optoblog.com

Like I planned, this morning I caught the bus to the transit center to the MAX to the Oregon Convention Center. It took 50 minutes, but I felt pretty cool because I thought I blended right in. I was wearing my blue water-resistant jacket and an mp3 player around my neck and earphones. I should have been listening to Jon Young, MD’s “As Seen from Here” podcast; however, I was listening to music since I was about to get a lot of CE credits live.

This year all of the GWCO classes are in the OCC (last year the first and last day was in the Double Tree hotel). The AOA president, Dr. Richard Wallingford, OD, was here and spoke a couple times. The big news is the whole InfantSee program and a new PR plan being implemented by a major PR company. To pay for it, all the AOA dues went up by $60 across the board. Also, there will be a monthly e-newsletter updating us on what is happening in Washington D.C. President Wallingford said the AOA has on file about 16,000 e-mail addresses.

When will people start catching on to RSS? The AOA news site would be ideal for RSS feeds, but I suppose they make you log in to read it because it’s a benefit only for registered members. Since they are putting the AOA Washington Update on the e-mail, they should expect it to become public domain through everyone forwarding it on to a (heaven forbid) non dues paying optometrist. So why bother with the E-mail? Just use RSS already!

Dr. Wallingford mentioned there are roughly 400 optometrists effected by the recent hurricanes. A disaster relief fund has been established with VSP, Essilor, and Luxottica leading the donations.

The morning CE was great. The doctor talking about coding sure knows how to side step a question. He should be a politician. I took a class from him later in the afternoon about medical records, and I’ll be he danced around more questions than he answered, yet you gotta love the guy. His Wisconsin accent and demeanor make him endearing. He should really be a politician. He could do the Patomic two step in his sleep!

I went to the PUCO alumni lunch, and wow there was a lot to cover. First, let me say the food was unusually good. They sprung for a very good grilled chicken over a nice salad with bread and cake.

Then they barraged us with a whole lot of awards and big announcements. Among the awards were:

GWCO scholarship: Kelsie Cutler
Award of Appreciation: Leland Carr
PUCO Alumni Service Award: Pat Cummins

Big Huge News:
Lee Carr is leaving his position as Dean of PUCO. Why? The rumor I heard was that he wasn’t “happy.” What does that mean? The rumor wasn’t very specific. I don’t know if health problems played into his decision either. I do recollect something he said in his accepting of his award, “Don’t accept 2nd best. Use your voices to make sure they do this job right.” I think he was referring to the next big news.
PUCO was forced to close their Northeast clinic and they will also be closing their Southeast clinic. What they’re going to do is open a clinic inside the planned Pacific University Health Professions Campus which will be in Hillsboro near Tuality Hospital and touching the MAX line. Phase 1 building (~4 years from now) will include ~5 optometry lanes on the ground floor and an optical. Phase 2 (~15-19 years down the road) will have a huge optometry clinic. Virginia Garcia will also be in Phase 1 (I mention it because I translated at VG).

Lots of miscellaneous news. Dr. Steve Cool retired. Tawna Roberts is on PUCO staff. Dr. Casser says that PUCO’s accreditation is up for re-evaluation in fall 2006. It is based on curriculum, admission criteria, and academic standards. Here’s a hint, PUCO. If you want your ABEO results to get better, don’t let the students surf the web during class! Some current students told me some teachers are cracking down on that (it’s about time). Really, board scores used to be good at PUCO until my class came along. We were the first entering students to get high speed internet available in the classrooms. It was supposed to revolutionize teaching, but it just made us all better at surfing the web. (Anyone remember Elf Bowling, Motocross Madness, Age of Empires?) Sheesh.

More big news is PUCO got some funding to equip every single exam lane with brand new equipment on a 5 year lease. They installed 5 semi-truck trailers-full in one week. They also got an OCT, Gdx, pachy, anterior and posterior segment photography, and corneal topographer. They’re starting a new PUCO retinal diagnostic services clinic that area eye docs can refer for special imaging. You can optionally ask for an interpretation with the report.

Really, there is too much for me to cover. I’m pretty sure we’re all bored reading this now. I’ll quit until tomorrow.

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I have a bad habit of not staying in the actual convention approved hotel. This year, it’s not my fault because they were already booked up.
Last year I tried staying in the La Quinta Inn nearest the Portland Convention Center. We stayed there only one night because the room we got had the worst moldy-musty smell ever. We then went over to the GWCO approved Double Tree Lloyd Center and stayed the rest of the time. The only room they had was a tiny closet with a queen bed in it. My wife, two small kids, and I didn’t have enough room.
This year, I wanted to stay in a nice, big, clean smelling room with free high speed internet access. I found it in the Phoenix Inn Beaverton. They offer free wireless high speed access, and since I didn’t have a wireless card for my old laptop, they loaned me one for free. Just one hang up. I have an old Windows 98 machine which didn’t have drivers for a wireless PC card. I just went down to the 24 hour business center, plugged into the wall, downloaded the drivers from the internet, and voila, here I am making this post.
I knew I would be far away from the convention center. I was banking on using the MAX, and I was hoping the hotel shuttle would take me to the Sunset transit center, but the hotel shuttle only operates from 9-5 and only within a 5 mile radius. The good news is that the bus stop is very close, and total travel time to the convention is 1 hour. Not bad.
More tomorrow.

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Tonight we’re packing, and tomorrow we’re heading for PDX! I love Portland. Very nice place. I lived in Forest Grove while going to school, but most of my social life was spent visiting friends in Hillsboro, Aloha, and Beaverton. We’d go to Portland all the time.
I’ve got a hotel that includes free high speed internet so that I can update this site nightly. Like I mentioned before, I’m going to blog GWCO. I hope to find lots of interesting things to report about from the CE and the exhibitors.
I know they always have stuff going on the evening of Wednesday, but I never go to that. They also have two classes in the morning on Sunday, but I don’t stay for those either. I’ll just be up for Thursday, Friday, and Saturday (10/13/05 to 10/15/05).
I’m going to tag all of the pictures I take with GWCO2005. I hope everyone else will do the same. I’ll have them posted with my account on Flickr. The most interesting ones I’ll also post here at optoblog.com.
In addition to posting pictures, I hope to find some interesting people who will agree to an interview. When I get some together, I’ll post a podcast on it. Off the top of my head, I want to ask about the latest in contact lenses, practice management and medical records software, and controversies in LASIK. Any topics you’d like to see covered?
If any of you will be taking pictures at GWCO, don’t forget to tag them with: GWCO2005

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I haven’t been posting recently because we’re moving. I’m leaving Indian Health Service and starting a private practice in Utah, so I’ve been busy finalizing my business plan, pro forma, etc. and getting ready for moving all our stuff.
Next week is the annual Great Western Council of Optometry meeting (GWCO) in Portland, OR. I went last year and enjoyed it. Actually, this year I was really looking forward to the AAOpt meeting in San Diego, but I can’t due to schedule conflicts. The GCWO meeting is a good choice, though, plus I get to visit all our friends in Portland. My favorite meetings also include the Northern Rockies Optometric Conference in Jackson Hole, WY.
Anyway, I’m going to GWCO and I’m gonna blog it. They do that all the time in techie circles, but to my knowledge it’s not done very much in eye care practicioner circles. Probably because blogging hasn’t caught on much with doctors yet. But it will.
Look for me wearing an optoblog.com t-shirt underneath my hawaiian shirt.

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Yesterday I had 5 minutes of my life wasted by a telephone scam.

My optician takes a call from a “Mike Randall” in California. I’m occupied at the moment, but he won’t leave his number. He says he’ll call back in a few minutes.

I’m free the next time he calls. I’ll loosely quote the conversation.

“Hi, I’m Mike from CSI in California. Listen, my boss asked me to call you because– You have a 4100 printer right?”

“Yes.” We do, in fact, have an HP laser 4100 printer.

“A customer nearby your location has been sent a supply of toner for the 4100, but the customer failed to notify my boss that they’d switched to a different model, so we’d like to call FedEx and tell them to reroute the package to your office.

“Okay. . .”

So, how do you spell your last name?

“L-A-N-G-F-O-R-D”

Okay, so I’ll send those on over. What was your zip code again?

That’s when one too many red flags went off. I had never had any contact with this person before. In my government setting (Indian Health Service), my supervisor asks for printer toner by making a requisition. Everything goes through the Supply Department. If we had ever done business with “CSI” (a rather dubious business name), then they would only have the supply department’s contact information, not my clinic number.

“Wait a minute, Mike. You are confusing me.”

“I’m confusing you? Well, let me explain. . .”Then he starts to launch into the same schpeel as before.

I interrupt him. “So, are you going to charge us for the toner?”

“Well, we would offer it to you at a dramatically reduced rate since it–“

“Do you realize you are calling a government facility?”

“Uh, yah. Uh, Health and Human Services, right?”

“Yes, and you see, in the government, everything is done by requisition. I am not the person you should be calling. I have nothing to do with ordering printer toner, and–”

CLICK. He hung up on me. I am positive this was some kind of scam. If he were from a real, reputable company, then he would not have hung up. He was also trying to confuse me. I’m sure if I hadn’t interrupted him, he would have continued with questions like:

“Oh, and I need to confirm your billing and shipping address.”
“Oh, and I need your credit card information to secure shipment for the toner.”

What I still don’t get is: how did he know I had an HP 4100 printer? Afterwards, I was thinking he could have guessed, since it’s a popular printer. If he guessed wrong, he could have danced around it. Now that I’m thinking about it, I wonder if my optician told him on the first phone call. I’ll have to ask her. I’ll bet he told her part of his schpeel and said toner and asked her about the model we have.

Anyway, I thought I’d give everyone a heads up that someone out there has targeted an optometrist for a scam. I’m sure you already have policies in place about your staff ordering stuff from people named Mike with CSI in California.

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The is my second installment of Practice Names Never Used. (The first one appeared here.)

Bull’s Eye Center
Dr. Range Bull

One Eyed Clinic
Dr. Cy Clops

Snake Eye Clinic
Dr. Snake Unlucky

Pop Eye Clinic
Dr. I. Yam

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I’m test driving a new theme. I started looking for a new theme when one of those automated robot news-grabbing-sites-on- eye-surgery used the same theme as the one I was using (Blue Fade). I put in a theme chooser pull downlist. Let me know which one you like best.

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Here is the link of Capt. Greg Ketcher, OD talking about his experience being deployed for Katrina. His original two week tour of duty has been extended.
Be sure to check out the pictures he links to.

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Eyetel Imaging makes a product they call the DigiScope which they market to your family doctor (PCP). The way it works is your family doctor handling your diabetes medications can also save you a trip to your eye doctor by performing a “ten minute exam.” They dilate your eyes, take a picture, send it to Johns Hopkins, then recieve the results. This supposedly is better patient care because you are giving the patient a valuable service and saving them time. Of course, the family doc can bill for this (CPT code 92250), and if no problems, then don’t schedule with Dr. Eye, just revisit your PCP next year.

The Indian Health Service has been doing “teleophthalmology” for years using the IHS/Joslin Vision Network where remote facilities without an optometrist nearby use a tech to take retinal pictures which are analyzed at Phoenix Indian Medical Center. (Don’t quote me, but I believe optometrists are part of the reading/interpretation of the photos.) It’s a good idea considering Native Americans with diabetes have annual eye exams only 50-60% of the time. (Part due to no-shows, and part due to access to eyecare- not enough or no optometrists at location.)
So if we have a population that lacks access to eye care, a product/system like the DigiScope is a great idea. What if you live in a well populated area with lots of eye doctors around. Do you want your neighborhood PCP to go out and buy one of these?

Of course not! It cuts into our turf! They can’t do that, can they? When I get into private practice and if the local PCP decides to get one of these DigiScopes, then heck, I’ll start steeling his/her hypertensive patients. Yah, my state’s laws allow me to treat with any medication as long as it’s eye-related. Hypertensive retinopathy is eye-related, so I’ll be kicking out the lisinopril Rx’s left and right. I’ll have the patient come back for BP checks and everything. If it gets complicated, sure, I’ll refer to the “Blood Pressure Specialist.” How do you like them apples, PCPs-using-DigiScope?

Another note.
It’s been tattooed on our brains that before dilating, we must screen for possible angle closure by performing pupils, angles, and pressures. On their“Dilating Instructions” pamphlet, they simple ask about history of glaucoma and do a pen light test of angle depth. They cite the Baltimore Eye Survey as their justification for using only these two criteria to determine that it’s safe to dilate, but they actually reference a follow-up to the survey “Incidence of acute angle-closure glaucoma after pharmacologic mydriasis” published in the American Journal of Ophthalmology (Am J Ophthalmol. 1995 Dec;120(6):709-17.) Here is the abstract, and these are the quotes that stuck out to me:

. . .Of the 4,870 subjects whose eyes were dilated on screening examination, none developed acute angle-closure glaucoma. However, 38 patients of the 1,770 who were referred for definitive eye examination were judged to have occludable angles on the basis of gonioscopic methods. Of note, subjects aged 70 years and more were three times more likely to have occludable angles than those aged 40 to 69 years (P [less than] .004). . .These criteria provide 60.5% sensitivity and 93.3% specificity. CONCLUSION: If screening is performed accurately and the results are negative, the risk of dilating a potentially occludable angle was less than one in 333 subjects (negative predictive value, 0.997) in this population.

So if your family MD’s staff don’t properly apply the screening criteria, then roughly 2/100 patients could get occluded angles (the 38 of 1770 stat), but if they do it right, then 1/333. I’ll bet many family docs are willing to take those chances. It’s also interesting their pamphlet tells them to use tropicamide 0.5%. Since diabetics tend to dilate poorly, especially if they have brown eyes, I always use 1%. (I haven’t had a chance to use Paramyd because your federal government in strapped for cash, especially in IHS spending.)

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Well, not exactly.
You keep you cell phone in your pocket and use a hands free headset. The new twist is the headset is integrated on your sunglasses or Rx glasses.
Very nice. The RAZRWIRE: a Motorola Bluetooth headset on an Oakley glasses package (O-luminum frame, XYZ optics, fabulous and trendy design) makes for an attractive package for your patients on the go.
Eye doctors in Portland, OR and Silicon Valley, CA should be all over this. Make sure you suggest it to any of your patients who take calls while in your chair. 😉

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