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Medical Forum / General / Vision / July 2006Americans getting too fat for eye exams too.
<http://tinyurl.com/mx6m3> | Study: More Americans too fat for X-rays, scans | Obesity hurting accuracy of images, doctors say. | | Wednesday, July 26, 2006; Posted: 9:11 p.m. EDT (01:11 GMT) | | MRI machines with larger-bore openings are in demand, a reflection of | increasing obesity in America. | | WASHINGTON (Reuters) -- More and more obese people are unable to get | full medical care because they are either too big to fit into | scanners, or their fat is too dense for X-rays or sound waves to | penetrate, radiologists reported Tuesday. I'd like to add to the following to that list of devices: o Slit-lamps I've had quite a few patients I've had to refer out for direct gonioscopy because they couldn't fit behind the slit-lamp. Or you don't get the testing done. Bringing a patient down to the OR to perform Koeppe gonioscopy with a counterbalanced gonioscope costs big bucks. Most hospitals don't have one -- you have to typically go to a University ophthalmology residency clinic. And optic nerve/retinal nerve fiber layer evaluation with a +14D or MaculaPlus using a head-mounted BIO is not nearly as nice as using a contact fundus lens or Super66 non-contact fundus lens at a slit-lamp because patients can't get their forehead close enough to the front of the slit-lamp for me to obtain or sustain clear focus. Same thing for Goldmann tonometry. I can't count the number of times having a TonoPen has alllowed me to check IOPs when I couldn't do it with a slit-lamp Goldmann. Good luck to ophthalmologists trying to perform ALT/SLTs on these pateints. Well, they can bill more for trabeculectomies anyways :(. Hand-held slit-lamps are a poor substitute. If this trend keeps up, I expect to start having problems at the perimeter. And I thought this was only me noticing this alarming trend. > <http://tinyurl.com/mx6m3> > [quoted text clipped - 41 lines] > > And I thought this was only me noticing this alarming trend. Maybe refer them to a diet tech? Obesisty is an epidemic just like myopia is, but at least you can lose weight much easier than lose diopters. > Maybe refer them to a diet tech? Obesisty is an epidemic just like > myopia is, but at least you can lose weight much easier than lose > diopters. It depends on the cause of the obesity. > > Maybe refer them to a diet tech? Obesisty is an epidemic just like > > myopia is, but at least you can lose weight much easier than lose > > diopters. > > It depends on the cause of the obesity. Correct, but usually its due to excess intake of calories and lack of exercise. Less often it can be due to some medicines, thyrod or metabolism problems. I had a teacher who was quite obese, short and 220 pounds(my guess/estimate) and she once explained that it was due to her asthma and other problems and the medicines she takes. She does not overeat. >> > Maybe refer them to a diet tech? Obesisty is an epidemic just like >> > myopia is, but at least you can lose weight much easier than lose [quoted text clipped - 8 lines] >asthma and other problems and the medicines she takes. She does not >overeat. Sounds like an excuse to me. Drugs don't make you fat. Steroids, often given for asthma, usually increase the appetite leading to overeating. Ann > Sounds like an excuse to me. Drugs don't make you fat. Perhaps you are unfamiliar with several psychotropic meds that are known to have that side effect, even with close controls placed on caloric intake. -aula > > Sounds like an excuse to me. Drugs don't make you fat. > > Perhaps you are unfamiliar with several psychotropic meds that are known to > have that side effect, even with close controls placed on caloric intake. > > -aula Are you talking about SSRI's that it seems half the population takes? DrG > Are you talking about SSRI's that it seems half the population takes? There is a significant number of folks taking anti-depressants, but perhaps they may need them. Either side of that question - yes, I'm talking about those meds. -Aula >> Are you talking about SSRI's that it seems half the population takes? > >There is a significant number of folks taking anti-depressants, but perhaps >they may need them. Either side of that question - yes, I'm talking about >those meds. It's debateable whether they cause obesity on their own or whether it's simply a matter of the person over eating as an effect of the depression. > It's debateable whether they cause obesity on their own or whether > it's simply a matter of the person over eating as an effect of the > depression. Hmmm. I'm not so sure. It's probably a case of increased appetite rather than altered metabolism. But, how the appetite is increased is conjecture. I have seen thin people gain weight only after they were put on SSRI's. DrG > It's debateable whether they cause obesity on their own or whether > it's simply a matter of the person over eating as an effect of the > depression. It can be quite depressing to realize that the OD, being, these days, a Professional, who does many of the Professional things that an opthamologist conventionally did, and who is consumed with the complexities of pandering contact lenses and remedies for their vagaries and pathological disadvantages, has very little time for such things as refractions, and frequently can not be bothered (assuming he does his own refractions) to tune to much better than 20/30, for the customer wanting ordinary inexpensive eyeglasses. Possibly the prevalence of fat customers, who do not physically fit the equipment, is, to some extent, of his own doing. That, of course, does beg the question that refractive error indirectly engenders overeating. But, I do remember that the fat girls almost always wore glasses. (Now, with contacts, lassie, and Oils, it is not longer possible to draw generalizations.) -- Dicky -- Dicky > But, I do remember that the fat girls almost always wore glasses. > (Now, with contacts, lassie, and Oils, it is not longer possible to > draw generalizations.) Oops -- spellchecker going wild again. (Now, with contacts, lasik, and IOLs, it is not longer possible to draw generalizations.) -- -d. >. > > It's debateable whether they cause obesity on their own or whether > it's simply a matter of the person over eating as an effect of the > depression. I've worked in mental health for 25+ years and have observed many individuals fight weight gain on these meds, fail to comply with the meds because of the weight gain, and actually become more depressed because of the weight gain. In all the cases of which I had good information on their eating habits [I was working in a residential treatment center at that time] I can attest to the fact that they were not bingeing nor did their caloric intake increase. There were several who decreased their caloric intake and/or increased their physical activity in an attempt to control or diminish the weight gain, often with little success. It is unfair and potentially harmful to their treatment progress to blame them for their weight gains. Some meds have side effects that can be somewhat mitigated but not always effectively controlled. It would appear that the known effect of SSRI's on a person's weight is one of those. -Aula [snip RE: obese patients] >Maybe refer them to a diet tech? Obesisty is an epidemic just like >myopia is, but at least you can lose weight much easier than lose >diopters. There was an article in the Journal of the American Optometric Association within the past year that dealt with obesity; in fact, IIRC it was the lead/cover article. This is a touchy area and I don't think there is a clear consensus in the Optometric community on how to procede regarding addressing a patient's obesity. I would feel comfortable addressing the issue with a patient that had, say, pseudotumor cerebri, but not one without obvious ocular or systemic pathology. I wouldn't mind an indirect referral to their internist, provided I had even a secondary reason. I think the situation would be the same even in the OMD community. Patients should be inately aware, in general, that being obese is "not good". They shouldn't have to be made aware of that *routinely* by a non GP, just like they shouldn't be clueless of the fact that smoking or abusing alcohol is bad. I think you can probably claim your ADA credits for the necessary equipment upgrades. DrG > [snip RE: obese patients] > [quoted text clipped - 21 lines] > non GP, just like they shouldn't be clueless of the fact that smoking > or abusing alcohol is bad.
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