optoblog.com

An interesting article about the Indian Health Service. Hat tip to Kevin, M.D.

I used to work for the Indian Health Service. By the way, I loved it. The work was great. The pay was acceptable*. The people were great. But we all know the system has problems, but an IHS optometrist is insulated from most of those problems…until you try to get a cataract surgery for one of your patients. We had to wait until the vision was 20/70 or worse before Contract Care would consider paying for a referral.

The reason? There’s no money!

*I didn’t leave because I was unhappy with pay. My wife’s and mine extended family is based in Idaho and Utah, so we left the service and moved back to Utah to be closer to the fam. That’s important to people like us. I would have transferred to Fort Hall, ID or Fort Duchesne, UT but these locations had just been filled by optometrists who look like they are going to be there for the long haul, so I saw no chance of being any closer than 8-9 hours away from extended family unless I went into the private sector.

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I saw at medGadget a commentary about MIT’s Technology Review coverage of a computer chip surgically implanted in the eye which continuously measures IOP.

MedGadget says:

a pressure sensor to measure glaucoma continuously, instead of once every 6 months in the ophthalmologist’s office.

I would just change that to read, “instead of once every 3-6 months at the optometrist or ophthalmologist’s office.” 😉

But I was wondering at what point we implant these devices? Is the risk of the implant operation justified for a glaucoma suspect? If we already know the patient has glaucoma and we are managing with maximum therapy, do we need the implant? Can we even get insurance companies to come on board to pay for the chip and implant operation?

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Emily Webb wrote an article about optometrists and blogging for the newspaper of the Optometrists Association Australia. I’ll link to her article if they make it available on their website. She sent me a copy of the original print version and it’s found in Volume 28 Number 8 August 2007. Another optometrist interviewed is Dr. Stuart Macfarlane. For now I’ll just post the original transcript of my e-mail interview.

Emily Webb wrote:
> Hi David,
>
> It will just be a few questions:
>
> 1. Why did you start blogging?
>
I was introduced to blogging by Intel blogger and friend, Josh Bancroft, of tinyscreenfuls.com. It was when I went back to visit Portland during the October 2004 GWCO conference. He introduced me to the wonderful concept of web site syndication and the blogs that were using it. He also introduced me to the Clue Train Manifesto (cluetrain.com) which my take home message was that people want to give feedback to companies, and the companies should listen and change for the better in response to the open conversations they have with customers.

With optoblog.com I started out wanting to share optometry news and write reviews for ophthalmic equipment- like engadget.com and arstechnica do with computers and electronics. But I found out that just repeating the news I read from sources like AOAnews.com and revoptom.com is redundant. I don’t have to be a news machine if these source authorities would simply publish an RSS feed for their updated content. Instead, I try to focus on how I can be “part of a conversation” and what significance the industry news has for me. I would like to write more reviews, but they are more time consuming compared to jotting down a few rants about the state of the profession and ophthalmic industry. I wish more optometrists would give feedback to the ophthalmic vendors because improvements need to be made in the usability of products like PM/EHR software and digital exam equipment.

I’ve recently added a new feature: cartoons. My inspiration derived from savagechickens.com who draws hilarious cartoons on a yellow sticky note. Mine are on a sea-foam green back ground (like optometry thesis project report covers), and they’re kind of like political cartoons except they are just about our profession. Sure, the art is bad, but they could bring a smirk to your face.
> 2. What positives/benefits have come from the blog?
>
This request for an e-mail interview from an Australian writer is a highlight. I think the industry vendors have finally caught on to seeking feedback. Just this week I saw in my website logs that someone with an IP address from Johnson & Johnson (Vistakon-Acuvue) browsed around my blog and then searched my site for the word “Ciba.”
> 3. What do you like about blogging?
>
I can express my opinion, and maybe someone will validate it for me. I don’t get the opportunity very much to speak with my optometric peers about the state of our profession, and it’s my hope that blogging will start conversations with other optometric physicians. I could be way out there on a particular issue, so it allows me to go on the record, get the opinions of others, and then re-evaluate my stance. I hate the current state of web boards because they usually are exclusive and talk in secret behind closed doors. The ClueTrain Manifesto is all about open conversations, and I subscribe to that philosophy.
> 4. Your advice to novice/would-be bloggers?
>
I got into the geeky world of getting a web host and using WordPress.org for the back-end of my blog. It requires a lot of maintenance. I would just open an account at blogger.com or wordpress.com and let them take care of your back end- er…the technical side that requires almost constant tweaking and security updates. Ready-made solutions would allow you to focus on your content, ideas, and conversations.

Also, don’t dwell so much on the negative and writing rants exclusively (do as I say, not as I do).
> Also, do you have a photo you could email? It needs to be high res
> (300dpi) and preferably a portrait.
>
The best photo that I’ve got for now is attached. It’s taken with my digital camera at 72 dpi but the pixel size is 1280 x 960. When does this publish? If you gave me a few more days I might come up with something better.

Thanks for the interview!
-DJL
optoblog.com

David Langford, O.D.

> Cheers,
>
> Emily
>
>
>
> —–Original Message—–
> From: David (optoblog) [mailto:david@optoblog.com] Sent: Friday, 30 March 2007 3:43 PM
> To: Emily Webb
> Subject: optoblog interview
>
> Sure thing. I can do an e-mail interview. I’m just some cheeky
> American who has only been in practice for 4 years, but fire away.
> For your background information I have attached my C.V.
> -David Langford, OD
>
> Emily Webb wrote:
>
>> Emily Webb wrote:
>> Hi David,
>>
>> I am a journalist with Australian Optometry newspaper, the member publication of Optometrists Association Australia. I am writing a feature on blogging and I’d love to interview you with a few questions via email. My email is [******]
>>
>> Cheers,
>>
>> Emily Webb

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I needed to know what brand/style of PAL a patient was wearing, but I’ve always been too cheap to pay $36 for the Progressive Lens Identifier book from the OLA, so I searched to find an online version. An optiboard thread linked to Laramy-K Optical’s website. They have their own progressive lens chart, complete with laser markings.

And they even have a blog (although no RSS feed for posts, but curiously they have one for comments). They had even talked about me! That reminds me, I need to find some time to draw more cartoons. Ever since I stopped working at Lenscrafters, I haven’t had time to draw.

Anyway, Laramy-K gets my vote for one of the coolest optical lab websites.

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I was in the contact lens room watching a patient put in the contacts that I wanted to give him. I mentioned how the prescription would be good for 2 years per Utah law.

“Wow, is that new?” he asked.
“Umm, it’s pretty new. The state lawmakers got together and decided that’s how it should be,” I answered.
Then he said, rather sardonically, “Why, because they’re all doctors?”

I laughed out loud. It’s so true. When lawmakers decide to micromanage an entire healthcare profession by telling us how long we have to make a prescription good for, then I think they better have some proof that this new policy won’t cause more problems than it helps. Where is their research that supports such a sweeping change? And the research can’t come from 1-800 or Canada because we know they have a biases.

Now, the Utah law does say that I can make it for less than 2 years as long as I document some medical reason why it should be less. So…since nearly every contact lens patient I see was brought up on AV2 contacts (or some other low oxygen lens that is cheap), I think I could probably make a one year expiration on most everyone since most everyone in that category has mild corneal neovascularization.

So do I? No, because I switch almost everyone into a high oxygen lens, my preferred method for treating K-neo, so if they’re wearing an AV Oasys or Ciba Night and Day, what more can I do to help them?

But if they refuse to switch to a more costly (yet healthier) contact lens, then I explain how we should decrease their wearing time, maintain an approved replacement schedule, and monitor it next year.

One question for you all. Why do you insist on telling your patients that it’s okay to throw away their Acuvue2 lens once a month?!??!! IT’S A TWO WEEK LENS!! You are the reason I see so much K-neo. I hope you’re proud of yourself.

15 Comments

Okay, so how did your practices do this firework season? In my previous practice as an Indian Health Service optometrist in Browning, MT, I would see 2-3 injuries in June-July.

I left town for the 4th thinking I would escape having to deal with fireworks injuries, but guess what! I still saw a woman who got hit with a bottle rocket. Sure it’s two days after it happened. Her chief complaint? She needed new glasses, since the bottle rocket made her old ones have a permanent black cloud on them.

Luckily, this woman doesn’t have any damage to her eyes other than singed cilia. The scary thing is she was holding her kid while her husband lit off bottle rockets, so that firework could have just as easily hit a poor baby without any eye protection. He had a bottle, but this errant one was launched from being stuck in the ground instead of in the bottle.

My family traveled to another state where bottle rockets are also outlawed. My kids and I watched some legal, colorful fireworks, but when the person broke out the bottle rockets, I took my kids kicking and screaming into the house (yes, literally). I told them they could look at it through the window. Scary thing…the firework lighter was also just planting them in the ground instead of using a bottle.

So, I’m glad I didn’t let my kids be around bottle rockets. The TV news in my area has been reporting about organizations that would like to ban consumer fireworks, mostly citing the wild fire issues. To date 5 states have outlawed consumer fireworks. I am almost ready to agree, but I still dislike having my freedoms being infringed on. The nearest parallel I can think of to the fireworks issue are firearms.

People misusing firearms cause lots of problems just like people who misuse fireworks. Maybe instead of an all out ban, fireworks could be regulated like the gun industry. Maybe people should be required to pass a fireworks safety class and obtain a permit to light consumer fireworks. Maybe no one should be allowed to light off fireworks except under the direct, on site supervision of a fireworks permit holder.

The negative? Fireworks would become too expensive to (legally) buy since demand would go down and government taxes would go up to cover the cost of firework regulation. Fireworks could only be cheaply purchased from gangsters. Lots of otherwise good kids would get a juvi record. But perhaps there would be less impact from banning fireworks, than say alcohol, since no one really thinks about lighting fireworks except on Independence Day and Christmas.

People shoot guns and light off fireworks safely all the time- except guns and the shooting of guns are heavily regulated while fireworks are not. I am still not for the all out ban of fireworks. I would rather have common sense prevail instead of expensive government regulation, but if fireworks injury cases are any indication, it appears that self regulation isn’t effective, at least anecdotally. We need John Lott to commission a study about how pervasive this whole firework injury problem is and whether government regulation would be cost effective.

For the mean time, I’m not allowing my kids near bottle rockets.

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Ahh, yes. The smell of fireworks will soon be in the air. Dia Del Diablo in Guatemala is worse, but still, you have to admit there’s a distinctive aroma to fireworks and punks.

Or maybe I should say that punks with fireworks stink. Seriously, irrisponsible use of fireworks have made bottle rockets and firecrackers get a bad name. Prevent Blindness America and many eye doctors support the ban of consumer fireworks.

I grew up in Wyoming and day dreamed about fireworks as soon as the snow melted. I spend weeks in preparation for the 4th of July. Army men needed firecrackers strapped to them. Paper air planes needed bottle-rockets taped to them. Log cabins made of Popsicle sticks needed an M-80 placed inside them. Christmas wrapping paper needed to be thrown away so I could use the cardboard tube to make a bottle-rocket launcher.

Yup, I was the American Academy of Ophthalmology’s worst nightmare.

But I’m much older and wiser now. More to the point, I live in a state that outlaws bottle rockets and firecrackers, and I won’t do anything illegal because I don’t want my gun rights taken away.

So this 4th of July, make it a safe and sane holiday. Instead of whining to the government to outlaw consumer fireworks, lets sell stylish protective eyewear for everyone to wear in case they get caught as the innocent bystander to an errant firework.

And by the way, Prevent Blindness America, give me a break about that girl who lost her eye sight do to a firecracker getting tossed into a crowd. If you toss a pocket knife into a crowd you could poke an eye out, but no one is trying to outlaw pocket knives. Charge the perps- don’t take away my rights.

See another optoblog entry about fireworks.

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Ah, yes. Summer is in the air. Bar-b-cues, baseball games, blockbuster movies. Those are some things I’ve been able to enjoy so far. Not on the list is camping, traveling, and outside summer fun. You see, I’m an optometrist. I spend all day inside until about 7:00 PM. I do this six days a week.

I planned on becoming an optometrist because I had observed that they work Monday through Friday, 9-5. Not so in today’s market place. Today’s eyecare consumer demands Saturday and evening appointments so as not to interfere with their work. Sure, if they have to schedule a physical with their PCP, that might be worthy enough to take off work, but the eye doctor…nope.

Some background on my situation. I left a great Indian Health Service career to pursue my whimsical fantasy of private practice. You see, I wanted to live near extended family, but there weren’t any openings available with IHS. I had the belief system that corporate optometry is the devil, so I had to open a private practice.

Before being able to open my private practice doors, I had to work commercial while the loans and build-out fell into place. I learned too late the corporate isn’t the devil. It’s only individual optometrists who don’t practice to their potential that make a bad name for corporate. Of course, this is true for private as well.

Now, since my private practice didn’t take off for me like I was expecting, I work commercial 4 days a week and my private practice 2 1/2 days a week. No, I don’t have a ton of money. In fact, I’m up to my eyeballs in debt. My private practice is losing money and my corporate income barely covers the losses. My wife wonders if we’ll ever be able to move out of an apartment and into a house.

The only people winning is this scenario are the frame vendors, the labs, the contact lens companies, the equipment vendors, and the financing companies. Everybody but the optometrist.

My message on this Father’s Day is: “Mamas, don’t let your babies grow up to be [optometrists].” For those of you who have already committed to oppie school, I would suggest that if you for some strange reason pursue the open-cold-private-practice nightmare dream, go small. Bootstrap instead of going big because that leads to one thing: going broke.

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My boy watches Thomas and Friends about these trains that need to be “really useful engines.” Well, I’ve come across an optometry blog that is really useful. The Optometry Blog by ClearView Training is based in the U.K. From what I can gather, they appear to be a consulting company that helps you be a better eye doctor. What the heck is going on? I thought that all optometry consultants were like a pyramid marketing scheme- you give them money for the promise of a hope that you will make more money. Here is a firm that actually continues your training! Amazing!

What caught my eye was this useful little tidbit about asymmetric phorias on a cover test.

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Some dude came in today as I was leaving my commercial fill-in job to say he wanted a copy of his toric soft contact lens Rx so he could buy more contacts off the internet. Only one problem…it’s expired…by more than 6 months.

Sure, the doctor that was there before and long since moved away had noted that the Rx should expire in one year. The Dude kept saying, “Utah law says it’s two years.”

Now, I know the national law says one year minimum, so how come Utah law states the following?

the expiration date of the prescription, which shall be two years from the
commencement date, unless documented medical reasons require otherwise.

Could it be that Utah is home to the most widely known Internet reseller and that they have deep pockets for paying off politicians?

So, in the end I gave him a copy of his prescription, including the expiration date which has already passed. I wasn’t about to put my license on the line to extend an expiration without first evaluating the patient for myself. And Dude, do yourself a favor and get an eye exam to make sure the contacts aren’t doing any harm. After all, they are FDA-regulated medical devices. Do people go around to their psychiatrist expecting a refill on their meds without regular consultations to monitor their condition?

When you think about it, a lot could happen within just one year, so I think that’s more than fair to ask for regular contact lens follow up- especially the way I’ve seen individuals abuse their eyes through noncompliance with prescribed wearing time, replacement schedule, and lens care system. The bottom line is that I have the patient’s best eye health in mind, and the internet resellers with all their lobbying power just have their bottom line in mind.

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