In many ways, what we do as ophthalmologists is easier than in other disciplines because most of the information is literally right before our very eyes. We can see the cornea and lens to assess its relative health and clarity. The eye is the only structure in the body where you can look directly at a major blood supply to see if the tissue is being supplied with blood to keep it healthy (in the retina). Everything from the movement of the eye to the responses to light can all be directly evaluated. Interpretation of dye staining and measurement of eye pressure, for example, are usually to support a suspicion of something we can see clinically. The trick is that the eye is very small, requires a steady hand and an unwavering gaze to be evaluated. Throw in a mobile patient that won’t respond to “Look up!” and you have the challenge of being a veterinary ophthalmologist.

Surgery may be a little easier since the patient is finally immobile for our examination, however, manipulation of needles and suture that are crazy small is a special skill all its own. And a scar in the skin is no big deal but the cornea needs to remain as clear as possible for it to do its job. So surgical trauma has to be minimal in cases of corneal or lens disease to keep them or other tissues functioning at their best after treatment. How do we do all this? On top of years of study and inherent or developed skills to keep that hand steady, we are reliant upon some pretty sophisticated equipment to do our job. So here is a brief rundown of some of the stuff we use to help your critters out in the world of veterinary ophthalmology.

The equipment used in human and veterinary ophthalmology is really quite interesting. We need high intensity light sources with focused beams and crystal clear magnification to be able to evaluate and treat all of the diseases that present themselves. The two workhorses of the exam room are the slit lamp biomicroscope and the indirect ophthalmoscope.

The slit lamp biomicroscope in use

The slit lamp is an instrument used to see the front structures of the eye like the lids, cornea and the lens. Ours has three different levels of light intensity and two levels of high magnification. In addition, the beam of light comes in four shapes, a circle and 3 vertically aligned beams of light that are progressively thinner in width from 0.8mm to 0.1mm. In addition, we can use a cobalt blue filter on the light source to help with observing fluorescein dye on the cornea to highlight ulcers. Along with good lighting and magnification, the benefit of this instrument is that we can swing the light to the side while looking at the structure from straight on. With a slit beam of light, we can see a cross section of a clear structure that then allows us to examine the depth or placement of a lesion. For example, if there was a mark on your glass door, you may look from the side to see if the spot was on the outside or the inside before you started cleaning. With a pane of glass 1/4 inch or greater thick, you could easily see the dirt was on the outside plane and not the inside and thus walk outside to clean it. The same process is applied when looking at the cornea only it is 0.5mm thick! So if we want to see how deep a thorn has punctured into the eye before we pull it out or see how deep a ulcer is to determine if it is a medical or surgical condition, the slit lamp is your instrument.

The slit lamp is also used to observe the size and location of cataractous opacities in the lens or the severity of inflammation inside the eye. With intraocular inflammation, called uveitis, the beam of light is used to see if we can see the light cut through the fluid inside the eye and create a stream of light like a flashlight on a foggy night. A normal eye should not have a stream of light, an inflamed one does and can be graded to assess severity. Our handheld version is similar to the large instrument you place your chin into at the human ophthalmogist to assess these same features. Our dogs and cats just can’t get their noses and chins to sit just right in this machines! Our version can be used by doctors visiting out-patients or doing rounds in a hospital situation where a cumbersome large machine or a non-mobile patient does not allow its use.

Viewing the retina with an indirect ophthalmoscope

The indirect ophthalmoscope is typically used to evaluate the back of the eye, primarily the retina. By using a focal light source and a second lens to focus the light, we can screen the entire retina with a single gaze. Different powered lenses can be used to magnify areas of interest or increase the field of view depending on what you may be looking for. These lenses can help even with small pupils so we don’t necessarily have to dilate the pupil if we don’t need to see in the far periphery. This exam can be a bit uncomfortable for you and I but most dogs and cats sit just fine for us to look.

Applanation tonometry in the dog

We do numerous tests in the exam room to evaluate everything from tear production, tear quality, tear duct function, corneal intergrity, detection of bacterial infection or inflammation and eyeball pressure assessment. Glaucoma is a very common disease and intracocular pressure measurement is performed regularly to determine this value. High values equal glaucoma, low values are suggestive of inflammation with a wide range of normal in between that varies slightly with species. There are also many different tools used to measure intraocular pressure which is called tonometry. We perform what is called applanation tonometry. In this test, a finely calibrated instrument with a sensitive mobile tip is tapped upon the surface of the clear cornea. The tip will depress slightly and the amount of pressure needed to flatten the cornea is determined by a microchip in the device to produce a number that equates to how hard or soft the eyeball is inflated. When pressure is high inside the eye it creates all kinds of problems that lead to vision loss. This is a very important test that is performed routinely on most exams.

Phaco machine and handpiece

Cataract surgery is a commonly performed procedure that is done on an elective basis to return vision to your friend if the lens has become opaque. This is performed by a technique called phacoemusification where high-frequency ultrasound power is used to break the lens up into small pieces while concurrently keeping the eye inflated with liquid and sucking out the particulate material that is created as the lens disintegrates. Our machine, an Alcon Legacy 20000, does a wonderful job of that and you can see in the picture the handpiece that is placed inside the eye with the computer screen that displays all our settings that affect power, vacuum, suction rate, etc. It really is a fascinating surgery to perform and watch. A video in our Helpful Resources page and a prior post about cataracts in the dog have additional details and images about this disease and procedure. The Legacy (we call her Alice!) is our workhorse for this procedure and we take great pride in keeping her in tip-top shape for this wonderful procedure.

Using the operating microscope

To perform most of our intricate corneal and lens surgeries, be it cataract extraction or repair of deep corneal ulcers, we need magnification to allow visualization of the tissues. Our operating microscope is a beautiful piece of equipment with a large arm that swings the microscope over the surgical table and directs the beam into the eye. We can zoom in and out, move up and down or from side to side with a foot pedal to keep our hands free and sterile. The intensity, width and focus of the beam can be adjusted to maximize our ability to see at any depth and degree of magnification. This expensive tool is mandatory for doing these surgeries not only to see the structures but also the fine suture we use. Sometimes it looks like there is nothing in our hands from the casual observer that is not looking through the scope as well. That’s why I frequently have an assistant scrub in with me to watch though the assistant’s eyepieces and pass instruments to me during the procedures.

These are only some of the instruments and technologies that are used in ophthalmology to allow us to see what your pet sees. Boarded ophthalmologists are trained to use these tools, understand their nuances and limitations, and then apply the knowledge they have obtained to aid in diagnosis and treatment of your pet’s ocular disease. As the saying goes, it’s not just the wand but the magician behind it as well! But it sure helps to have some nice wands!

Sassie and Dr. Stuhr

It has been a decade since I became the sole owner of the Animal Eye Clinic in Wilton and it stuns me to think of all that has happened over that time. When Dr. David Covitz gave me the keys and I promptly found the basement in the old clinic had flooded the next morning, it hit me right between the eyes that this was now my baby to care for and shape into the practice I wanted it to be. Ten years later, I can gladly say that the journey so far has been a pleasure and that I am happy and proud of what my business here represents to those who use our service.

From the get go, our mission has been to create a warm and friendly atmosphere where our professionalism and expertise creates an atmosphere where you as the client and your pet feel comfortable and reassured that you are in good hands. Our new location (since January 2010) is perfect as we renovated a beautiful house on a hillside property right on Route 7 to accomodate our needs as an out-patient facility. It is bright and cheery, clean with spacious exam rooms to allow examination of all your pets, big and small. My experience is that without the stress, odor and tension of a multispeciality hospital or general practice, most pets here are very comfortable and allow examinations more readily than in those other environments. We hope you will share that feeling.

But the variable that makes us shine is the personality of the staff that supports my philosophy of excellent care in a nurturing environment. My office manager, LisaMarie, technicians Chris and Christina, and receptionists Suzanne and Katie define our excellence by taking care of each individual with great pride and compassion. We take the approach that if we give you the time to learn, make educated decisions and trust the people that are handling your pets, you will be able to make a better and more confident decision than when given the facts alone in a more hectic and less friendly environment. I hire staff based on their skills in handling these situations and insure that we are a cohesive group when it comes to your pet’s care. As a single doctor practice, I rely on my staff to make many phone calls to doctors and clients to pass along information promptly. I trust my staff implicitly in this facet and they have rewarded me with their loyalty of many years devotion to this business. I could not operate without them!

I approach each client in a personal fashion, presenting the the information in the best way I feel gives you the facts in a clear and concise manner. If you need your hand held, we’ll hold it. If you are busy and need to cut to the chase, I do. And if we can’t fit you in but we can schedule a drop off and you accept a phone call with the information later, that can work for us too. We won’t skip the details to lessen the time, just have to make the time to get the information to you from me or my staff. And if we don’t have time to do the best job we can, unfortunately we might have to talk with your veterinarian on the phone and/or potentially recommend you go elsewhere to those with a different philosophy.

The Animal Eye Clinic continues to evolve over time, both in our services and our expertise. I continue to attend meetings and purchase equipment to keep our skills current. The American College of Veterinary Ophthalmologists (www.ACVO.org) is our core governing body that organizes these meetings and other continuing education seminars. It plans the annual Service Dog Month and has developed a list serve that the diplomates of the college can share to ask questions of each other about difficult cases. I continue to educate as well, speaking to local veterinary associations like in Hudson Valley this month and Fairfield County next month. All in all, we hope that if you use our service, you and your pet will be comfortable, confident and happy with the experience here in Wilton.

The AEC reception area

Welcome to the Holiday edition of the Animal Eye Clinic in Wilton, Connecticut!

To date I have posted medical information and photographs of some disease states that may be of interest. But today, as Thanksgiving has quickly passed us by and the Christmas holiday bears down on us, I decided to wax poetic about something I feel strongly about: Customer Service.

I am one of those folks who really enjoys this time of year. One of the reasons is that many people seem to embrace the Christmas spirit and actually start treating people nicely, are thinking of giving rather than receiving, and are looking on the bright side of life. Whether you are religious or not, the positive vibe given off at this time of year can be infectious if you are open to receiving it.

Alas, many are brought down by the demands of the season. Gift giving, party attendance, travelling to the in-laws are some of the many responsibilities that can become a hassle rather than a pleasure during this busy time of year. Getting trampled on Black Friday just does not seem to be a good way to start the season off right to me!

But seeing the joy of children while writing their letters to Santa can bring me back to a time of innocence in a hurry. Meeting that person that smiles at you while hustling down a crowded street can prompt the smile back when, during other times of year, you may be facing straight ahead to avoid eye contact. Stopping to gaze at a decorated tree or house in your neighborhood when otherwise you would be racing home for dinner is special this time of year. Or taking the time to give someone directions that is obviously lost while looking for that perfect gift in the mall may otherwise not be considered at any other time. It makes me smile to see people treat others nicely, be approachable or themselves approach someone inspired by the season.

But why should this attitude be more apparent or present in December and not April? Why not have the Christmas spirit all year long? Why is this simple act of taking care of each other so difficult to find? Why do clerks in stores or receptionists in offices sometimes talk to you like you just insulted their mother? I mean, really, why do so many businesses continue to treat their customers like you need them more than they need you?

In a way, my business philosophy tries to reflect this lost art of customer service. Isn’t taking care of people what customer service is all about? And shouldn’t that be the easiest task in you and your employee’s day? It is just not that hard to be friendly!

This doesn’t have to be a big act of kindness, but rather the day-to-day friendliness and interaction between client, patient, staff and doctor that sets a tone in a practice. Or elsewhere between shopper and clerk, homeowner and contractor, patron and waiter. Isn’t everyone more pleased if someone treats them nicely, with respect and courtesy rather than with a gruff response? I don’t care how good your retail items, counter tops or beef satays are, if you don’t give me the time of day, I doubt I will use your service.

Here at the Animal Eye Clinic, I have chosen to remain a small business for exactly these reasons. I feel I can provide my excellence in veterinary ophthalmology in a warm, friendly, and personal setting better than in any other venue. It’s like Cheers here where we know your name and you will see familiar faces every visit. Our new waiting area is quite pleasant and you would be surprised how well many dogs and cats behave here when they may not at your primary veterinarian’s practice. They sense the calm, are not surrounded by sick animals and are comforted in a clinic that feels like a home. We think you will feel the same. Sure, we sacrifice the benefits of having other specialists right down the hall as you might experience at a multispecialty or emergency practice. Yes, I am not open 24/7 as I prioritize my family when not at work, and maybe I will be a little behind if an emergency comes in that needs attention while you are waiting. But most clients will tell you that once I am present, you will get my 100% attention, a thorough description so you can understand your pet’s problem, and a staff that will follow you from beginning to end of the process. And if you don’t get a smile, a hello, goodbye or thank you somewhere along the line, I would be surprised.

We may be only one of few veterinary ophthalmologists in the area, but we won’t act like it. It is our pleasure and priviledge to be be here for you, and we try to prove it every day. It doesn’t have to be Christmas season just once a year.

Happy Holidays from the Animal Eye Clinic! Treat someone nicely today and see how good it feels!