optoblog.com

MedGadget reports that optical coherence tomography helps diagnose and manage multiple sclerosis, and they display an HRT2-3 picture.
So my HRT2 may still have legs! Now I’ll get the referrals from the neurologist (to use my HRT2) instead of the other way around!
I’m sure they’ll charge extra for the stats package that helps manage MS. But listen to this:

In addition, says Calabresi, OCT scans take roughly one-tenth as long and cost one-tenth as much as the MRI, which means they are faster and cheaper to use in studies that track the effectiveness of new treatments for MS.

They must have really cheap MRI’s where he comes from. The average price in my neck of the woods for optic nerve imaging with Stratus OCT, HRT2-3, or GDx is ~$80-90 for both eyes. Do you know of any place that just charges $800-900 for an MRI? I believe it’s more like $1200. Also, you’d have to additionally pay a Radiologist to give an interpretation and report, but the optic nerve imaging fee includes the report.

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So I went to the bank today and the new teller said, “So you’re an optometrist. What’s the grossest thing you’ve ever seen?”

I assumed she meant personally, so I didn’t answer anything about what I’ve seen in text books or CE.

“Well, I haven’t had to see a lot of gory stuff since I’m an optometrist and not a surgeon…but I’d have to say something that gave me the willies was crab lice on the eyelashes. That’s an STD.”

You should have seen the look on her face. Her reaction was a combination of shock and disgust. She said, “Oh gross.”

Then she turned to her co-worker running the drive through and said, “Did you here that?”

Yep, she was so appalled that she had to share it with others.

Next time I’ll just keep it simple and say something like, “Well, there was this really, really red eye. I mean really red…”

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I once heard this from a rep, and this cartoon was immediately spawned in my brain.

And I know that women don’t normally buy the engagement ring, and yes, I just use the same pictures and change the words.

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Seriously, would it be okay if we farmed out patient education on presbyopia to the techs or opticians or something? Are eye doctors the only ones on the planet who have ever heard of it? From the 40-something mildly farsighted patients especially I get these incredulous looks.

“But I’ve never needed glasses in my entire life!” they say.

If they can mandate that my child take sex ed in school, why can’t they mandate that everyone be forewarned about the whole presbyopia thing? I remember in second grade health class learning about the digestive tract with a slide show of a cartoon character traveling down a river on brown barrels. Why can’t they do a little ditty about the eyes too?

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Here’s another example of why everyone should consider getting a yearly eye exam despite what Canadian studies say. A college student came in for a routine eye exam to get more contacts since the last doctor made her contact prescription expire only after a year. Everything seemed normal except that this year she didn’t pass the FDT screening field with one eye and that same eye had 20/30 vision. The ONH looked a little pale and both were elevated.

If I was still in Indian Health Service, I could have handled this myself- ordering all kinds of fun tests. But what I’ve learned out in the private sector is that insurance companies HATE it when optometrists order tests. Patients get denial letters on labs. Forget about imaging. Besides, I was having a train wreck day, so I just punted to the ophthalmologist.

Turns out that an MRI ordered by the OMD diagnosed a brain tumor that would have killed her if allowed to fester. I know that because she stopped by last week on a day that I wasn’t there to say thank you. When I heard that, I felt ashamed. I should have been the one to piece together the information and order the scans and have the burden to tell her the bad news.

But regardless of my personal shame, the patient is now okay. She is yet another shining example of why Utah state law should not mandate to me that I have to make prescriptions good for two years. I saw her chart from previous years. No VF defects, 20/20 vision in both eyes- no indication that the next year she would be diagnosed with brain cancer.

Hey 1-800 and your lobbiests! Who knows how many people you will kill or blind because you force by law that every eye doctor in the state of Utah has to make their Rx’s for 2 years.

So everyone: check yearly, see clearly, live longer.

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This is what I wish I could say to patients when they ask about private practice glasses prices. Do you ever feel like we’re being sold out by the very lens companies that say they’re looking out for us? For example, Wal-Mart sells lenses for cheaper than I can buy them from my lab. How does that happen?

What if a whole bunch of private practices started a co-op lab so that all profits from the lab go to the doctors? Or is Red Tray Optical the answer?

I like the consignment deal that VSP offers with their line of glasses. Why should I have to pay for frames that haven’t sold? Since frames now days look so freaking wacked, I think all frame vendors should work on consignment.

All I know is that doctors seem to be getting the short end of the stick while the frame and lens makers are assured their cash. I don’t see a profit motive for Big Lenses to help out private practice docs since commercial makes them more money overall.

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At my round of golf after some CE a couple weeks ago, the topic of conversation drifted to what practice management software was everyone using. Of course, for years we have been inundated with PIM/EHR software ads in industry magazines and booths at conferences and conventions. I still haven’t seen an appreciable improvement in the EHR part of the package. Sure, the PIM helps me track the money, but the EHR still slows me done. It would be faster to draft a paper chart and then scan it under the patient’s name in the PIM.

The whole reason to utilize a database for EHR would be to track numbers over time. For example, OfficeMate has this feature in the fields of IOP and C/D ratio. BUT THE WHOLE CHART SHOULD BE THIS WAY! And it would be great to have the functionality to analyze binocular testing data according to OEP, graphical, and normative analysis.

Anyway, if your EMR is just basically storing text for you instead of inserting data into searchable/analyzable database fields, I think it’s faster to scan your paper copy and link it into the PIM instead. Plus it will save you money on buying a separate EMR module.

Here were EHR wants number one and two.

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[Edit: For some reason, this is the most popular page on my site thanks to people searching the internet for mentions of Biofinity. Please be sure to read my other article entitled There is No Biofinity Conspiracy.]
Also, be sure to read my Full Review of the Biofinity Lens!

I posted an entry on my practice website about the Biofinity lens. Within less than 2 hours, I got the following comment in the comment moderation cue:

Author : John Bird (IP: ***.**.**.** , [URL removed to protect the innocent])
E-mail : jbird@aol.com
URL :
Whois : http://ws.arin.net/cgi-bin/whois.pl?queryinput=***.**.**.**
Comment:
I have tried Biofinity and quickly went back to Oasys. Oasys is a more comfortable lens, and it doesn’t have the problems with protein build up that Biofinity does.

Before approving the comment, I sent the following e-mail to “John Bird”:

Mr. Bird,
I’m skeptical of your comment. Tell me who you are, how you know the
phrase “protein build up” and how you happened upon my article shortly
after it was posted, and then I’ll think about approving it for my
patients to see.

Then I recieved word from AOL that the message couldn’t be delivered:

This is an automatically generated Delivery Status Notification

Delivery to the following recipient failed permanently:

jbird@aol.com

Technical details of permanent failure:
PERM_FAILURE: SMTP Error (state 13): 550 MAILBOX NOT FOUND

So, someone made up a fake name and e-mail address and tried to push people away from Biofinity to Acuvue Oasys. The IP address links the poster to a company named ************, a “***** ******* *** ****** ******* firm.” He could be just a random employee of a big company in New York who happens to subscribe to content from the website of a small optometrist office in Utah.

Or…what do you think?

And is there any truth to Biofinity getting deposit build up? From what I’ve read the Aquaform material is supposed to resist deposits.

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I was listening to an ophthalmology update podcast number 7:

# Program Title: Deciding when to treat glaucoma, and what to tell patients.
Description: A conversation with George L. Spaeth, MD, Professor of Ophthalmology and Chief of Glaucoma Service at Wills Eye Hospital in Philadelphia. He has a special interest in the quality of life of patients with glaucoma, and insight on deciding when to treat.
Speaker: George L. Spaeth, MD

Dr. Spaeth’s premise is that when you tell someone that they have glaucoma, you lower their quality of life. At one point in the conversation he states that even if someone has visual field loss, you still may opt not to treat, again citing quality of life concerns.

Okay, let’s step back. The mere fact that you are running all these extra tests like visual fields, fundus photography, HRT2/OCT/GDx, and checking their IOP every 3-4 months is going to cause some worry. Am I going to look them in the face and say, “No, you don’t have glaucoma even though, as I just showed you on your visual field printout, you have some areas of decrease vision. And disregard these big, red X’s on the HRT2 printout.”

So, I’m not going to treat someone because I don’t want to hurt their feelings? I suppose that would go over really well in a malpractice suit.

What if I simply said something like, “Yes, you have glaucoma, but odds are you won’t go blind if we start these drops as soon as possible and make sure you take them everyday and see us back for regular follow-up to maintain our target eye pressure goal.” Would that approach be enough to soften the blow to their quality of life?

And while we’re on the subject of glaucoma, I think it’s preposterous that the American Academy of Ophthalmology stopped admitting optometrists to their annual convention with CE. The public health is at stake. Already someone over in the UK did a study and smeared optometrists by saying that optometrists were more likely to miss glaucoma than ophthalmologists (listen to As Seen From Here podcast episode #48, start listening around minute 26:00).

This whole glaucoma topic just makes me shiver when I think that there is such thing as a glaucoma specialist. I know I’ve already gone over this before, but ALL eye doctors must be glaucoma specialists for the sake of our patients. I foresee in the future that maybe every complete exam will include stereo photos given to the patient in case they switch doctors, HRT2/OCT/GDx testing, and using one of those new fangled ways of testing eye pressure thingies that I don’t quite understand yet because I can’t afford yet another expensive instrument in my practice.

Yes, the expense will be enormous to implement these tactics. Maybe those who don’t include such things in every exam should just call their routine eye exam an eye screening. But doing that is one step away from having the ophthalmology establishment legislate out of existence the optometry profession since we would be ignoring the public health by only providing eye screenings and not full eye care.

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Dr. Epstein elucidates the ramifications of the staining grid in the latest Optometric Physician e-journal.

I think the real reason there is any controversy is because Renu, which has a huge market share thanks to lower cost, has so much to loose. Of course Alcon/Optifree and Ciba/ClearCare are jumping all over it since it makes them look good. I guarantee Renu would embrace the Staining Grid studies if it would have shown favorable results.

We saw the same thing when Renu Moisture-Loc was recalled. Optifree and Complete sent e-mails out to optometrists gloating that their products were safe. Then we saw Complete get recalled.

There are even studies trying to show that the Staining Grid study design is flawed; however, noticeably absent from inclusion in the study is Renu. All I have to say is, make a better product and you’ll get better results. If Bausch & Lomb is so concerned that Renu doesn’t do so well with most contacts in the Staining Grid tests, then maybe they should re-tool and make a better solution. Don’t try to tell me that, awe shucks, corneal staining really doesn’t matter.

Meanwhile, Biofinity, Acuvue2, and Acuvue Oasys are also capitalizing on the staining grid by sending to my office pamphlets and copies of studies saying (in effect), “Look at us. It doesn’t matter what MPS your patients use if you fit them in our lens.”

I’ve actually posted on my practice website a little ditty about the staining grid.

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