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A friend and classmate of mine, Bret Ball, died yesterday, December 9, 2005 in his home. He was diagnosed with cancer 10 months after we graduated from optometry school. He went through many treatments, but the Lord saw fit to call him Home. He will be greatly missed, and I pray for his wife and family.

I first met Bret while in undergrad. It was outside the biology complex. Him and Nate (another PUCO 2003 classmate) are good friends, and I talked with both of them about optometry school aspirations. The first semester of opt school, there were 4 of us “Idaho Boys” that sat next to each other in the front row. I routinely sat next to Nate and Bret through most of opt school. We studied and practiced together. I was part of the crew that helped him move into a different apartment. He helped my family move when we left Oregon. We ate ribs, Bret’s favorite, to celebrate the end of a semester. Bret and Rachel have left many positive memories with my family. They are true friends.

I can say without hesitation that Bret was a very good man. He was a man of faith, family, and friends. He was also one of the smartest in our class. While the field of optometry has lost one of its rising stars, his impact will most be felt with family. I would ask any of you reading this blog to pray for Rachel and the kids and help the Ball family in any way you can.

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My father used Lensco for his contact lens lab, and now I use them as well. I love how they reduced their price on Ciba N&D. I also love that they offer a new service at www.directcontactlenses.com where patients order contact lens refills online or via telephone.

What are the benefits to using DCL?
Convenience for both you and your patients.
Incremental profits from potentially lost business.
Patient recall with our email notifications.
Patient Toll Free ordering.
Unique to DCL is a pre-paid return label with every shipment.

I’ve heard of other companies offering something similar, but it seemed like they took too big a cut. This service is simple and only costs $240 per year. I’m signing up because I think this would save tons of time for not only the patient but also staff. Check it out (lensco.com doctor registration required to see FAQ).

(I have no contact with Lensco other than ordering contact lenses via internet. I just think this service is cool and think all labs should offer this.)

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Liberals Pick up the Nose-picker Fight

Well, maybe they haven’t yet, but if their current philosophies and democrat history provide any indication, Liberals will soon be spending tax payer dollars to champion nose picker “rights.”

Nose picking is mostly frowned upon in our society, but since several studies¹ have concluded that nose picking is an inherited genetic “condition,” liberals will soon champion special treatment, “rights,” and tax advantages for out-of-the-closet nose pickers (NPs).

But, David, isn’t nose picking a public health hazard? Isn’t it “wrong.” Sure, irresponsible nose picking can transmit diseases to other people: colds, gastroenteritis, conjunctivitis, impetigo². When these illnesses are caused by nose picking, the natural reaction would be, boy I shouldn’t pick my nose- nor should anyone who comes in contact with me or my food! However, this would be republican “hate speech.” Benevolent liberals would have a plan for us all.

The first thing liberals would is pass laws requiring businesses to divert money from profits and install in their buildings one hand washing station per 500 square feet, one hand sanitizer dispenser per 250 square feet, and offer complementary latex-free five-fingered condoms (a.k.a. gloves) at all entrances.

But the liberals would be remiss if they didn’t educate our children about nose-picking. Special NP Ed classes would enter school curriculums nationwide. Liberals will also try to create a provision that students may not opt-out of the class if their parents object to what is being taught about nose picking. Republican parents may object to:
in-class demonstrations on nose picking.
adulation of the sensual nose picking experience.
hand washing and the use of hand sanitizers and hand condoms will be taught as the only source of preventing the public health risk caused by nose picking.
the fact that one could avoid auto- and trans-inoculation by abstaining from nose picking, but this relevant information will not be admissible in the class room.

Parents and students objecting to NP Ed will be called all sorts of hateful things by the Party of Love, among them will be “old prunes” (which look a lot like humongous boogers with a dark tint). These conservative parents will be laughed at in every state except Utah and Idaho. ACLU will mercilessly monitor the teaching habits and curriculums of Utah and Idaho school districts to make sure they comply with the liberal’s interpretation of the law.

I foresee a problem with a blue-state school district in a predominantly conservative neighborhood where the majority of workers are in the health care industry. They will pull their kids out of school to protest NP Ed. Of course, the liberals will call for troops to be sent in to squash the rebellion. Photos of 7th graders being “escorted” back to school with MP5 machine guns pointed at their head will be only available on the Internet since major media outlets will, at first, pretend such photos don’t exist. When the issue is pressed, they will admit they didn’t publish them because of “journalistic integrity.”

Of course, what the parents would also object to would be “Unit 2: detailed instruction on how to pick your friend’s nose.” Of course, picking your friend’s nose will be touted by the liberals as a “routine act, like going to the bathroom” and is also protected by the first amendment. The NP Ed curriculum will encourage students to believe that picking other people’s noses (POPN) means nothing, has no consequences, and relieves a physical and psychological need given to us by Evolution. Of course, forcible POPN with a non-consenting party is “strictly prohibited” unless you are from Arkansas or hold influence in the liberal hegemony. In that case, it is “someone’s personal NP life” and “we shouldn’t meddle in such private affairs” and “what goes on between people’s fingers and noses is none of our concern.”

The ACLU will make sure that all school districts know that they are not allowed to notify parents if their child is an NP or POPN, since that is against “privacy laws” and could defame the child (even if “everyone” does it?). The liberals will make sure heavy fines are enacted on school districts who deal so treacherously against the NP student, which will raise taxes (future headline: San Francisco Residents Donate 80% of Income [to government]).

In conclusion, the plight of nose picker rights to date has largely gone unnoticed, but I guarantee that liberals will soon come to their rescue as they try (in vain) to increase their party’s base.

1. Please note that, like many studies cited by liberals, these studies don’t actually exist. But come on! Isn’t it common sense that many people are born nose pickers? Think of all the kids in the world who pick their nose until their parents scornfully shame them into suppressing their Evolution-given desire to shove a finger up their nostril.
2. Staph. Aureus is one of the primary bacteria found in our nasal mucosa secretions. It is also a causative organism of impetigo (skin infection). Pretend you get a scratch on your skin which creates an open wound. A finger makes a journey from inside a nostril to touch the scratch, and theoretically you could get impetigo.

Comments:
I recently completed reading three books by Ann Coulter. Wow. I wish every “liberal by default” person in America could read her collective works and wake up from the brainwashing given to them from birth by the media outlets and education establishment. Reading Ann Coulter’s work was a direct inspiration for this blog entry. I wrote it because I want America to know that: I am a conservative, I have a blog to voice my opinions, and I vote.
I also misleadingly made the headline look like fact, because as Ann Coulter has shown, the NYT does it all the time with liberal opinions.
David Langford, OD
www.optoblog.com

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I commented in August about the preposterous claim that a Similasan eye drop could improve cataracts (or its symptoms). The FDA apparently sent Similasan a letter basically asking them to drop Cataract and Pink Eye drops since an average consumer can’t be trusted to make a correct diagnosis; therefore, the treatment shouldn’t be available over the counter. Kind of like it you experience rectal bleeding, there shouldn’t be an over-the-counter treatment available since it could be cancer, or it could just be the fact that you ate 2 pounds of almonds the night before.

I got the news from Contact Lenses Today e-mail newsletter. I suggest that everyone subscribe. (My only complaint is that it doesn’t offer an RSS feed.) Here is the transcript of the news regarding Similasan:

FDA Sends Warning Letter to Similasan
Last week’s CLToday included news on Similasan’s Cataract Care eye drops (See, Natural Relief for Cataracts, Nov. 23). It has been brought to our attention that the FDA sent a warning letter to the company in August of this year, after review of the company’s pharmaceutical manufacturing facility in Switzerland. The letter details problems with the plant’s equipment, control procedures and labeling for some products, including Cataract Care. The letter states, “Similasan Pink Eye Relief eye drops and Similasan Cataract Care eye drops are misbranded … The conditions for which they are offered are not amenable to self-diagnosis and treatment by individuals who are not medical practitioners.” The FDA also says because patients can’t distinguish symptoms of cataracts from symptoms of other serious disorders, OTC treatment is inappropriate.

By the way, I believe you pronounce Similisan the Japanese way, not the red neck way. “Sim-IL-i-sahn” not “Simil-ASS-an.” Imagine how Miyagi would have pronounced the Karate Kid’s name if he was Simil instead of Daniel.

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Ontario’s Health Minister called optometrists in his province terrorists because of a funding dispute between the government and optometrists. Imagine that. Optometrists just want to get paid and a socialist healthcare regime calls them terrorists. That’s a case of the pot calling the kettle black if I ever heard one. May freedom ring and capitalism prevail the world over!

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I’ve recently become aware of a site for opticians, www.opticiansfriend.com, because the site administrator left some comments in this blog. I really like this site. He’s got a lot of information pertinent to optometry. The site has a blog and a forum. It’s also got a good iseikonic lens calculator. In the two years I’ve practiced, I actually did that once for a guy who had cataract surgery in one eye, but wasn’t eligable to get it in the other eye yet. In IHS I couldn’t do contact lenses. I saw there was a proprietary software solution out there, so I just demo’d it and made some pretty funky looking lenses! But hey, they worked and the patient was happy that he didn’t see double any more.
Anyway, Mr. Cordova has a very nice site, and I encourage everyone to check it out. I’m subscribed!

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[edit 11-12-2005: Don’t read my original entry below. I just sound mean when I rant. I should have just politely e-mailed the person in private, stating my concern about RSS feeds (or lack thereof). All is better now because dryeyeblog.com has an RSS feed (see the comments for the link). Woohoo! Sorry that I’m mean. I’ll try to be less mean in the future.]

In my opinion a blog that does not include an RSS or Atom site feed is really only a “blog.” It might as well be just another website. If you subscribe to the e-mail newsletter Optometric Physician, then you saw in the 11-7-2005 news section that

“Vision Research, makers of TheraTears dry eye products, has launched www.dryeyeblog.com, aimed at providing doctors and patients with a means of keeping updated on the latest news, research and information on dry eye.”

Excuse me, but how can you keep me updated unless you provide a site feed? (Do you actually expect me to remember to always go check your site every day?) Since they are just using a blogger.com template, they could at least turn on the Atom site feed so that their news imports automatically into my bloglines feed aggregator. (If they ever get it, someone please leave a comment so I can subscribe.)

UPDATE: They responded and added a feed. That’s what I call service.

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I wrote a brief entry a while back critiicsing the concept of InfantSee. I would encourage everyone to read the reply I recieved from Dr. Scott Jens because I am going to discuss my opposition to InfantSee more in depth with this new entry.

Somehow the concept of InfantSee (ODs offering free exams for infants) was founded, the AOA champions it, and they get former President Jimmy Carter to be its spokesperson. They also paid a visit to Surgeon General of the USPHS, Admiral Richard Carmona (my former boss), and he praised the AOA’s efforts.

Now, let’s put aside this rosy newspaper fluff and talk about the sinister concept of InfantSee. To summarize the remainder of this entry, InfantSee is nothing more than a left wing, liberal agenda concept, but instead of government footing the bill, they want you, the private entrepreneur optometrist, to foot the bill.

Catering to the liberal agenda is not a new concept with the leaders of our optometric associations. You will recall that the keynote speaker at the 106th Annual American Optometric Association (AOA) Congress (June 2003) was Al Franken (a.k.a. that guy who played Stuart Smalley and also the author of the libelous “Rush Limbaugh is a Big Fat Liar.”) This also coincided with Franken’s doomed-to-failure launch of liberal radio, “Air America.” (I’ll save my comments on how hypocritical, ironic, and down right deceitful it is for liberals to feign patriotism in the title of their radio network because Ann Coulter and Rush Limbaugh have already made a panoptic study on how unpatriotic liberalism is.)

So, how does Al Franken, probably desperate to spread the word of his left wing radio show, get to be the keynote speaker at an American Optometric Association meeting? Obviously there are liberal forces in the leadership of the AOA. At least Essilor footed the bill to bring him there. In all fairness, I did not attend the 2003 AOA convention, so I did not listen to Franken. I still ask the question, “ What relevance does liberal Al Franken have to organized optometry?” Obviously at lot if the leaders of our AOA are involved in a socialist movement like InfantSee.

How does InfantSee relate to liberal agendas (i.e. socialism)? I just read the last pages of Ann Coulter’s book, “How to Talk to a Liberal (if you must).” She makes it painfully clear that our nation’s government has become a Nanny. Rush Limbaugh’s book, “See, I Told You So,” while written in the early 1990s, is still pertinent today. Liberals haven’t changed. Limbaugh asserts that liberals think they know what’s better for your family than you do. Liberals want you to abdicate all your resources the government, and they will benevolently redistribute it. The government must make children have free exams because their stupid parents won’t do it on their own.

I think the AOA is trying to make this a bigger public health issue than it really is. Here me out. Ideally, we pay taxes only for those things we couldn’t do ourselves or in small populations, like build roads or provide public health response in the case of something like the plague breaking out. With all of the challenges facing the public health of the nation, how far up their do eye exams for all children rank? I think exams for children applies to the free market principle of supply and demand. If parents really wanted their child to have an eye exam, that child would get an eye exam with parents footing the bill (either by pay-out-of-pocket or insurance premiums and co-pays). Our dues money that AOA spent on forming and advocating InfantSee would be better spent with public/parent education on the importance of eye exams for their children. If the parents want their child to potentially experience poor performance, or in some cases disability, due to an unrecognized vision condition, then that a decision that their child will have to live with. I’m sure society can always use more minimum wage workers.

However, if a parent is responsible enough to do all they can to ensure opportunity for the success of their child, they will no doubt budget for an eye exam along with soccer cleats and preschool tuition.

That being said, another free market principle applies: business marketing. We all do things like give away freebies as a marketing tactic. The idea being, whatever I give away for free will be compensated by generating increased revenue. In healthcare, we typically offer free screenings as not only an exercise in public health, but also to increase business! If I do enough screenings, I’ll find individuals that fail, and, therefore, will be in the market for my products and services. Why didn’t the AOA advocate free screenings instead of free full exams in the first place?

At the GWCO conference in October 2005, the AOA president himself told us that the AOA is sponsoring a bill before congress requiring eye exams to children. He mentioned that organized ophthalmology is sponsoring a competing bill, which emphasizes screenings, not exams. Of course, I wouldn’t want to refute InfantSee in my blog because if I say screenings would be better, then I’m dangerously siding with the arch enemy of optometry: organized ophthalmology (which is sad because on a personal and professional level, I’ve only ever met 1 or 2 ophthalmologists who are unfriendly to optometry.)

I think the only ones to benefit from InfantSee would be ophthalmologists, not optometrists. In many cases, if there is a problem at age 6 months, I would refer to the pediatric ophthalmologist (who can now make more money because she/he can bill for a consultation while I made zero dollars for my expert diagnosis and management plan).

Also, in an exam, I have all the liability if I’m wrong. If I give away the exam, I just assumed some risk without any reward or compensation for malpractice insurance premiums. Now, lets change the idea of “free exam for 6 month olds” to “free screening for 6 month olds.” That makes me happy. Children either meet the criteria or they don’t. Now I’m comfortable with the risk because the criteria were set by some highly educated body.

But these last two arguments aren’t really the point. The point is that InfantSee is a veiled liberal/socialist program. We should all have recognized it as a liberal plot when we learned Jimmy Carter is the spokesman. I encourage every conservative eye care practitioner out there to embrace free market principles and reject InfantSee. Do not become an InfantSee provider and encourage your colleagues to boycott this program. Instead, we should educate our patients on the value of early eye exams for children just like we educate them on the value of progressive addition lenses. Parents should expect to pay for children exams just like they do no-line lenses.

P.S. The following paragraph is taken from the AOA website. The items in perenthesis are mine.

Join AOA in the “pomp and circumstance” as the AOA officially opens its 2006 Optometry’s Meetingâ„¢ in Las Vegas by bringing a well-known keynote speaker to attendees. Previous speakers include: former President Jimmy Carter (liberal), Al Franken (liberal), John Naisbitt (who?), Paul Harvey (a thorn in my side because he markets vitamins as helping floaters go away which I have to constantly explain to patients was debunked by AREDS), Frank Sesno (CNN journalist and most likely a liberal), John Stossel (most likely conservitive), Dave Barry (just a funny guy- politics not immediately clear), and James Carville (very liberal) & Mary Matalin (conservative).

It is obvious to me that our AOA leadership caters to liberalism with their keynote speakers 4-2.

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Well, my family is home safe from PDX. We had a miserable time because the kids were sick (at both ends) and we didn’t get to see all of our friends. On the plus side the people we saw were great and the CE was good. On Saturday I especially enjoyed Dr. Smythe’s class on GP contact lens fitting considerations. She mentioned how it’s hard to get docs to come to contact lens lectures anymore. (I guess there’s not as much money in CLs.)

There was not only a free lunch but also a free breakfast on Saturday. I talked with more exhibitors. The best conversations I had were with other optometrists. None of them were willing to do a podcast with me, so I’ll loosely paraphrase. Dr. Adam Dayley in Orofino, ID has taken a dying practice and started to turn it around. Dr. Dayley graduated with me 2 years ago. He found a diamond in the rough. Apparently, one of the reasons the practice hadn’t been doing so well was that the Dr. was not TPA certified! Ouch. Think of all the missed opportunities if you can’t even Rx drugs for eye conditions! Adam has a lot of sage advice for the new O.D., and I wish he had a website I could link to.

Another couple of new ODs out there, making the grade on their own: Chris Johnson and Jon Ashbaker. Chris actually used the Williams Consulting Group and told me, “What ever they say, just do it. Even if you don’t understand it, just do it.”
That’s saying something from Chris because he’s a smart person that has to understand everything- figure it all out in his head.
I talked with Jon a lot about coding and billing. He has some pretty good office forms that he graciously showed me.

One thing, doctors. When I was searching for your office website, I had to do a lot of searching. Ideally, I should just be able to type in your first and last name (or your practice name if I know it) and city and state, and bam, I should see your practice at the top of the list. Your web sites? Nowhere to be found. I had to search through VSP’s doctor locator or eyefinity. Let’s get some web search savvy!

Back to GWCO, they cater to the coffee drinkers. There is always a free cup of joe in the foyer, but what about the hot cocoa drinkers! It would have been so easy to have hot water and packets of cocoa. I particulary enjoy Stephen’s gourmet hot cocoa. (hint hint ;)) My tuition money went to pay for coffee I would never drink.

Anyway, my final thoughts on GWCO. It’s hard to blog an optometry conference. I heard Adam say they are all pretty much the same, and he’s right. I will go on to say that they shouldn’t require new grads to have CE for 2-3 years after graduation since things change relatively slowly. I also dissagree with most state boards limiting the amount of CEs one can obtain via correspondence (internet, mail). I can get a whole degree online, so why can’t I get most of my CE’s online? After blowing $1000 in tuition, travel, room, and food, I’m a little disappointed in what I’ve come away with. On the whole a good experience, but worth the monetary price? I don’t know. I was happy to see that the president of the AOA came, but I’m pretty sure there were less people in attendance this year than last year. I don’t know if GWCO releases their numbers.

GWCO does well in Portland, but since it is the Great Western Council of Optometry, will they ever hold the meeting in another state? I’d like to see it held in Seattle, Boise, or (Heaven Forbid) Salt Lake City. Since the meeting has been held in Portland every year in recent memory, I’m sure they’ve come to some consensus on why it has to be in Portland every year. I’d just like to see the arguments. If it’s all about money, then why do any of the conventions change venues from year to year? I’m sure it has to do with the PUCO support of the whole thing. They rely on PUCO interns to help with the doors. They rely on many of the speakers being from PUCO. It’s a great meeting, but it’s clearly an Oregon meeting. I like visiting Oregon, so I don’t hold any grudges.

GWCO 2005 overall Grade: B
That’s just me. What’s your opinion?

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I forgot to mention yesterday that to get CE credit, they have you wear a name badge with a bar code on it which is scanned with a red laser deal with a VERY loud beep. Isn’t there a silent mode on those things or at least a volume dial? Lining up to “get scanned” feels like a violation somehow. It feels wrong. Maybe I watch too many movies.

To add insult to injury, you’ve also got to get a paper stamped for your personal records. Over at the AAO meeting, they usually have you swipe a card. You do it yourself. No violation feeling. They send you a printout a week later with the CE events you swiped in and out of. I hope GWCO is transitioning out of the paper stamping. I also have this ARBO card. How come I’m not swiping it instead of getting scanned like some kind of cattle?

Anyway, it was another great day of CEs at GWCO. The conference is large enough to run at least 3 classes at a time for the ODs and then another for the para-optometrics. I stayed up waaaay to late last night blogging, so I was a little tired for the first two classes. The first class by Dr. Teplick kept me awake, but the second class I took put me to sleep. While it was very interesting content, taught by a very knowledgeable doctor, my tiredness combined with the speaker’s near monotone voice put me down. One hour into it I realized that it could be considered unethical to take CE credit for a class I slept through, so I exited and left my paper with the door attendant. The main floor of the Oregon Convention Center has a surprising lack of seating, but the third floor administrative area has an endless row of couches along a hallway. Since it was vacant, I lay down for one hour of deep sleep. I awoke to find a security guard perched two couches down. I secretly wonder if he was sent there to monitor me. I have delusions that someone called down to security and said, “There’s some stranger laying down on a couch up here, clutching to a backpack. He looks suspicious.”
Of course, this would be movie plot security which I hope the OCC security team doesn’t subscribe to (unlike the NYC subway incident). When I got up and headed to the elevator, the security guard asked, “Have a nice nap?”
“Yah, it was great.”
“Sometimes a power nap is all you need to get refreshed.”
“Yah.”

So, I’m pretty sure he was just sitting there by coincidence, but I can’t help but imagine these movie plot scenarios where some innocent napper is mistaken for a “person of interest.” This thought process is what happens when you have too much time to yourself.

Anyway, the exhibit hall opened today. While it was pretty big, it wasn’t really big. I’m sure there would be more vendors if they weren’t all recovering from partying too hard at Optowest (Las Vegas) one month ago. I’ve taken an interest in PIMS/EMR software. There are just three that I noticed at GWCO: Maximeyes, Compulink, and OfficeMate. I couldn’t speak to the OfficeMate people because they were always slammed with people around their booth. There were more people at OfficeMate than the Optomap booth!

Now comes my next gripe of the day. When I’m pricing things like equipment and PIMS/EHR software, how come the pricing schema is so complicated? How come they have to get back with me and send me a quote over the e-mail? How come there is a regular price, plus add-on module prices, plus maintenance pricing, plus support/training pricing, plus convention discount, plus new practitioner discount. . . And what’s the deal with a “quote.” Quoting a price makes it sound like I could have gotten a better deal if I were someone else, like my competition down the street. If they would just immediately state a price that everyone pays, I wouldn’t feel like I was getting played.

Can you imagine if everyone had to put up with this garbage to buy a computer or palm pilot? I guess we already kind of do with buying a car, but I wish our ophthalmic industry model was more like consumer electronics: open access to pricing, lots of independent reviews available from multiple sources so we can research which products to buy (for example, which topographer or AutoK/Rx do I buy? There are so many out there, but so little reviews). When I access ophthalmic distributer websites, they don’t list prices. Why not? Do they expect me to call every firm and get a price quote? Save me some time and publish the prices! Of course, they might contend, we are entering a relationship with you when you buy something from us. Well, I want a product, not a relationship! I don’t want to get soaked because I’m a business instead of a consumer. Just because I’m a business doesn’t mean I’m made of money.

The bank I used to finance our minivan has a service where they’ll call to every dealer nearby and haggle and get us the lowest price on the car we want. Websites out there get you the cheapest price guaranteed for hotels and flights. I propose someone out there start a service like this for the ophthalmic industry. Gimme the cheapest price. Why should I pay more than necessary?

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