As a caregiver for a disabled parent who exhibits behavioral issues during in office medical visits, it has been a GREAT PLEASURE to meet Dr. Amanda Paull! Dr. Paull and her staff are very dependable, caring and professional. I HIGHLY RECOMMEND Dr. Paull and her team... She does it all!!!!
Thank you so much - AGAIN - for coming to the house to tend to and treat my parents. You save them both a great deal of time!!! Thank you - All the best,
Dr. Paull makes home visits which for me is such a blessing as I am home-bound. She is very kind, patient, and a great optometrist. She personally and literally "goes out of her way" to help you!
Dr. Amanda Paull started her in-home eye care service in 2007 when she was asked to go to nursing homes to help several residents who could not make the trip to the optometrist’s office. She set up an eye chart and used specialized handheld equipment to give a full eye exam to those with mobility issues.
“I have about five percent who are under the age of 60,” Dr. Paull says. “They have some mobility issues like Multiple Sclerosis or they may have had some sort of trauma that keeps them from coming to the office.” Most of her in-home patients are 65 and over with some eye issue. She monitors patients with cataracts to determine if the patient needs surgery or if they can wait. “I see a lot of diabetic patients,” she adds. “If you have diabetes, it can show up as blood leaking out of the blood vessels in the back of your eyes. If this is occurring in your eyes, it may be occurring in other places of your body like your brain, stomach or kidneys. I also check for glaucoma, which is a silent thief of sight. The prominent condition, though, is cataracts.”
Dr. Paull explains that studies have found that a person with growing cataracts may have an increased chance of developing dementia. “Because, not only can they not see well, but it decreases the stimulation to the brain,” she says, “and decreases the correct circadian rhythm patterns. Removing cataracts can reduce the worsening of dementia.”
A homebound patient has little chance of having cataracts detected early if he or she doesn’t have regular eye exams. The concept of this came from a combination of Dr. Paull’s personality and her recognition of the need.
When I was eight years old, I needed glasses for the first time,” she says. “I actually had to get bifocals in the third grade, so I made yearly visits to my eye doctor. I loved her, and I loved the set of lenses that she showed me. I thought: That’s what I want to do when I grow up.”
She worked toward that goal from then on. “In high school, I worked at my eye doctor’s office and then at college – at William and Mary – that was my direction.” She earned her degree in Biology with a pre-med focus. At the time, only sixteen optometry schools were scattered around the U.S. She graduated from the University of Alabama’s School of Optometry. Returning to her hometown of Richmond, Dr. Paull worked for the same optometrist she’d been a patient for as a child. “She was my role model.”
While working at that practice, Dr. Paull began holding eye clinics in nursing homes. “We found that there was a niche for serving patients at their nursing facility or residence. I had volunteered in nursing homes with my church since I was about twelve. I loved working with the elderly. I’m really comfortable with that generation. My personality and the need came together in the perfect match for me.”
She found that patients in the office would say that they had a relative or friend confined to home, and they would ask if she could bring the same portable equipment used off-site to the person’s home. “We started trying that on an as-needed basis. It took off.”
The service began in Richmond but then Dr. Paull began working with a nursing home company that had clinics in Virginia Beach. “With my nursing home clients in Richmond and some in Virginia Beach, my family and I moved to Williamsburg to be half-way in between,” she explains. “Williamsburg is a beautiful city with a lot of nostalgia for me. This is where my husband, Travis, and I went to college. We have some close family and friends here. Travis and I have a five-year-old daughter, and this is a great place to raise her.”
The in-home eye exam is geared for patients who have great difficulty getting into a doctor’s office. “The elderly or people who are homebound,” she adds are the focus. “If a person can get to an office and say ‘better one or better two?’ on the tests and sit in the machine, that would be best for that person. My in-home exams are tailored for the elderly or those who may have trouble answering the questions asked in a regular eye exam.”
She says that she and her technician use the same type of equipment that is in the office, except it is portable. “We can set up the same thing in a patient’s home as we do in our nursing home clinics. It is specialized, handheld, state-of-the-art equipment.”
For example, she has a special machine called an autorefractor that sends an infrared beam into the eye to measure the patient’s focusing ability. “We don’t have to do the ‘better one or better two?’ questioning with multiple lenses to determine the best prescription to correct a patient’s vision. Based on the measurements from the infrared beam, it can report how much astigmatism or how much nearsightedness the patient has. It gets the prescription of the patient.”
Dr. Paull can also test for glaucoma in the home. “We can dilate the eyes. We can check the pressure – everything with hand-held equipment. We do a lot of non-subjective testing that can show us exactly what the patient is seeing and what he or she needs. We tailor it to the patient. Some can tell us their concerns and vision, while others cannot voice it so we do tests. They don’t have to respond to us. You can see in their face when the new glasses make their vision better. The patient doesn’t want to take them off. You see the ‘smile effect,’ and their eyes light up.”
One of her most memorable patients wasn’t a house call, but a boat call. “This man is very funny and personable,” she describes. “He has mobility issues and lives on a boat. He was a captain in the Navy and bought a boat instead of a house when he retired.” His condition keeps him from easily stepping out of the boat, but he can move around on it with his walker. “He was referred to me because he was starting to lose his sight.”
Dr. Paull found that his vision was good, but he had a disease of his optic nerve. “It was causing him to lose oxygen and nutrients to the nerve. He had to do some dietary changes. He didn’t like that. He really just wanted some simple glasses to correct the problem and to be able to see. But I explained the problem. He contacted me later and told me that the treatment had worked, and he could see again. That was rewarding for me that we were able to catch it and diagnosis it early.” If he had waited until someone could have helped him into an office, his recovery might not have been so successful.
Another patient was referred to Dr. Paull because of the need for a yearly exam from having diabetes. “I thought it would be a routine exam,” Dr. Paull says. “When I checked the woman, her eye pressures were in the 30’s. Usually, they should be between 10 and 20. Her pressures were very high, and she didn’t realize it. If that goes too long, a person can go blind from glaucoma. For her, we were able to prescribe some eye drops to lower that pressure. It’s like high blood pressure, you don’t know until it’s really high. You typically have no pain or visual symptoms with a gradual increase in eye pressure. It starts with the loss of your side vision, and most of the time, one eye will compensate for the other – you wouldn’t notice it. The eye pressure test is the way to identify that.”
She warns that there are a lot of conditions of the eye that are slow, painless, and can be permanent. “Age-related macular degeneration is the same. It may show in one eye and the other eye compensates for it. You want to know that you have it as soon as possible to get the early treatments.”
For those who are homebound, a yearly eye exam may be critical, yet sacrificed due to confinement. Dr. Amanda Paull wants to alleviate that barrier. “I want to make it easier for everyone to get eye care. I think I have the best job. It’s great knowing that I’m helping people. I hope I can be a little light in their life for the time I spend with them.”
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