optoblog.com

What is a web bulletin board, and why should optometrists care? Well, the problem lies in the very asking of this question. Doctors, as a whole, are slow adaptors to new technology. Webopedia has a short definition of a web board. They go by many different names: forum, web board, bulletin board, conference board, discussion group, and online community. I like the term forum since it’s short, but I also use bulletin board, but others prefer online community because it captures the environment they want to foster.
For those of us optometrists enlightened enough to join an “online community” or “bulletin board” with other optometrists, there is a surprising variety of choices. I will try to elucidate the features and foibles of these forums. They are in no particular order:

Seniordoc.org
A private (or moderated registration) forum for the optometric community only. Features: lots of knowledgeable, educated posters. Five post minimum for custom avatar. Drawbacks: can only register using your real first and last name (they argue that you can make an anonymous post, but still, where is the fun of having a cool username?) They have one forum viewable by the general public and then 10 forums viewable only by registered users. I argue that this gives the general public the impression that ECPs have something to hide. They don’t offer RSS feeds of new posts because, hey, that would mean Jon and Jane Public could see what we’re writing about them. On the same token, I’m sort of glad that you have to register to view posts because my real name is attached to my rantings, so I don’t want any of my patients to read something I wrote and realize, “Hey, he’s talking about me!”
Your view of that situation depends upon your goals, I guess. It’s a mess. At least you get a custom avatar relatively quick. My quick take of the community: overall good but one of the administrators is snooty and posts waaaaay to often. Seriously, if he’s got that many opinions, he should have a blog instead of monopolizing board space.

Optiboard.com
This is an open forum sponsored by opticians, but optometrists are welcome. Features: open registration. Can use any user name you want. Biggest advantage: RSS (Really Simple Syndication a.k.a “feeds”) of optiboard posts. This is huge. Now I don’t have to click through their website to read new posts. They just show up in my favorite feed aggregator (like bloglines) and then I can reply to any that interest me. This way you can lurk without having to actually click through the website. Drawbacks: mostly dispensary oriented discussions (which can be good depending on your goals). Biggest drawback is that you have to post a million times before you can get your own custom avatar. This seriously ticks me off. I tried to just post a bunch of bogus messages, but the administrator just deleted them. I had a PM (private message) with him, and he was cool, but the policy is not. An avatar represents you. It’s part of your identity. I think you should be allowed to have a custom avatar from the get-go. My quick take of the community: really friendly people.

forum.ihs.gov/~optometry
I have to admit that I moderate this forum, but I think I can be detached enough to limit my bias. Advantages: open registration with any username (but need any valid e-mail address). Get inside look at IHS optometry. Option to receive and post messages via e-mail. Disadvantages: right now it’s just starting up, so not very many users. (By the way, anyone can join in, not just IHS optometrists. I would encourage any OD2B to login and ask questions about IHS as a potential career option.) Big drawbacks are no avatars at all, and the user interface is confusing because it’s not like most web bulletin boards out there (attention IHS IT people: could we please switch to phpbb? It is practically the standard for community forums.) No RSS. My quick take of the community: so far just banter between 2 or 3 ODs. Needs more members to get it going.

visioncareforums.com
This community is sponsored by an ECP publisher. Pros: custom avatar, custom username. Cons: forums are organized by the different magazines instead of topics, so a topic could overlap from one forum (magazine) to another. Watch out for “forum spam.” No RSS. What’s weird about this forum is that it says there are a ton of topics in a forum, but when you click on it, there’s only a handful. My quick take of the community: navigation and forum organization too confusing to even get a sense of the community spirit.

EyeOrbit
There is a fine line between group blogs and a forum. I believe this ophthalmology group blog is more like a bulletin board. Anyone can register to post stuff, so I don’t see the difference. They also offer an ophthalmology resident forum. My only complaint is that it gets a little old when every other post is complaining about optometrists doing YAG capsulotomies and stuff. A big plus is that the eyeorbit blog/forum offers an RSS feed. [–EDIT– I had originally inculed the RSS link, but it’s an “rdf” file which iPodder picks up as an enclosure and tries to play in my music player. Is there anyone at eyeorbit.org that would be willing to change the file extention for their feeds to .atom or .php?]

So these are the 5 ECP-related forums that I’ve found. Which should you join? All of them, of course! Actually, web boards can take up a lot of time, so I can see how you may want to limit how many you join. I would join any eye-related forum that offers RSS feeds so that it would take minimal effort to post only to threads I care about instead of endlessly browsing topics every few days. Seniordoc really irks me because of their mandatary real-name-user-name, but Optiboard vexes me because of the mandatory 50 posts before obtaining a custom avatar. (Even though the IHS forum doesn’t have avatars period, it doesn’t bother me as much as Optiboard’s policy because it’s like they’re saying, “Look at this generic avatar! It belongs to a no-good, rotten newbie.”) Visioncareforums is just plain disorganized (which wouldn’t be so bad if they had RSS for new posts). IHS optometry web board is just starting and needs more members to create a sense of community, and it needs to drop its current software and switch to phpbb.

A community forum’s spirit is largely dependant on the users, but the forum organization and the moderators have a large role in creating that spirit. For examples of highly successful forums not related to eye care, see ericdsnider.com or wordpress.org.
Any other forums I should have mentioned?

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At work, one of my responsibilities is to be the content manager for the Indian health Service optometry web page. Derek Best over at the IHS IT department has put together a fantastic looking template design.
New features are a feedback form, link to IHS Optometry forum, IHS Eye Care Directory (word document), and rotation announcements for optmetry externs.
Go to the site and use the feedback form to let us know what you want added! Also, I started a thread in “THE LOUNGE” at the IHS optometry forum to discuss what new features everybody wants on IHS optometry site.

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In my first review for Optoblog, I’ll focus on the most recent equipment addition to our clinic, the Sonogage Corneo-Gage Plus 1AS. There are a couple different versions out there, the “1” and the “2.” We somehow got the 1AS. I’m not sure what the AS stands for, but it might have something to do with not having a printer. Sonogage’s website isn’t clear on the different models available, and the complete set of features they list are only available on the “2.” We chose not to get one with a printer because. . .what’s the point? Just write the numbers down in the chart! A few years ago, the docs that used to work in my clinic chose to staple into the chart note the little printout from our ARx/AK instrument. The ink has faded beyond recognition, so in my opinion the optional printer is a waste of money, and I’ll detail another reason why later.

We’ve had our Corneo-Gage Plus 1AS 6 months, and it hasn’t required a recharge on the battery. In fact, the battery level indicator still reads 100%! Truthfully, we only been using it 1-2x per day on average, but still, the battery life is pretty impressive.

The probe has 50 MHz transducer, which is a big selling point because it’s supposed to be more accurate than lesser frequencies. Available on the “2″ is the ability to measure epithelial thickness. Sonogage states they are currently the only pachymeter that does this. Also, the “2″ has feature of automatic IOP correction instead of having to look at a paper table.

On the downside, the most glaring inconvenience is that the Corneo-Gage Plus requires pressing buttons 3 different times in order to turn it off. Sure, I can see how you wouldn’t want to accidently turn it off, but requiring two button pushes would be sufficient. Three is overkill and a nuisance.

While the cord from the instrument to the probe is 4’10”, that isn’t long enough to reach from my counter to the patient in the exam chair. Actually, I could get one eye, but the other is too far away. Many doctors will not have this problem, though, since my exam lane is probably wider than average. I just have to set the pachymeter on my stool during testing.

I can’t imaging they can’t make the Corneo-gage form factor smaller, especially for those of us who didn’t get the extra printer option. After all, the Pachmate DGH55 is a little larger than a big pen. I assume the bulk of the Corneo-gage form factor is from the battery inside. (I’d love to open it up, but that would void my warranty.) Despite being shoe-box size, it is completely portable between our 4 exam lanes.

Now, I will explain why the printer option is a completely useless option that is a total waste of money. The Corneo-gage Plus is continuous read, so you put the probe on the cornea and stay there until you here 5 beeps. Then go to the other eye. In the end you would have 10 readings, the first 5 are for the first eye, and the last five are for the second eye. For each eye, you automatically throw out the first and last readings. The lowest of the middle three readings is the corneal thickness which you record. No averaging is required. That is why I see no point in getting the printer models because you only have to write down (or hopefully type) one number per eye in your chart.

Some might say that not having a “Right” and “Left” button for taking readings is undesirable. I answer that it’s easy to listen for 5 beeps then switch eyes. No fuss with having to press extra buttons. It’s a time saver, really.

So, why did we choose to buy the Sonogage Corneo-Gage Plus 1AS sight unseen and without a demo? Thomas and Melton, of course. Those two guys’ word is optometric gospel. In fact, to all the drug reps out there, don’t even bother coming to my office. If you want me to use your product, you need to convince Thomas and Melton- not me. Anyway, they endorse this pachymeter, and that’s good enough for me.

One of their selling points was a free table for corrected IOP from corneal thickness. I would expect it to come with any pachymeter, so it’s not a real selling point. Also this is information available for free from many sources, including Melton and Thomas’s website. Another selling point is that they used this pachometer in some study. Big deal. Other pachometers were used in other studies, and any ophthalmic instrument maker can donate a several thousand dollar instrument to some poor study. (By the way, we paid ~$2,500 for our pachometer. That’s the government price. It’s hard to believe they’re worth that much, but selling to ECPs is kind of a small market.)

Some very useful information came with our Corneo-Gage Plus. The instruction booklet was very clear, helpful, and comes with a handout entitled “Pachometry Reimbursement Codes” to help you know how to bill. The guideline for billing pachometry is if there is “a reasonable expectation that the outcome of corneal pachometry will impact decision-making in the medical management of the patient.” So, every glaucoma suspect in your office needs this, and they will allow anyone with a c/d over .3 or elevated IOP to be a candidate for pachometry.

While following corneal disease, like Fuch’s, bullous keratopathy, or corneal edema, you may bill for every pachometry reading as long as you documented in your original plan of care the need for repeat pachometry. Reimbursement assumes a bilateral procedure, so don’t try to bill for one eye at a time. Just plan on always taking readings from both eyes. Medicare only reimburses a small amount (~$12) and only once in the lifetime of the patient with glaucoma.

So, your pachometer is not a money-making machine, but it is standard of care now. We should all have one, unless you are satisfied to be practicing like a commercial optometrist in the back closet of an optical shop whose only care is to sell more glasses. (Seriously, I interviewed for an optical chain which shall remain nameless. They had several locations all within one state. When I asked where the visual field machine was, he said none of the 16 locations except one had a visual field instrument. So then I asked how much disease they see. He replied something like, “Oh, the people who come see us don’t have much disease.” Right. Or maybe it’s just that you don’t look because your 10-15 minute exams don’t allow enough time to find any problems. And what’s the deal with having an exam “room” the size of a thimble and a curtain instead of a door? What are you- the wizard of Oz?)

Anyway, thumbs up for the Sonogage Corneo-Gage Plus 1AS (no printer). If I did a lot of LASIK co-management (or CRT?), I would opt for the “2″ for it’s epithelial thickness measuring ability. If fact, I would tell everyone to opt for the “2” anyway because it has the feature where you press a button on the selected measurement, and it tells you the adjustment number to find true IOP.

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I’m going to depart from my optometry theme to sing the praises of Subway. I’m also going to admit to the whole world one of my most deepest, darkest secrets. One that sometimes alienates me from the rest of humanity.
I am not a sandwich eater.
I think it’s the texture, mostly. I can’t reconcile it. It seriously grosses me out. My wife, of course, is a normal person who eats sandwiches and loves to eat at Subway. When we spring for fast food, she always wants to go to Subway. I have to go across the street to some fast food place to get chicken nuggets (I don’t get a burger because that, of course, is a sandwich).
Enter Subway’s recent addition of toasted subs. Several years ago I forced myself to try a pizza sub because I like pizza, so I was hoping it would be similar. Wrong. The coldness of it all changes everything. Now, with toasted subs, it tastes and feels just like a pizza. It’s delicious!
Now I can stay by my family while ordering food. My family spends more time together because of Subway’s toasted subs/pizza sub.
I love Subway.
To Subway owners, please make sure pizza subs are on the menu in your store. You never know when I’ll travel outside of my home town and need a hot, toasted pizza sub.

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*shameless self promotion mode: on*
Optoblog is a rising star on the optometric blogging scene. This site was finally indexed by Google, so now people can find us. Yahoo and MSN indexed us right of the bat. Now when you mention optoblog.com when talking to your friends, they can actually google it and find the official site.
Another cool thing is if you enter “optometry blog” in a Google search, optoblog pops up in the middle of the second page. If you do the same search with Yahoo optoblog pops up on the first page at number 1.
We’re moving up in the world and big things are on the way. Soon I will have my first optometric instrument product review, and then we’ll start podcasting. Optoblog’s podcasts will be mostly informative and interesting interviews with distinguished players in the eye world. Right now I’m getting my things together for telephone interviews, but I plan on attending the June 2005 AOA meeting in Dallas to get quality recordings of live interviews. I will have daily blogs coming out of Dallas, so if you can’t make it, just read optoblog, and you will feel like you’re there.
Stay tuned for exciting things coming from optoblog.com.
*shameless self promotion mode: off*

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I recently received in the mail a free audio CD from The Williams Group which goes over important features for optometric practice software. Of course, their product, Enterprise Solutions by OD Professional, has all of these. Actually, I was fairly impressed, and their software doesn’t have the silly restriction that MaximEyes has of an 800×600 pixel display.
On the whole, though, I feel that the EMR features of all current optometry software fall short.
My goal is to have a paperless office. How can I do that if my visual field machine tests and corneal topography maps aren’t automatically imported into the record? There is no software vendor on the market with the capability to import a Humphrey visual field into the EMR. This is my biggest beef. Why is it so hard for the software companies to import the hardware data? Proprietary interests I suppose. DVD, JPEG and other formats where defined by different companies in the industry coming together in a work group to sort out the details. Software vendors and ophthalmic instrument companies need to make standards for exporting data or at least an image of the reports. I would prefer data import to allow database searching and reports.
Also, I would expect from my practice software true website integration (while maintaining HIPAA compliance). The main website feature I would like is a contact lens re-order system that doesn’t require my staff to manually look up patient file to see if the CL Rx has expired. I definitely don’t want patients to schedule themselves online, but it would be nice to have them fill out patient information and history forms online (of course using encryption to be HIPAA compliant) that would automatically import into the software so my receptionist doesn’t have to type anything, just verify the information is correct when the patients comes in.
Also, the optometric software/hardware working group should come up with standards for optometric EMR database rules to allow easy conversion from one software suite to another. It would also allow an office to use (if desired) one brand of software for scheduling, one brand for EMR, and another for billing and financials. The standards group could also facilitate the format for ordering via web to any lab and billing to any insurance or clearing house.
Since Ziess Humphrey is the main perpetrator of not allowing data/report exportation, I suggest they become the leader in the proposed work group to devise these standards. Of course, Topcon, Marco, Tomey, Nidek, Optos, OD Professional, maximEyes, VersaSuite, RLIsys, and others should get involved as well.

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When the Acuvue Advance (Dk 89) and Ciba O2Optix (Dk 138) lenses came out, my first reaction was “Why?” The Advance and O2Optix are high Dk but not as high as Ciba Night & Day. They can be worn for occasional overnight wear and/or up to 6 nights extended wear, but Night & Day can be worn 30 days. I myself wear Ciba N&D and love them, so why would I want a “lesser” lens?
Now I have seen the light. The O2Optix and Advance lenses are 2-week disposables for patients in the real world. You know, the patients who are wearing their lenses 16-18 hours a day and occasionally sleeping in their lenses. I think most patients are like this, or at the very least, would be like this only they can’t stand the feeling they get when they over wear there regular hydrogel lenses, so they have no choice but to take them out.
This is where the newer not-as-high Dk lenses come into play. They allow the patient to “flex wear” their lenses for 2 weeks then throw them away and start again. Since they aren’t wearing them continuously, they don’t need as high of Dk as N&D, yet, they have enough oxygen passing through to allow what would normally be considered “over wear” with other regular hydrogel lenses. Nice.
I think the Acuvue2, Frequency 55 and the other regular hydrogels should be history. Most patients should just be directed over to this new 2-week replacement modality because that’s how most patients live their life. I can’t tell you how many patients I see that could have avoided corneal neovascularization if they could have had this type of lens. They’re not bad patients. They were just trying to live life without worrying about their contacts. They were trying to wear their contacts like their friends and family with contacts do, but their eyes won’t allow it without repercussions. Now, there’s a contact lens modality that fits their lifestyle and won’t bring neo and the wrath of their optometrist.
Please note, I wish I had a financial interest in the above companies, but I don’t and cannot since I work for the government. Also, my practice doesn’t include a contact lens service, so I have never actually fit any of the above lenses. I read the available information and specs on the products and submitted my opinion to this blog. For what other ECPs are saying, visit the Optometric Management forums which includes a thread on O2optix.

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In Utah, the Daily Herald reports that Judge Bruce Jenkins decided Intermountain Health Care is not in violation of anti-trust laws. For those of you outside Utah, IHC is the major HMO in Utah. Almost everyone is a member of IHC. My understanding of the issue is that IHC allegedly favors ophthalmology over optometry.
I agree with the plaintiffs. IHC is patently biased against optometry. Do a search on the IHC web site for optometrist providers, and you will see there are only 32 optometrists paneled with IHC in the entire state of Utah while ophthalmology has 87 providers. This ratio is out of proportion to the number of Utah eye care practitioners (157 optometrists registered with American Optometric Association and 111 “EyeMDs” registered with American Academy of Ophthalmolgy.) Also, note that only 2 optometrists are in the SLC valley, none in Provo, none in Cache Valley, and none in Ogden. The rest are all located outside of the Wasatch front which is the main population area in the state. Tell me how that happens unless someone has a vendetta against optometry.
Supposedly, if the optometrists would have won, they were going to finagle a way so that only the 49 optometrists paying money for the suit get the benefits of getting on board with IHC (I heard this with my own ears from one of the plaintiffs). I don’t see how that would happen. The law is the law, and I would think everyone could reap the benefits if IHC were found guilty. I believe they were hoping that IHC would just settle instead of go to court and that a condition in the settlement would be that only the 49 plaintiffs would get paneled to IHC as optometry providers. So much for that game plan now that Judge Jenkins has ruled.
Even though the lawsuit has failed (but still can be appealed) IHC should allow any Utah optometrist to participate as a preferred provider. IHC should recognize that optometry is the primary eye care profession. You would also think that an HMO would recognize that optometrists on average bill much less that ophthalmologists. (Of course, I guess that doesn’t matter if you are a preferred provider which accepts the allowables.)

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U. Waterloo, which has an optometry school, has an official blog for students. One of them is a pre-optometry student. The lame thing is that only a select group of students are allowed to blog on the official site. Lame really is an appropriate word here because they’re neglecting the leg of the animal which tells us the not so warm and fuzzy aspects of the school.
But let’s restart this discussion. Wouldn’t it be great if an undergrad could research which optometry school to choose by reading blogs of the current students?
Wouldn’t it be great if the current fourth year students could blog about the cool stuff they see and do during their rotations? “Oh flip! One more item of busy work to do,” I would have said three years ago. But knowing what I know now, I would have blogged and read others’ blogs to enhance my experience. I had one rotation where the first week, I saw an inferior, mac off retinal detachment, a macular hole, and something else cool that I can’t remember because I didn’t blog it. You can learn all you want from a textbook, but until you go through the process yourself, you don’t internalize it. What if the students could go through the process vicariously several times by reading their classmate’s blogs!
Also, the optometry student bloggers could give their opinion on how well their optometry school facilitates their becoming an optometric physician. But here in lies the danger for optometry schools to sponsor an official blog space. Universities have to worry about brand and image. Having a student blogger being overly or unfairly critical of the school could be a problem for the brand. On the other hand, aren’t campuses a bastion of free speech– the epitome of civil liberties in action? Maybe, but nothing says the school needs to provide via blog space the outlet for critical tirades. But hey, if an institution is that worried, they should read the 95 points of the cluetrain manifesto.
But, back on the other hand, optometry schools with nothing to hide should sanction blogs for their students, provide gentle guidance as to their terms of use, and let the students run with it. The students should remember the case of the Google employee who was fired over his blog posts. In fairness, many schools like Pacific University offer webspace to their students and one could easily use blogger.com to manage the content, but it would be more cool to see a designated blog space where most interns are information sharing.

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www.optometrynews.it appears to be a blog set up by some Italian outfit for the sole purpose to get people to visit their site and display adds. It looks like a link blog that is probably set up automatically to search the internet for mention of “optometry” or “optometrist” and then display a short summary and provide a link to the original article.
Don’t be fooled by these automated robots. Here at optoblog.com, there is a real person behind the information.
However, I do have to say a link page for the optometric industry, research, and patient information would be a great idea, and I’m trying to get one done. Give me a couple weeks.

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