F U N   W I T H   O C C L U D E R S :   (Off Label Uses)
 

An occluder is a simple object with one simple function. It's purpose is to occlude or obstruct the vision of one eye in a patient in order to test the vision in the other eye.

An occluder is a simple object. It's very straightforward. Since it's sole purpose is to obstruct the vision in one eye, almost any object that could be used for that purpose can become an occluder. You could use your hand or the hand of the patient as an occluder. However we seldom do that because it would be too easy to cheat and peek between the fingers.

Most offices have special plastic objects, shaped somewhat like a spoon that are used to occlude the vision in one eye. This is what I use in my office. The problem with these devices is that they seem to break easily. I don't really know why. They are actually made from fairly sturdy, rigid plastic. However, some patient's seem the have the mistaken notion that the purpose of the occluder is not only to cover up one eye, but also to create an indentation in the skull bones around the covered eye. Since occluders aren't specifically made for creating indentation in bones, they will frequently break when used for this purpose.

Some patient's have difficulty following the simplest directions when it comes to testing the vision in one eye, as well. At least once a week, I'll hand an occluder to a patient and tell them to cover their left eye. Then I'll turn on the eye chart and ask them to read it, only to discover that they've not only covered one eye, but they've CLOSED the OTHER (uncovered) eye. Needless to say, they seem to have difficulty reading under these circumstances.

I suppose it is at this point that these patients seem to get the idea (from where, I have no clue) that since I obviously don't want them to see the chart, I must want them to make indentations in their skulls with the occluders.

Once the occluders break, I have to find other uses for them. They cost too much to simply throw away. A broken occluder has many uses. You can use it to dig boulders out of the back yard. You can use it as a soup spoon. Or you can use it to slap a patient upside the head when they break one of your new occluders.

R A N D O M    O B S E V A T I O N

I don't think I will ever ceased to be amazed by the way some patients arrive in "pairs".  Let me explain:  It seems like when you see one unusual case, you'll often see another similar case later the same day, or within a day or so.  Sometimes this can be easily explained.  For instance, you have a kid come in with amblyopia in the left eye because his refraction in that eye is +4.00 while the other eye is +1.00.  Then the next patient is his brother and lo and behold, he has the same thing.  Not too much of a coincidence there, I know.  But sometimes that happens and the patients aren't related.  Bigger coincidence.

Then you'll have a patient come in with a conjunctivitis (eye infection) in one eye, and later that day you'll have one or two more.  Now since this is contagious, they tend to come in in groups, so that's not a huge coincidence, either.  But this sort of thing happens often enough that I've talked to other docs and they experience the same thing.  It's common enough for people to notice.

Some days, you'll have a patient with a metallic foreign body in one eye, and then an hour later, another patient comes in with the same thing.  What are these guys doing?.... sitting at a bar and saying, "Hey, let's freak out the eye doctor.  You put a piece of metal in my eye and I'll put one in yours, then we'll both go in and have them removed.  Ha ha ha." ???

But then every once in a while, something happens that's such a HUGE coincidence that you KNOW there must be a God and that he has a REALLY twisted sense of humor.  This happened to me in my fourth year of Optometry school.  I was working in the pathology clinic and had a patient come in who was monocular, meaning he had only one good eye.  In his case, he only had one eye; the right one wasn't just blind, it was gone completely.  And he had an infection in the remaining eye.  Normally an eye infection isn't too much cause for alarm, but when a patient only has one eye, it is potentially devastating.  While treating the infection, the patient is often light sensitive and blurry and a monocular patient with an eye infection can be effectively disabled.  Well, believe it or not, less than an hour later, I had another patient come in who was missing his right eye and had an infection in the remaining eye!!!  Now that's TOO MUCH of a coincidence to be just random chance!!!  Somebody up there was having fun that day!!!