optoblog.com

Of course I understand that everyone should have an eye exam at ~6 months of age. We should also have one at about age 3 and then every year after. Sure, many adults can reasonably go every 2 years. The goal of the AOA’s InfantSee^TM is that all 6 month olds should have an eye exam, and that eye exam should be free.

What??? Aren’t the practice consultants constantly telling us to value our time, charge fees for the services we provide, be willing to raise fees, and don’t give away exams, low fees or no fee devalues our services and expertise?

If that’s true, why does the AOA expect us all to become InfantSee^TM participators so we can give the whole world a free eye exam at age 6 months? Why stop there? Let’s create another organization to give away free eye exams at age 3, 4, 5,6…115.
Also, if these exams are so darn important, wouldn’t it be reasonable to expect people to pay for the service?

To restate, I’m all for promoting public health issues. Sure, public health problems like an epidemic requiring meds/shots should be sponsored by the government for the greater good of not getting the rest of us sick. In a time of crisis, I’d be happy to volunteer time and resources, but I fail to see why I should give away free eye exams to 6 month olds on a routine basis. They need them anyway, so let the parents pay or use their insurance. If they can find a benefactor to pay-Great! Let me know who foots the bill because I could use a benefactor to pay off my optometry education loans!

If anyone can find a link to what any of the respected optometry practice consultants have said regarding InfantSee^TM I would appreciate it.

If you’ve been reading this blog at all, then you know I give the whole commercial practice a very hard time. This was shaped from my perception of the only detailed view of commercial practice that I observed: a certain optical confined to a certain state. It was awful- no visual field machine (or any other special testing equipment), a curtain instead of a door, and an exam room the size of a closet. The worst thing were the opticians constantly complaining that the doctor isn’t fast enough (those darn dilated exams. . .). The doctor was there for only one reason: give out glasses prescriptions.

I visited a different chain this last week, and now I am willing to cut some of them some slack. The reason being I visited a doctor who runs 3 stores for a big box retailer. He has a digital non-myd camera and manages tons of eye disease in addition to the Rx-ing of glasses and contact lenses. I can now respect some commercial optometrists because they actually dilate most every adult and look for and treat eye conditions instead of “referring to a specialist” if the optic nerve looks suspicious for glaucoma.

If I was a patient, how would I know if I got the good commercial doc or the lens flipper? Look for the special testing equipment: digital camera, visual field machine, pachymeter. The biggest sign would be dilated exams: lens flippers don’t do them on most every adult and good docs do. Sure, I recognize that not every patient requires dilation every year, but there are some good guidelines published by the American Optometric Association,

“Pharmacologic dilation of the pupil is generally required for thorough evaluation of the ocular media and posterior segment. The results of the initial examination may indicate the appropriate timing for subsequent pupillary dilation.”
-Page 10 of OPTOMETRIC CLINICAL PRACTICE GUIDELINE- COMPREHENSIVE ADULT EYE AND VISION EXAMINATION

The first time the doctor sees you, it’s a good bet that you should get your pupils dilated. An optometrist pressured by the optical department to keep kicking out the glasses prescriptions as fast as possible will tend to dilated less, in my opinion. As a patient, how can you know if the doctor has your best interest in mind if he decides not to dilate? I would look for conflicts of interest. If the doctor is an employee of the optical, then there is an obvious conflict of interest. The chain employee will undoubtably get pressure to keep examination time down (and thus, not dilated as much).

There is another class of chain optometrist who is an “Independent Doctor of Optometry.” This lingo means that the doctor is not an employee but rather leases space adjoining the optical. These doctors have more autonomy, but at the end of the term their lease could not get renewed if they are consistently slow, people don’t like them, or any number of reasons- including no good reason.

This is why I still feel that commercial chains are not good for optometry or patients. Continuity of care is better if one can go to the same doctor year after year. If a patient moves away, (s)he knows where the records can be found. (See my previous post on this issue.) I would encourage all patients to visit the private practice optometrist of their choice. If they go to commercial practices, then “buyer” beware. There are good ones, but patients would have to know what to look for.

I probably won’t transcribe my podcasts unless they are really interesting. Since this is my first one, it’s just me talking about this site. At the end is some surprise information that you won’t want to miss. 😉
In the future, I intend these podcasts to be recorded conversations and interviews with other interesting eye care professionals and industry persons.
You can listen to it by clicking Optoblog Podcast for 2005-06-11 or you can just use your iPodder application to automatically grap this and future podcasts. Simply copy the feedburner site feed into iPodder’s subscription list.
For those of you who have no idea what a podcast is please see ipodder.com or podcastx.com

Podcast: Play in new window | Download

I’m upgrading my CMS from WP 1.2 to 1.5 so please excuse the mess.

When one is an “independent doctor of optometry,” then where do the charts go when the sell out commercial optometrist stops working for beside that particular chain? Well, the charts are theirs since (s)he is independent, so they go with the doctor. That’s fine and dandy as long as the optometrist works for long stretches of time in the same location.

I had a patient come into my office because the commercial doctor said she has a “spot” in (or on?) her eye and should be checked. He asked her if she had insurance, and she said no. He told her it would cost a lot to have the spot checked. She then said that she is enrolled with Indian Health Service, so he suggested she go there. Since I’m an IHS eye doctor, I saw her. I did a complete, yet unremarkable, exam. Since I didn’t find anything, I decided it would be best to get the previous doctor’s notes.

This is where I ran into trouble. The patient gladly signed the release and was thankful that I didn’t find anything wrong; however, when I tried to locate the doctor to fax him the records request, he had left Chain A and didn’t leave a forwarding address or phone number. The receptionist thought that maybe he went to Chain B. I called Chain B, and they stated that it would be best to not fax them anything for this doctor because he only very occasionally does fill-in work. I tried to look up his home phone, but he is unlisted. The state board does not list address information. Apparently he doesn’t belong to the AOA nor the state association because he wasn’t listed in their directories. I finally found what appears to be a home address in a search at www.arbo.org, so I sent my records request to the listed address (no phone number available). I don’t even know if the address is current because he may not live in that city anymore (Chain A and B are in different towns).

So, how can we fix this? First, let the consumer/patient beware. If they go to a commercial eye doc, they should realize that it could become a very big pain to try and track down their records later. Maybe they should ask for a copy immediately after each exam and file it at home. Second, I would hope the docs would leave a forwarding address and phone number with the commercial shop. That should be automatic, but the chain I contacted apparently doesn’t bother. Third, maybe the state boards should allow anyone to search for address information. If my letter comes back, maybe I’ll send the records request to the board and let them forward it to the doc’s last known address.

All of us optometric physicians are concerned about how HIPAA effects our practice- or specifically making sure we don’t get in trouble. Bruce Schneier, a security expert, has an interesting read on the latest HIPAA news. Apparently HIPAA’s enforcement may be weak.
I think most of us agree that HIPAA is just a big government bureaucracy that is unnecessary since we doctors have always protected patient privacy- it’s in our code of ethics. The big thing, now, is that we can’t ever slip-not even once, for fear of Big Brother repercussions. We can’t even let our employees slip. The common example is of an office assistant who tells a mother that he’s sorry to hear that her child is HIV+. The mother had not been told, so it becomes a big issue. The doctor, not the employee, suffers the legal/financial backlash.
Anyway, since HIPAA is apparently weak, can we expect it to be repealed and then reimbursed for the hassle it caused us in complying?

Oh yes. USA’s Independence Day is celebrated by fireworks in most places. Even though the 4th of July is just one day, there is a whole firework season for a couple weeks before and after “The 4th.” I have personally seen 2 kids in my office that had a bottle rocket blow up on their eye. Even after all of the expensive surgical procedures, they were left legally blind. Very, very sad. I wouldn’t wish that on anyone.

However, there is an organization that hopes to spare us all from witnessing and/or experiencing this type of tragedy. Prevent Blindness America, as one of its noble missions, wants to stop blindness caused by fireworks. I agree.

HOWEVER, their policy is that all consumer fireworks (firecrackers, bottle rockets, sparklers, etc) should be BANNED. That’s right, they want to take away your fun. I’m pretty sure our Bill of Rights includes the right to keep and light fireworks for the two weeks surrounding Independence Day. (Those of us in Latin American culture can also use them during Christmas and New Years. 😉 )

Seriously, one could parallel the NRA vs. gun control arguments, but I’m not going to (if you outlaw fireworks, then only outlaws will have fireworks!). My argument is that as long as kids are supervised by a parent, and as long as everyone around is wearing safety glasses, then there shouldn’t be a problem with consumer fireworks.

They cite a story of some punk throwing exploding fireworks into a crowd, and an innocent young woman is now blind. How does that translate into a reason to ban bottle rockets? This punk should have been charged with assault just as if he would have thrown a knife or other injurious object into the crowd.

The real fact of the matter is that parents must be more involved with their children while lighting fireworks and should ensure everyone present is wearing safety eye wear. Every man, woman, and child in America should own and use safety eye wear since many of our activities, hobbies, and sports necessitate eye protection.

Use your common sense and ANSI Z87 eye protection this firework season. Happy (early) Birthday, America!

Post Script:
I personally have a great poster made by Prevent Blindness America hanging in each of my exam rooms. It shows a child with bilaterally taped and bandaged eyes with the caption, “Fireworks can really make a kid’s face light up.” It’s a year round reminder to my patients. The agenda of banning all fireworks is in small print at the bottom, so most people don’t (or can’t) read it since it is across the room.
The organization also has some useful first aid tips for anyone involved in a fireworks injury.

I am having the hardest time finding a blog/CMS software that installs on my box instead of a web server with database. The idea is that I would like a blog with RSS feed, but my work won’t allow dynamic content or a database, so I just want an application on windows that will allow me to make a blog then export everything into static HTML with an xml file for the RSS feed. The files and folders that the local CMS app create are then copied and pasted into my work’s web development folder.
Obviously without dynamic content I can’t accept comments, but the main thing is I want to post news columns with an RSS feed.
I think there are lots of people out there that could use this because when I google for “static blog cms html” there are lots of people asking for it on the boards, but no one has posted a reply as to where one can find it.
Any ideas? Anyone at Lazyweb.org have a solution?

kcenter.org is a site all about keratoconus. What’s neat is they run a forum dedicated to discussing KC. Doctors and Patients conversing online about their eye conditions! What a novel concept! This is really cool, and I urge all ODs to go register for this site. Even if you don’t specialize in KC, is has some good stuff.
Now, I know what some of you are going to say. Won’t this spread rumors and half truths that we’ll just have to clear up in the exam room? Is it a good idea for patients to talk to each other about stuff like this?
Heck ya’! Knowledge is power. Forums like this empower the patient to be more proactive in their own care.
On the downside for some less knowledgeable practitioners, now your patients will know when to cut through the bull. A common sentiment that these forum members tell each other is that they have to trust in their eye doctor to manage their condition competently and if they don’t believe the doctor has the knowledge, skills, and ability to do that, then find another doctor.
This is what’s called riding the Cluetrain. Patients want feedback and discussion. A couple minutes in an exam room doesn’t satisfy. Find resources like this a give them to you patients. Ideally you would have your own practice forum, but for specific, life-altering conditions like KC, it’s nice to link to an international forum.

Kaiser, APHA, and some other foundation are 1. presenting a webcast of a forum on American Indian health issues. One of the topics will be funding. As I’ve said before, Indian Health Service funding is inadequate. The stats show we spend less per capita on American Indians than we do on the vets.
\rant
I can’t get my patients referred for cataract surgery until their vision is worse than 20/60! If I’ve got a patient with verrucae–tough luck. Only emergency referrals like PDR and RD are being allowed through the referral process right now. Let’s increase funding for American Indians to meet their needs! We signed a treaty, let’s abide by it.
Luckily, some of my patients have Medicare and/or Medicaid. The ones with Medicaid will usually go get their cataract sgx anyway and just pay the $5 copay. But the treaty didn’t say anything about only those on Medicaid can get access to care not provided by the local IHS service unit.
/rant
Anyway, the webcast should be interesting because funding isn’t the only issue. It will be available on 5-9-2005 after 4PM ET.