$IC9E M ?AN 9T5D$4 ,I H HE>D T "S D5TI/S EV5 P]- =M BLEPH>OPLA/IES4 ,ORAL SURGEONS H BE- -E "P ( M$ICAL PRACTICE = _M YE>S4 ,_! RESID5CY PROGRAMS H TAK5 PLACE P>ALLEL 6M$ICAL S*OOL PROGRAMS1 & _! ABIL;Y TO TR1T SURGIC,Y 9 ! H1D & NECK >1S HAS BE5 REM>KA#1 3SID]+ T !Y H N G"O 6M$ICAL S*OOL4 ,!Y AL C D BLEPH>OPLA/IES1 ,I "U- /&4 ,I AM N SAY+ T ORAL SURGEONS %D 2 REQUIR$ 6G 6M$ICAL S*OOL1 B X IS NATURAL 6ASSUME T IF !Y DID1 !Y WD 2 BETT] PRE- P>$ =! "W T !Y D4 ,( C\RSE1 GRADUATES (A M$ICAL S*OOL WD N 2 =C$ 96A #DJH "PICUL> >EA ( TR1T;T IF !Y1 = C#AFH EXAMPLE1 WANT$ 62COME FAMILY PRACTI;N]S OR O!R SPECIALI/S4 ,PRE-D5TAL S*OOL1 ,I "U/&1 Z F> Z REQUIRE;TS IS SIMIL> 6PRE- OPTOMETRY4 ,BASIC SCI;ES & G5]AL M$ICAL BACKGR.D >E AL "P ( D5TAL S*OOL1 & ,I ?9K SIMIL> CR$IT %D 2 ALL[$ S T A D5TAL S*OOL GRADUATE C F9I% M$ICAL S*OOL 9 TWO YE>S4 ,NURS+ S*OOL & PRE-NURS+1 ( C\RSE1 >E P>ALLEL1 9 "S DEGREE1 6T ( M$ICAL S*OOL4 ,_M NURS+ S*OOLS N[ PROVIDE A GRADUATE DEGREE S Z 62COME A NURSE PRACTI;N]1 "S- "O :O IS 3SID]$ TRA9$ 6BE A# 6PRACTICE M$IC9E AL"O1 )\T A PHYSICIAN SUP]VISOR4 ,! GRADUATE PROGRAM1 ,I 2LIEVE1 IS ?REE YE>S4 ,:Y N (F] A NURSE PRACTI;N] :O IS 9T]E/$ 9 M$IC9E 6AN ADV.ED DEGREE ! OP- PORTUN;Y 62COME A ------------------------------------#AFI M$ICAL DOCTOR 0F9I%+ M$ICAL S*OOL 9 TWO YE>S8 ,ACTU,Y1 ,I AM TOLD1 ? OPPORTUN;Y IS ALR (F]$4 ,X MAKES S5SE 6ME1 B !N ,I H DIGRESS$4 ,BACK 6EYE C>E4 ,! FUTURE IS V #DJI B"R = EYE C>E4 ,NOTE ! 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DOCTOR &! #DAJ PATI5T PO9T ( VIEW4 ,H["E1 IF B#AFI PATI5TS >E 6BE MAK+ DECI.NS = !MVS 9 EYE C>E1 !N !Y NE$ 6BE WELL 9=M$ S Z 6MAKE 9TELLIG5T DECI.NS4 ,I AM WRIT+ ? BOOK TO HELP P "K ! BASICS AB _! [N EYES1 6PO9T \ "S ( _! *OICES 9 EYE C>E1 & 6HELP !M MAKE 9=M$ DECI.NS4 #DAA C#AFI #DAB