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Optometrist In The One Eye Community

Erica at the clinic, wearing teal scrubs, and posing next to the chair to get your eyes examined.
Erica at the clinic

*Erica Levinson shared her story with us previously. She was diagnosed with retinoblastoma when she was 2 years old. She went on to become an optometrist. In this blog, she answered a lot of questions about her field of work.

1. How long have you been an optometrist? Where did you go to school?

  • I graduated from Nova Southeastern University College of Optometry in May of 2021. Following optometry school, I completed a 1-year residency in primary care with an emphasis in ocular disease at Dorn VA Medical Center in Columbia, SC in which I saw about 1,700 patients and learned to fit specialty contact lenses and perform low vision exams.

2. What made you want to become an optometrist?

  • I have known for a long time I wanted a career involving eyes. When I first started college, I was a biomedical engineering major, and I thought I wanted to do research to help develop bionic eyes! When I realized I would not do well mentally if I ended up sitting in a lab all day, I began exploring careers in healthcare. After shadowing several eye doctors, I fell in love with optometry! Read my story for details!

3. What is something most people don’t know about optometrists?

  • Most people think of an optometrist as a person that fits glasses and contact lenses. Many people think they need to see an ophthalmologist if something is wrong with their eyes besides blurred vision. Optometrists in the United States are required to obtain a 4-year doctorate and pass extensive national board exams to practice optometry, and they are qualified to diagnose and treat many eye conditions.

4. What is the number one question most patients ask?

  • I can probably form a lengthy list of commonly asked questions, but the most notable question I get is “What is the purpose of being dilated?” I explain to my patients that dilation opens the pupil and allows the doctor to examine the retina tissue inside the eye. Without being dilated, only the central ~15% of the retina can be examined. It is so important to have the full retina examined, as many things can occur that don’t cause any symptoms. The retina has a pigmented layer just like the skin, and new neoplasms or growths of tissue can appear, just like new freckles on the skin, and if they have concerning characteristics, or if they change color or size, they sometimes need to be evaluated by a specialist (oncologist). This is just one example of why being dilated is important. In my case, dilation is what led to my retinoblastoma diagnosis. Retinoblastoma is a malignant tumor inside the eye that if left untreated, can spread to the other parts of the body. Once diagnosed, my eye was removed within a week. Retinoblastoma, while rare, is the most common ocular cancer in children. Dilation saved my life and I encourage all my patients to get dilated annually. I got a little carried away on this one. I can write an entire blog post on the importance of dilation!

(Cover photo: The indirect ophthalmoscope is used to examine the retina during a dilated exam.)

5. Do you have one patient, in particular, you will always remember? Why?

  • This is a difficult one because I have so many patients that have had an emotional impact on me. One, in particular, had graft versus host disease (GVHD), a condition in which donor cells attack the recipient after a stem cell transplant (or bone marrow transplant). The form of GVHD that the patient had was one with a very low survival rate (~10%), and he had to go through extensive treatment. His treatment was successful, and he remained stable on maintenance doses of several medications. GVHD caused severe dry eye disease for him, making it so he had to put drops in his eyes every two hours. He was fit in specialty contact lenses that solved this issue and greatly improved his quality of life. He shared with me that his treatment was the most difficult thing a person could go through. He spent months on bed rest and had no energy and no appetite for a long time. When he found out his treatment was successful, he stated he would do it all over again, because even though it was difficult and some days he didn’t want to keep going, he will now live to see his son graduate high school. I felt inspired by his positive outlook on life, despite what he had to endure.

6. Can you walk us through the process of checking the health of an eye socket?

  • Anophthalmia is the medical term for the absence of one or both eyes. It is important and often overlooked for patients with anophthalmia to have an eye doctor examine their eye sockets regularly. Many times, anophthalmic patients can develop discomfort or infections, and an optometrist such as myself is the best person to examine and treat these issues. When seeing a patient with a prosthesis, I remove the eye and have the patient sit in a slit lamp, a device that helps me examine the socket under magnification. I check for any implant exposure and check for signs of infection, such as mucous, red or white bumps, or redness of the tissue. Just like people have different skin types, some people may have eye socket tissue that is more sensitive or more prone to infections than others. Children tend to get infections more often than adults. When examining a patient with an infection, it is important to determine if it is bacterial or viral, as the treatment is usually different. While an ophthalmologist is also qualified to diagnose and treat these cases, ophthalmologists usually specialize in ocular surgery (such as enucleations, or more commonly cataract or glaucoma surgeries), and typically prefer patients who do not need surgery to be seen by an optometrist so that their appointment slots can be reserved for surgical cases.

(The slit lamp device I am leaning on in the photo above allows examination of the eyes under high-intensity light and magnification.)

7. What is your least favorite thing about your profession?

  • Insurance… Without universal healthcare, people in the United States must pay out of pocket for exams unless they have private health insurance. This can make my job heartbreaking at times, as some patients can’t afford certain treatments that can benefit their eye health, and sometimes can’t even afford a pair of glasses.

8. What is your favorite thing about your profession?

  • I have many things I love about optometry, but a big one for me is getting to interact with my patients who have prosthetic eyes. I really enjoy educating patients on how to care for their prostheses. With my education and personal experience, I have a lot of insight regarding dos and don’ts. Many patients get very little information from their other healthcare providers regarding their prosthetic eye, and I love filling that gap and getting to bond with someone who has shared experiences.

9. How many patients do you see in a day, week, or year?

  • I see 15-19 patients per day. This number can vary depending on location, type of practice, and how much support staff is present.

10. In your experience, how many different ways can a prosthetic eye be made?

  • I have seen a few different ocularists, and their practices are very dependent on who trained them. There are no schools that teach ocularists. Ocularistry is an art and from what I have seen, each ocularist makes prosthetic eyes in a different way. For example, to create the vessels overlying the sclera (the white part of the eye), one ocularist used small pieces of red thread while another ocularist used a fine-tip paintbrush and red paint. As stated in the blog post from Andra Striowski, ocularist practices are often handed down through generations, so each ocularist uses skills they learned during their apprenticeship, which is often with their parent or other family members.

11. What age group do you see the most?

  • I see patients of all ages, but I have the most experience with patients over 60.

12. How has the profession changed over the years?

  • In recent years, there has been more focus on eye issues that arise from patients spending many hours per day on screens. Since the pandemic, many students have begun doing more of their schoolwork online and many jobs have become remote. Patients who spend several hours on computers and phones each day have a higher incidence of dry eye disease and are more likely to have accommodative issues such as trouble focusing or eye fatigue.

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