Re: Americans getting too fat for eye exams too.

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Re: Americans getting too fat for eye exams too.

Dr. Leukoma	28 Jul 2006 00:58
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.

Anon E. Muss

27 Jul 2006 15:35

[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.

acemanvx@yahoo.com	27 Jul 2006 09:29
> <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.

Anon E. Muss

27 Jul 2006 02:26

<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.

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