optoblog.com

I took my son to see Godzilla in 3D on opening night. It was great that we shared the experience, but the Godzilla movie left me emotionally unsatisfied for 3 reasons:

(Spoilers ahead)

 

1. I thought the movie was about the father, but then they take a turn, and I guess we follow the son the rest of the movie even though the father had all the emotion in the first act.
2. Everyone knows you don’t kill the mentor until the end of the second act.  If the father isn’t going to play the hero, then I guess he is the mentor.  They kill the father in the early second act.
3. Fine, you kill the father early on, but you’re not going to let us see any catharsis with the father and son? Seriously, the closing image should have been the son at the father’s grave or something. Emotionally I want to see the son reconcile with his father.

Anyway, other than not being emotionally satisfying, Godzilla 2014 was…fine.

Tags: movies

I wanted to let you know about a useful site: eyewiki.aao.org

I particularly liked the page about slit lamp photography using your digital camera, a.k.a. “phoneography.”

I like the DIY homemade version, so I’m going to try it out and let you know how it goes within 1-2 weeks.

Tags: optometrist, photo

I would like to propose that someone perform a series of studies regarding living a low carbohydrate/high fat diet and its effect on inflammation-related eye disease.

I read The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable by Drs. Stephen Phinney and Jeff Volek. An interesting conclusion is how our bodies become carbohydrate intolerant as we age, which pushes many people into metabolic syndrome, diabetes, and hyperlipidemia. It turns out that carbohydrates, by taxing our insulin response, cause inflammation.

Hence, the American Heart Association’s war on fatty food is misguided (see Good Calories, Bad Calories by Gary Taubes) because dietary fat is only bad in the presence of too much carb intake.  While there are some high omega-6 oils which increase inflammation, it is easy for people on Very Low Carbohydrate (VLC) diets to intake the good fats like olive oil, canola oil, high-oleic safflower oil, butter, animal fats, and coconut oil. In VLC diets, your daily Caloric intake is approximately 80% fat, 15% protein, and 5% carbohydrate.

Recent research, CE lectures, and trade articles have been advising us to tell our patients to increase their omega-3 fatty acid intake via Fish/Flaxseed oil pills.  With the latest research coming from Dr. Phinney et al, wouldn’t it be more responsible to educate them regarding the New Atkins/Paleo/VLC diets?

VLC diets are already proven to tighten diabetes control which we know decreases incidence of diabetic retinopathy. Logic tells me that Atkins/Paleo/VLC will soon be proven to reduce incidence and/or severity of macular degeneration, dry eye syndrome, and any eye condition related to inflammation.

So, anybody want to do some studies?

I’d start by visiting this helpful website and reading these books:

DISCLOSURES:

In 2010 I lost 35-45 pounds using the hCG diet, but could never keep off the last 10 lbs, so in 2012 I switched to the New Atkins. Now I easily maintain a 50 lb weight loss (221 to 170), and my body doesn’t even crave things like pizza and popcorn.
Also, if you click on the links above and actually buy a book, I get a tiny referral bonus from Amazon.

Tags: AMD, DES, diabetes, diet, disease, nutrition, patients, weight

The Humphrey Acuitus 5015 autoRfx/AukoK has been the most accurate autoRfx that I’ve worked with, but for a while, it’s been taking 20-30 minutes to warm up. No big deal because I get to work 20 minutes early anyway; however, for the last week it’s been taking 40-45 minutes to warm up!

I read that Humphrey stopped supporting it in 2009. Does anyone know why it would take an autorefractor 45 minutes before it stops snowing on the viewfinder video and allows you to begin using it?

Tags: ophthalmic equipment, vendor

Flurisafe comes in a 6 mL dropper manufactorered by AL-ROSE Enterprises and is composed of Fluorexon disodium with benoxinate. Fluorexon’s heavier molecular weight makes it “safe” for use with soft contact lenses since it won’t permanently dye it yellow like fluorescein will.

If you don’t use Flurisafe, then you should try it out. I’m confident that you and your patients will like it better than fluorescein sodium/numbing drop combinations (benoxinate or proparicaine).

Here are my reasons:

1. My patients report less stinging with Flurisafe compaired to FluorBenox and especially proparicaine.
2. The mild stinging from Flurisafe seems to have a few seconds delay after installation, so that allows me to get the drop in both eyes easier for the little kids.
3. Most older patients report NO stinging with Flurisafe.
4. I can use it on any patient and not worry about rinsing it out with eyewash if they happen to want to try soft contact lenses later.

On the downside, it is a little more expensive than FluorBenox, but not significantly more. Also, I turn up my light level a little more using the blue light compared to using a Fluorette or BioGlo Strip; however, Flurisafe still lights up nicely while using a yellow Wratten filter (my slit lamp has one integrated; I just lower a pin.)

I get mine from Wilson/Hilco, but your usual ophthalmic supply company should have it also.

Try it! You’ll like it.

Disclosure: I have to financial interest in any companies or products mentioned above, and to date none of them have ever given me any free stuff.

Tags: eye drops, optometrist, pharma

I have previously announced my intention to dump OfficeMate because I didn’t want to spend close to $1000 updating my server software from WSBS2003 to WS2008R2-standard for the version 9 upgrade (and that’s in addition to the painful yearly software agreement fee).

Well, now I’m not so sure. All I need is for something to easily enter data and claims, export an ANSI 837 file, and include a ledger, receipts, and reports system so that I can easily see my accounts recievable.

Well, apparently that’s too much to ask because I have test driven several competitors, and believe it or not, their interfaces are actually worse than OfficeMate’s!. Several of them won’t export a simple ANSI 837 file to upload to a clearing house like Apex. Maybe it’s just because I’m used to the OfficeMate system after four years. I can quickly do all my insurance billing and receipts myself (no paid help) in OM8. Of course, so far this year I only bill insurance for 27% of my exams, which is close to average for my practice profile.

So if I abandon OM for another system, it’s going to take me way more time to process claims and figure out accounts receivable. With Walmart getting into the Medicaid game on glasses, now I’m sure I’ll have even more insurance to bill in 2011. So, as of now, I am leaning towards biting the bullet and doing what it takes to upgrade to OfficeMate 9.

An interesting topic is how many mouse clicks per patient one needs in EHR/PIM software. A doc at EHR Compare forum reports that it takes his office 200 clicks per patient in OfficeMate. Is it any wonder that many docs think EHRs are not ready for prime time? (Example 1, 2, 3)

Why hasn’t someone created a free or cheap, open sourced PIM/EHR that is easily navigable? I tried OpenEMR (which you can install on a windows machine using XAMPP), but it was confusing how to create charges with attached ICD9 and CPT codes, let alone create an ANSI 837 file.

Tags: EHR, EMR, OfficeMate, PMS

So I have OfficeMate in my practice. I started using them in 2006 with release 7.x, and I currently have 8.x. It uses an access database which never really needed a server because it’s just a file that you could put on one computer and share it peer to peer. At the time I went ahead and bought an expensive Windows/Dell server because they recommended it, but I found out later from working with it that I could have just put the OM db file on cheaper network attached storage.

Anyway, along comes progress. OM with release 9 has implemented the famous, awesome SQL database. What makes it famous and awesome is that SQL is opened source and cross platform. So of course OM implements a Microsoft only version of SQL. The Windows Server Small Business that I’ve been using isn’t supported, so now I am faced with paying a whole bunch of money for a new edition of Windows Server standard. If I upgrade to that, I might as well update my client machines to Windows7. If I do that, my current video cards don’t support it, so I’ll have to either buy new video cards or just a new box.

So now, with all that plus the yearly, over $1K fee for OM, I’m wondering if I shouldn’t start over with some other solution. To tell you the truth, the only thing I use OM for is electronic billing. I just scan my paper charts with my awesome and fast Fujitsu Fi-6130 document scanner.

I really wish OfficeMate would have implemented a cross platform implementation of an SQL db. I could have just used a free Linux server to host the db.

Tags: EHR, insurance, management, optometrist, PIM

I have a little side project at roadmapplanner.com. It’s especially suitable for students (college or high school), but as a professional I use it too. It’s really helped me since this summer to stop being a slacker spiritually and get on task. My family is happier for my becoming a better person by performing the tasks and achieving the goals I set for myself. Please consider it for a Christmas gift for you or someone you love.

The Roadmap Planner with the Daily Dats System™ is a set of 53 small, portable weekly planners with goal tracking integration and 3 week future calendar and white space for taking down notes.

An 8 1/2″ by 11″ sheet of white, uncoated, card stock paper is scored for a trifold on the y axis, and the user also trifolds it along the X axis. This double trifold design (like a road map 😉 ) compacts the page to a 2 7/8″ by 3 11/16″ footprint that fits in your pocket. Because it’s card stock, it’s rugged enough to last traveling in and out of your pocket the entire week. Fifty-three sheets come in the package, one for each week of the year.

Features:

• The Daily Dats System™ for making, tracking, and achieving your goals.
• To do list at top of each day.
• Plan A and B for each time slot of the day.
• Half hour time slots starting at 6:00 AM and ending at 11:30 PM.
• Current week planner on front and 3 week future calendar on back.
• White space for recording new contacts and other notes.
• Different motivational quote for every week.
• The day and date is pre-printed so you don’t have to write it out.

Tags: Goals, management, off topic, Roadmap Planner

Since “Biofinity” and “Biofinity contact lens review” are the most frequently searched terms leading to my website, I thought I would give everyone my view of the Biofinity contact lens.

Its technical specs can be found at the Coopervision website. Silicone hyrdrogel lenses (the super breathable class of contacts) have been on the market for years, but Coopervision came to the game after Ciba, Bausch & Lomb, and Vistakon. All the latter use a special coating on the surface to make the silicone material wettable for your eye, but Coopervision’s unique Biofinity material is wettable throughout the matrix of the material.

It’s a one month lens, which is convenient for most people to remember when to toss their now old lenses which will soon become cesspools ripe for eye infections. The reason is because they build up deposits, like this:

Lots of lenses are only two week and toss lenses, but Biofinity is resistant to deposits enough to allow it to be a one month lens. Official and approved.

Biofinity also got an FDA indication for extended wear. In other words, if your doctor thinks your eyes can handle it, Biofinity can be worn one week straight, take it out, clean it, soak it overnight, and then repeat.

Now, I’ve tried this, and while it was totally doable, for me it’s not as comfortable for extended wear compared to Ciba’s Night & Day (by the way, I refuse to call it Air Optix Night & Day Aqua because that is just waaaaaaaay too long a name for a contact lens.) But guess what. That’s just me. Maybe for you it could be fine. However, almost every patient I’ve tried this with comes back a week or two later and says they would rather be Rx’d Night & Day if extended wear was their approved goal.

If you’re just interested in daily wear (taking out every night) or if price is the main consideration, then Biofinity wins over Night & Day because it’s only around $50 per box of 6 lenses rather than Night and Day at ~$70 per box of six. Another consideration is that you can now get Air Optix Aqua (regular, NOT Night & Day) for ~$47 per box. My only beef with that is that it’s basically the same lens as O2Optix which was released as a two week lens, so I’m not sure whether to believe that Ciba wants you to wear a 4 week lens for two weeks or a two week lens for four weeks.

Comfort-wise, it seems to me that the percentage of patients that like the comfort of the Biofinity is about the same percentage of people that like the feel of O2Optix. Now, the only thing is, both those percentages are less compared to Acuvue Oasys comfort. But consider that a year supply of Acuvue Oasys (a 2 week lens) is about ~$272 while Biofinity is around $200.

Biofinity has a great toric lens in case you have low to moderate amounts of astigmatism (0.75-2.50) in one or both eyes. For mild amounts of astigmatism (0.25-0.50 and maybe 0.75), its aspheric optics help mask it for clearer vision compared to contacts without aspheric optics.

Anyway, my advice is to just try it out. If you like it, buy it. If not, try something else. That’s how I roll. I alternate between wearing Biofinity, Acuvue Oasys, and Night & Day. Mostly Night & Day. But hey, I’ve been wearing contact lenses so long that you could poke me in the eye, and I’d barely feel it. But seriously, I think I have significant corneal hypoesthesia which allows me to tolerate pretty much any lens that gets pushed out into the contact lens market.

Another consideration for you is the compatibility of lens material to your desired contact lens solution system. Some lenses can only tolerate the most expensive solutions. The Biofinity material is pretty much compatible with even the most cheapest of house brand multi-purpose solutions. On average. Your eyes may vary.

I think Biofinity is a quality lens, but take it home along with your Oasys and Night & Day or O2Optix and see which one works best at which price for you.

There, does that answer your question?

Tags: Answers, Biofinity, contacts, Coopervision, patients, Reviews

I have been exploring the option of accepting Medicaid in my practice. I have been told by some not to bother because the reimbursement is so low. Anyone can look up the reimbursement rates on the Utah state website. I’ve compiled the ones I expect to commonly use into a spreadsheet and compared them to Medicare’s reimbursement rates. Keep in mind that Medicare typically sets their rates at 60-80% of the average usual and customary.

The first thing you will notice is that UT Medicaid reimbursement is ridiculously low. Now, take the time to read the vision provider manual at the UT Medicaid site.

If you are like me, then you will have some questions. Here are the ones I had. Can any of you answer them?

1. Can I be a provider of Medicaid optometry services but not bother with providing Medicaid frames and lenses? I’m asking this because I may not be able to break even with thier reimbursement for materials.

2. Does Utah Medicaid have a lab I should use or would I be expected to find some ridiculously cheap frames and lenses to dispense? Oregon has a Medicaid optical lab where all Medicaid orders are processed. The doctors don’t lose money on materials, and they can charge Medicaid a dispensing fee.

3. The example of a frame upgrade in the manual was: normal price $35. Upgrade $50. Medicaid reimbursement $27.50. Is it okay for me to find some frames that I sell for $27.50 and dispense them to all Medicaid patients? I have heard stories of opticals using frames they can’t get rid of (i.e. discontinued models, ugly frames) as their Medicaid frames. Then they use an in-house lens grinder and put cheap plastic lenses with only a single side scratch coat into the frame. Is this okay? Pretend I only have ugly, BC frames for 27.50. The rest of my stylish frame selection runs around $100-$300. If the patient wants anything fashionable, then they’d be forced to upgrade and pay the difference themselves. So, why would I have any frames in the low price range other than 27.50?

4. Does the state of Utah honestly expect $27.50 frames to last two years? Seriously!

5. Can I opt to see only Medicaid children, not adults? I can see as many as 3-4 children in one hour, whereas adults take longer (they have more problems and love to orate about what a shock it is that ever since they turned 43 they can’t see up close anymore), so I can only see 2 per hour. If I’m getting so little reimbursement (39.29 on an S0620), then why not earn more money per unit time?

6. Can I opt to see only blue card recipients and not purple or yellow? From what I understand, blue card allows me to bill Medicaid $30 and any difference between 30 and my usual and customary can be charged to the patient. With Purple and Yellow, I have to accept Medicaid’s assignment as payment in full. Why would I want to see anything but blue card patients?

7. Why does UT Medicaid require refraction be included with 92004 and 92014 when that is not the definition of these services in the AMA’s cpt code manual? This question could be asked of most vision insurance companies. I believe the reason lies in getting something for nothing.

8. Why does Medicaid not pay for polycarbonate lenses for minors when that is the standard in the entire eyecare world? I believe the answer will be fiscal-no concern for trauma prevention.

9. Why is pachymetry (76514) not a covered procedure? Even Medicare pays 11.04. It’s only standard of care for not only Glaucoma, but many acute corneal conditions.

10. Why is the reimbursement for 92060 (VT Diagnostic exam) and 92065 (VT progress exam) set at the ridiculously low price of $5.32 and $4.13? Even Medicare, which typically reimburses 60-80%, pays $50.43 and $31.83. Do you think it’s ethical of me to know how to treat vision therapy conditions, do so regularly on patients with other insurance, but refer out a Medicaid patient because the reimbursement would cause me to lose money? The overly low reimbursement for VT services really chaps my donkey. They are forcing us to be unethical if we decide to be a provider because who in their right mind would accept 5-10% of their usual and customary as payment in full? The assignment is so low you would lose tons of money to try VT on a Medicaid patient.

Anyway, this is just the start of my concerns about becoming a Medicaid provider. I talked with an OBGYN physician once, and he says that for him, seeing Medicare and Medicaid is his charity work.

Another thing I don’t think is fair: How do you explain to your private pay patient that your exam really is worth the $85-100, but at the same time accept $35.50-39.19 as payment in full from a Medicaid patient?