“It’s a Small World?” Not Anymore

I’ve been examining patients 20 years now, and I’ve been able to gauge America’s growing trend toward obesity by how difficult it is to fit my patients into a slit lamp.

A slit lamp is the microscope that sits on a swinging table that I use to examine the front of a patient’s eyes. Back in the late 80s when I was starting out, I hardly ever recall having difficulty getting a patient into one of those. But over the years, the increasing girth of the average American belly often has a patient forcing themselves against the table and gasping for air as I try to do an exam.

I’ve altered my technique a bit to compensate and often have the patient scoot up on the edge of the chair and lean forward so that gravity takes over and the tumor, er, I mean stomach, drops toward the floor out of the way.

And it’s not just your stereotypical Southern fried chicken-eating, Budweiser-guzzling guy either. Most of my women patients are overweight too, and with the larger bellies come larger breasts which make for some awkward moments when it comes time to use the slit lamp. Normally, I try to size up the situation, so to speak, before I start and make the adjustments so as to avoid needless embarrassment. Some patients notice what I’m doing and figure out why and are obviously red-faced, others just laugh it off.

As it turns out, slit lamps aren’t the only pieces of equipment which are begging to be biggie-sized. The retired ragin’ Reverend and now undertaker Greg (aka, “Stoogelover”) visited Disneyland recently and noticed (with no small amount of rejoicing) that the ride “It’s a Small World” was closed for repair.

He overheard a worker tell someone the reason: The boats were “dragging bottom” because the average American bottom is so much bigger than it was in the 1960s when the ride was built.

Folks, if that worker is correct, then that’s sad (or maybe “saggy?”). We have no business pointing our fingers at anyone over food shortages when “average” Americans seem to think that they absolutely can’t get by on less than 3,770 calories a day.

“It’s a Small World?” Not anymore.

  1. JRB

    I’m giving you a big, fat Facebook link for that goodness.

  2. Mike the Eyeguy

    Facebook…Facebook…oh yeah! That’s the thing that my kids don’t want me looking at.

    Aight, I’m down with that. Thanks!

  3. Hal

    Oh, dude. You have hit on my soapbox topic.

    In my article I wrote on obesity (a couple of years ago) I discussed the difficulty of getting the obese patient in the slit lamp. It’s also common to measure a falsely high IOP when measuring in the SL for the same reason. I generally measure the IOP with a Perkins when they have to strain to get their head in the SL to avoid a false positive reading.

    You make an excellent point regarding our overindulgence compared to countries that have a overall lack of food.

  4. Mike the Eyeguy

    I remember that article, and as I recall, you lectured at the Academy on that topic as well.

    I use the Perkins full time now. I recently updated to a Carl Zeiss SL-120 slit lamp, and my old SL-mounted tonometer doesn’t fit on the new one anyway.

    I also recall when the patient with diabetes was the exception rather than the rule. Those days are long over.

  5. Hal

    Also, rather than avoiding needless embarassment, as you say, I use their embarassment as an opportunity to tell them how their additional body mass can cause them to lose vision in the future. It oftentimes motivates them to do something about it. Some of my proudest moments in practice have been patients that return in a year and tell me how they’ve lost 50 (or even 100) lbs because of what I told them.

  6. Mike the Eyeguy

    Along that same line, I’ve had several patients who’ve lost weight who’ve said that they were inspired by my own 40-pound weight loss 2 years ago. Those moments have been immensely gratifying.

  7. Stoogelover

    I couldn’t respond on my computer at the office, but I’m humbled by your link to my site! Thanks for the lifting of my spirits yesterday.

  8. Mike the Eyeguy

    Hey, thank you for the hot tip on the Disneyland ride. And yes, I agree with all the others, that grandson of yours will drag you back there several more times before you’re done for good.

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