We have all either heard someone or ourselves brag that we have “20/20 vision”. But what does that exactly mean? And is it an accurate indicator of “perfect” vision?
That 20/20 number is a term used to represent normal or ‘perfect’ vision. This number measures visual acuity, which is the clarity or sharpness of your vision measured at a distance of 20ft. So if you have 20/20 vision, you can see at 20ft what someone with perfect vision can see at that distance. If someone has less than average vison, say 20/70, what they see at 20ft is what a person with perfect vision can see at 70ft. While visual acuity is a good measure of the sharpness and clarity of your vision, it does not take into consideration other fundamental aspects of vision. Visual acuity is also not the determining factor in your overall eye health.
If you’ve seen an eye doctor, your visual acuity was tested using the “big letter poster” or Snellen chart. A Dutch ophthalmologist developed the chart in the 1800s. The sizes of the letters are precisely calculated to adhere to the standard of the 20/20 scale. The letters are also carefully chosen. You may have noticed that the only letters used are C, D, E, F, L, N, O, P, T, and Z. The reason behind these letter choices is that some letters can be distinguished even with blurry vision. For example, the letter Q’s tail can be recognized because there are no other letters like it. While the standard for this chart is 20/20 A.K.A “perfect” vision, some people can see better than 20/20 and are born with 20/15 or even 20/12 vision. These people have what is called “supernormal vision.” People who had LASIK surgery can usually see 20/20 or better, and people can be prescribed glasses or contact lenses that can help them see 20/20 (or better).
The Snellen chart is an excellent indicator for your eye doctor to determine if you need glasses or contacts. However, this is not the only test you should be given during a comprehensive eye exam. While vision and focus are critical, overall eye health is also essential. Good focus and good eye health do not always go hand in hand. Vision traits that contribute to your overall visual ability include your peripheral vision or side vision, eye coordination, depth perception, focusing ability, and color appreciation. Even if you have excellent vision, you should go for an eye exam once every year or two years. Eye doctors are also looking for your risk of eye diseases such as cataracts or glaucoma. If you have any pre-existing medical conditions, this could also impact your vision as well. Besides, focus is not static through a lifetime, and changes are bound to happen to everyone.
So the next time you hear friends or family say they have 20/20 vision and don’t need their eyes checked, be sure to inform them there is a lot more to vision than they think.
How Columbus Ophthalmology Associates came to be. Enjoy Dr. Orlando’s story of how Columbus Ophthalmology Associates got started!
“The first time I ever visited Dublin, Ohio was when I was in medical school back in the winter of 1977. After years of playing basketball, I wanted to continue to stay in the game and began to referee middle school and high school games. One of my first assignments was a game in Dublin at the 1909 Building on Bridge Street. I recall driving there from campus and thinking “wow, this is way out in the country” and as I crossed the bridge past the Historic area and pulled into the parking lot, it reminded me of Mayberry. Two lane roads, no street lights, one traffic signal and a school that had a basketball court that doubled as the stage!!! I recall making sure I would not fall off into the audience and prayed no one would get hurt doing the same. That spring one of my classmates told me they were looking for weekend caddies at Muirfield Village Golf Club so again I made the long drive up Riverside Drive, across that same bridge and up a two lane road to the course. There were some new houses being built along the fairways there but for the most part there was not much around. Someone told me the zoo was nearby but all I wanted to do was meet Jack Nicklaus, my golf hero. I caddied there off and on the rest of medical school and did get to see Jack every now and then when he was in town to fix something on the course and prepare for the Memorial Tournament. My hope was that someday I would get to play there. I never imagined that within five years I would establish a medical practice there, build a home and become a member at Muirfield Village and be part of the medical staff for the tournament!!
The road to Dublin was paved by a chance meeting the very first weekend I was on call as an intern at Riverside Methodist Hospital. It was July 4th weekend and a time with minimal hospital staffing. Since I was just out of medical school, I was pretty green at managing critically ill patients. Around 10 pm that night I got a call from the Emergency Department to come and admit a patient in acute kidney failure. After doing all the appropriate blood tests and starting IV’s, I was called to the phone to talk to the patients primary care physician, Dr. Ken Carpenter. We had never met but he explained the situation and that this patient was a farmer that had been a long time patient of his from Dublin. He wanted me to do some special tests and get the patient into the ICU where he would meet me around midnight. I thought, ‘what doctor is coming in at that time when there are plenty of physicians here to help stabilize his patients?’ Well, around 12:30 am, the curtain around the patient’s bed was pulled away and in steps a man that looks like he had just come from the disco. Braided pony tail, funky glasses, full beard, polyester flowered shirt unbuttoned with a gold chain adorned with a dollar gold piece, bell bottoms and leather boots. I recall thinking ‘who is this guy?’ He introduced himself as Dr. Carpenter and he talked to the patient for a long time telling him I was a great young doctor and would take excellent care of him. Then we went into the consultation room where he told me to make sure I stayed with him all night and call him in the morning. I did all he asked and we got the patient through his illness and from that point on Ken Carpenter would call me to go see his patients and he often would come in and meet them and explain their illness, how they were to be treated and what his expectations were of me. After a few months, he asked me what specialty I was going into and when I said ophthalmology he told me that he would check in on me from time to time and wanted me to come out to Dublin because he was going to open a multi-specialty clinic where he needed an eye surgeon. Over the next few years, he would have me come up to his office which was in an old house in the Historic District and we would talk about his plans. One spring day, we drove over to Frantz Road, which at the time was two lanes of country fields. He showed me the plot of land he had purchased where he was going to open The Dublin Medical Mall and it would have a pharmacy, lab, urgent care center, his family practice as well as specialists, including myself. He was also recruiting an OB GYN practice, allergists, dermatology, ENT and urology so that his patients would not have to drive miles to see their sub-specialist. His vision was remarkable as I had no idea how such a facility would work in the middle of nowhere.
In 1983, I completed my training and worked part-time in a downtown practice while Dr. Carpenter completed my office space and opened the Dublin Medical Mall. Our original office had two exam rooms, a waiting room with about ten chairs and a single staff member that answered the phones, checked patients in and out, filed insurance claims and got all the charts ready. On our first day, we saw two patients and that first week we were happy to have a total of twelve new patients. Dr. Carpenter reminded me that I should always be available as he had a large practice and the urgent care center would help grow my patient base over time. There were days I would sit for hours between exams. Slowly but surely he would bring over and introduce me to one of his long time patients that needed an exam or had an eye infection or that wanted cataract surgery. I was open the two Saturday mornings he was and those became very busy days for me. My wife would often work those days to cover the front office and on days we could not find a babysitter, patients had the added benefit of our infant daughter Kristen being behind the desk!! Dr. Carpenter always reminded me that Dublin was going to be a very large suburb and, indeed, his instincts were correct. We now have a full-service hospital and a medical school in our city but I am happy to have been a part of the very first full-service medical center in our great community. He passed away five years ago but his former patients, staff, and long-time Dublin residents still fondly recall his unique and caring relationship with them as well as his importance to the growth of our city. In 1999, we had outgrown our original office and moved to the Bradenton Building but if not for that chance meeting in the ER 20 years prior, Columbus Ophthalmology Associates may have never been founded. Now, I hardly ever leave the city as we have wonderful parks, restaurants, medical care, shopping districts and the club where I caddied nearly 40 years ago. It has been quite a road to where we are now and I am so appreciative of the support of this wonderful community!”
Monae had 20/50 vision and wore contacts her entire life. “The one thing I hated most was driving at night. The glare I would see around lights made it pretty much impossible to drive.” Monae has a condition known as keratoconus. Keratoconus is an eye disease in which the usually spherical cornea thins and begins to bulge into a conical shape. The conical shape defocuses light as it hits the cornea causing distorted and blurred vision. Many people with this condition find it hard to wear contact lenses because of the discomfort it can cause to the person’s already thin cornea. “I didn’t really know anything about scleral lenses but Dr. Hartman encouraged me to try scleral’ s and when I found out I could get 20/20 vision I was all in.”
Scleral contact lenses are usually more comfortable to wear than smaller RGP contact lenses. The cornea is filled with thousands of nerve fibers that make it very sensitive to the environment. Because it is so sensitive, most people can feel a regular contact lens as it moves around on the eye. A scleral lens rests mainly on the conjunctiva and sclera. The conjunctiva is much less sensitive than the cornea, producing much less awareness and discomfort. A patient who finds a rigid gas permeable lens intolerable may be able to wear a scleral lens easily with little to no discomfort. This was perfect for Monae because of her condition; people with keratoconus cannot go under LASIK like many others with vision issues because it could actually make their vision worse. The only effective treatment is custom contact lenses.
Scleral lenses are a little bigger than traditional contacts, that may scare some people, Monae says, “If they’re going to allow you to see better than that is all that matters. I would tell anyone hesitant to try it, it may sound scary but overall it is nothing but comfortable.” Monae now says she has no problem driving at night and the glare has been reduced drastically. “I’m asking everyone if they want to take a road trip cause I’m finally comfortable driving at night!”
We are so happy to help patients like Monae improve their vision and make them more confident in their everyday tasks. If you have any questions about our specialty contact lens examination and fittings please feel free to schedule an appointment HERE!
Our measure of success at Columbus Ophthalmology Associates is how satisfied our patients are with their experience. Our goal is to improve the lives of people in our community by improving their vision. For many, poor vision hinders their ability to accomplish goals, and enjoy life. Recently, we have had 3 patients whose lives were changed by surgeries received by two of our doctors at COA, these are their stories.
William Ernst: Cataract Surgery
William said that his biggest complaint was not being comfortable driving, at night is when it became particularly worse because of distracting halos he would see around other lights. This made it nearly impossible to clearly see the road. Once he had enough, his optometrist referred him to Dr. McHale. William said “I liked Dr. McHale the moment I came into the office. Mr. Ernst described his procedure as “so relaxing” and “painless”. When asked what he expected out of the surgery he stated ” I was very reassured with the entire procedure, I’ve always had sensitive eyes so I was nervous it might be painful but talking to Dr. McHale reassured me that I had nothing to worry about. I told Dr. McHale I did not want to wear glasses after the surgery, so he recommended that we do mono vision. My one eye is in focus in the distance while the other eye can see up close and I never wear glasses the procedure went better than I could have ever expected. If I had to do any surgery again I would choose cataract surgery with Dr. McHale.”
Robert E. Hockenberger: Cataract Surgery with iStent for Glaucoma
Robert recently had cataract surgery with an iStent put into his eye for glaucoma treatment. The iStent is a relatively new minimally invasive glaucoma surgery designed for patients with mild to moderate glaucoma to help reduce the need for glaucoma drops. After being on glaucoma eye drops for over 5 years, he came to COA through a referral from his optometrist, “They told me, you have to go see the best surgeon for this, and that’s exactly what I did.” Robert mentioned that he could only see with his glasses and was getting tired of never seeing with full clarity. “To me, the television never had a clear picture and now I can see every hair on someone’s eyebrow,” he remarked. Mr. Hockenberger didn’t really know what to expect during the surgery but said overall it took about 10 minutes, it was painless and he was surprised by how quick the aftercare process was. In addition, he no longer requires medications for his glaucoma. His advice, “If you need the surgery, get it done and do it with Dr. Derick because not only will he do it right, he will listen to your bad jokes along the way.”
Kenneth Puterbaugh: Cataract Surgery and Hydrus Micro Stent for Glaucoma
Kenneth met Dr. Derick through his auto body repair business and was complaining about tension in his eyes causing headaches. When he came to COA Mr. Puterbaugh had nothing but kind words about the staff and the care he received. “Overall, it was a positive experience; I could not believe the incredible bedside manner I got from Dr. Derick and the rest of the staff.” He had cataract surgery along with implantation of the hydrus implant to help treat his glaucoma. The Hydrus, like the iStent , is a minimally invasive glaucoma surgery designed to treat patients with mild to moderate glaucoma. Kenneth’s passion is art, he works with oils, watercolors, and sculpting, but as an artist with vision problems, he felt like he wasn’t at his best. “Being an artist, I want perfect vision. After my surgery, I now know that an eye doctor is an artist’s best friend.” Mr. Puterbaugh had his doubts when it came time for surgery, he stated: “I expected surgery of the eyes to be uncomfortable and not pleasant, but I was shocked on how simple and painless it all was, that’s why I told Dr. Derick I want to be your poster child for this!” Kenneth mentioned the healing process was quicker than he expected, he stated: “I would tell everyone you will only be inconvenienced for a day or two after surgery, but it will heal before you know it.” He now enjoys 20/20 vision is glaucoma medication free and is back to his painting and sculpting like never before.
Good patient experiences like this are why we come to work with excitement and purpose every day at Columbus Ophthalmology Associates. We are humbled to be a part of each and every patient’s success story.
Ophthalmologists have been using Botox to treat patients longer than any other physician. In the 1950s, scientists discovered that botulinum toxic could reduce muscle spasms. In the 1960s and 1970s, researchers studied its effect on patients with crossed eyes. In 1989, Allergan (a pharmaceutical company that specializes in products for the eye) introduced Botox, the first botulinum toxin approved by the FDA to treat blepharospasms (eyelid spasms) as well as crossed eyes. Botox was used by Ophthalmologists exclusively for over a decade. But after recognizing the impact Botox had on decreasing the appearance of wrinkles, the FDA approved Botox to minimize frown lines between the brows in 2002.
Botox works by blocking signals from the nerve to the muscles. The injected muscle can no longer contract which causes wrinkles to relax and soften. When injected into the eye muscles, it reduces their movement and can be very effetive in aligning in the eyes. They can also be injected for eye spasms, and can help with overactive blinking.
Since the FDA’s approval of Botox for cosmetic purposes, Botox use has exploded. It has been found to improve not only eye issues and wrinkles, but is now being used to treat severe underarm sweating and migraines. Botox is even being studied to measure its effects on treating depression. So while its uses continues to grow, Ophthalmologists will always be steeped in Botox history and will remain the physicians with the most experience.
Between school, soccer and family activities it can be difficult for parents to keep everything in order. Since good vision is essential for academic progress, comprehensive eye examinations should be a priority for your child’s annual health care strategy. While screenings at the pediatrician or school nurse can detect significant visual disorders, they are not a substitute for a comprehensive eye examination.
Our measure of success at Columbus Ophthalmology Associates is how satisfied our patients are with their experience. Our goal is to improve the lives of people in our community by improving their vision. For many, poor vision hinders their ability to accomplish goals, and enjoy life. This was all too true for one of our patients, Joe Altomonte.
Having an extremely high prescription Joe’s struggles with his vision were life-long, and required thick glasses at an early age. He then wore contacts for years, until having a surgical procedure to correct his vision. The procedure that Joe had was the predecessor of LASIK, called radial keratotomy (RK). Unlike LASIK, RK was found to be unstable and have many negative side effects and has therefore been abandoned by eye surgeons since the 1980s.
Joe was getting by with his surgically corrected vision for many years until he turned 60 when it rapidly declined which prevented him from fulfilling his dream of becoming a golf teaching professional. Joe shared that “It seemed like all of a sudden I was losing quality, clarity, colors and overall vision. My poor vision actually led to me not passing the on-course portion of my exam.” Joe was diagnosed with cataracts that are routinely diagnosed and surgically corrected, but given his previous RK surgery his case would be complex and his chances of seeing well without glasses postoperatively were far smaller than someone who had not had RK. “Because of this my optometrist told me that there was only one place I should go and that was to Columbus Ophthalmology Associates, to see Dr. Litzinger,” Joe recalled. He also admitted that he was nervous and pessimistic about having a good outcome. “I have been to many other ophthalmologists, and with the mistake of my last surgery, I wasn’t very confident. However, after the visit with Dr. Litzinger, I felt reassured.”
During his cataract surgery, Joe described being perfectly at ease. “I had absolutely no pain, no discomfort, no anxiety, nothing during the entire procedure. I took the medication given to take the edge off but I didn’t really need it. Being prepped by the nurses and all of my conversations with Dr. Litzinger made me 100% comfortable.” After surgery, Joe couldn’t believe how well he could see. “My vision is almost too perfect now. It’s like I can see everything, far beyond what I ever thought could be accomplished with one surgery in one facility. It’s really like being reborn because of the colors and the beauty I can see now. I am now able to accomplish things I haven’t been able to over the past 10 years.”
A patient experience like Joe’s is why we come to work with excitement and purpose every day at Columbus Ophthalmology Associates. We are confident that Joe will be central Ohio’s newest teaching golf professional in a few months, and are humbled to be a part of his success story.
Blinking is essential. Every time our eyelids close, salty secretions from our tear glands sweep over our eyes’ surfaces, protecting them from harmful particles. The average person blinks 12 to 15 times per minute but when you’re in front of a computer screen, that number decreases dramatically to 3 to 4 times per minute. With the average American spending 6 to 8 hours each day in front of a computer, we’re missing out on hundreds of opportunities to cleanse and protect our eyes.
Macular degeneration (AMD) can be a visually devastating disease. It can affect our grandparents, our parents, our aunts, uncles, brothers, sisters and friends. It is the leading cause of blindness in those over 65. America’s aging population is growing rapidly and AMD affects 10-15 million of these patients today. It is projected to affect 20-25 million in 2020.