optoblog.com

Opt School or a house?
Electricians make more cash.
Too late to drive truck?

As a mid-career optometrist still 20 years from any kind of retirement, I often wonder if I made the right decision. I’ve had to do some electrical work on my 1960 house (because that’s the kind of house an optometrist can afford) and really enjoyed it. Also I really like driving, so I probably should have been a trucking electrician or an electrical trucker.

If you liked this one, read more Optoblog poetry.

Tags: career, Jobs, optometrist

Utah Medicaid is changing their copays for 2014:

For Non-Traditional (Blue Card), they used to only cover the first $30, then you would pay the balance. Now, at my office your routine eye exam is covered without any copay since I am an optometrist. (At an ophthalmologist office, there is a $3 copay.)

For Primary Care Network, a.k.a PCN (Yellow Card), you used to have a $5 copay. For 2014, there is no copay on the routine eye exam at my office since I am an optometrist. (At an ophthalmologist office, there is a $3 copay.)

For Traditional (Purple Card), there is still no copay for 2014 on a routine eye exam.

I think it’s funny how the patient pays less to see an optometrist vs an ophthalmologist. On the face it doesn’t feel fair. Theoretically, for the same procedure code, why should the patient pay any different?

Practically, OMDs charge more than ODs, so maybe this is a way for Utah Medicaid to incentivize “clients” to see an optometrist instead of an ophthalmologist. OMDs could be miffed, but they probably aren’t because $3 isn’t that big of a penalty; therefore, it should cause very few patients to actually alter provider choice.

Still, it’s curious. I wonder at what OD/OMD copay differential the OMDs would become vocal.

Tags: Government, insurance, ophthalmologist, optometrist

Are you looking for a part time, fill-in-type optometrist job in Northern Utah? VisionHealth EyeCare is hiring a Saturday-only optometrist. See this webpage for a job description and how to apply.

Tags: Jobs, optometrist

I wanted to let you know about a useful site: eyewiki.aao.org

I particularly liked the page about slit lamp photography using your digital camera, a.k.a. “phoneography.”

I like the DIY homemade version, so I’m going to try it out and let you know how it goes within 1-2 weeks.

Tags: optometrist, photo

I was halfway done administrating non-contact tonometry (a.k.a. air puff test) when a 30-something man asked, “This is safe, right?”

To which I replied, “Well, yah. A small percentage of people could faint, but…pretty safe.”

To be fair, I have never had anyone faint after the air puff, but I have had two different men almost faint (lightheaded, sweating, nausia, paleness) after Goldmann applanation tonometry and corneal foreign body and rust-ring removal.

It helps to be prepared for the vasovagal response, so I have on hand an ammonia-based respiratory stimulant and Sunny Delight sugary punch.

Tags: @optotrician, Airpuff, fainting, optometrist, patients

Our Walmart Vision Center has a life-size poster of a tough-looking beared guy from Duck Dynasty. Someone thought it would be fun to put a Walmart name tag with the name “Willie” on it.

It’s strange having Willie in the optical because you see him out of the corner of your eye and you instinctively have to look over at him to see who’s there, but the then you feel stupid because you’ve already told yourself a thousand times before that Willie is just a cardboard picture.

The other day, an optician saw a lady trying to talk to Willie and asking a question. Of course it was only for a few seconds, but it was a couple seconds longer than most people would talk to a cardboard picture.

The VC manager decided to take the name badge of Willie after that. Now most people just come over and have a picture taken with cardboard Willie.

Tags: @optotrician, commercial, frames, Jokes, optometrist, patients, Wal-Mart, WalMart

Optoblog revolutionized optometric blogging with eye doctor-related comics and poetry. Now we have “@ the Optotrician” which contains quick anecdotes and conversations that actually occur at a vision-center/eye-clinic/optical/eye-doctor-office.

This is à la Love the Liberry blog that I discovered when it was linked to by Mental Floss the other day. It’s so awesome that I’ve already read the archives back to 2007.

By the way, if you would like to be a contributor to optoblog, please see this page.

Without further delay, here is the inaugural post of @ the Optotrician:

Teenage Girl: Hey does anyone have a dime? Do you have a dime?

An asian male (from Asia), 20s, doesn’t want the full glasses power I found written in his Rx. He wants less so his eyes don’t get worse. I explain it’s debatable whether that would help, hurt, or make no difference for his future glasses magnitude, but he insists. I am fine with it as long as he is legal to drive. I show him a +0.75 shift, and he is satisfied with that.

What’s the deal with optometrists in India not prescribing cylinder? I’ve seen several Indians (from India) that have 0.75 diopters or more of astigmatism, and their glasses from last year are spherical.

Guy in 20s: Can I charge my phone here?

Man walks right past sign posting prices of eye exam. Asks optician, “How much is an eye exam?” This happens thousands of times a day.

Tags: @optotrician, Jokes, off topic, optometrist, patients

When I went to renew my Utah optometrist license, I was greeted with this pop up:

Since my photo is grainy, it says,

“Under Utah law a contact lens prescription expiration date shall be two years from the commencement date unless documented medical reasons require otherwise.”

Here is the excerpt from the Utah Code regarding “Contact lens prescription”:

58-16a-102. Definitions.
(3)
(b) A prescription may include:
(i) a limit on the quantity of lenses that may be ordered under the prescription if required for medical reasons documented in the patient’s files; and
(ii) the expiration date of the prescription, which shall be two years from the commencement date, unless documented medical reasons require otherwise.

I would say it is pretty standard practice to make youth Rx’s one year, but my advice to other Utah eye doctors would be to make sure you have a check box in your chart documenting how the youth’s Rx is still changing which requires yearly monitoring, history of eye infections and need to yearly monitor eye health, etc.

I am not exactly sure when this law came into effect, but I have known about it since 2006 after I moved to Utah. From intermittent observation of outside Rx’s brought in to my vision center or patients coming in for an exam, I would say about half of the area eye doctors know about this law. Either ignorance or they document every little thing as an excuse to yearly monitor contacts. I don’t want to slight The Vision Council’s campaign of “Check Yearly. See Clearly.” but the law is the law.

What would you say is sufficient medical reason to change an adult’s contact lens Rx to less than two years?

1. Seasonal allergic conjunctivitis? What would you change before two years after recommending Pataday/Alaway, ClearCare, and daily disposable during the worst weeks?
2. Contact lens-related dryness? What would you change before two years after recommending Oasys/Biofinty and ClearCare/Optifree PureMoist and Refresh Contacts?
3. Mild corneal neovascularization? What would you change before two years after recommending a silicone-hydrogel, adhere to manufacturer replacement schedule, and no overnight wear?

I would be careful because if you get too knit-picky, your patients will go elsewhere for exams.

Tags: contacts, doctors, Government, law, optometrist, Organized Optometry, patients

The Utah Optometric Association is very worried about H.B. 408 which is being introduced for the 2012 legislative session. I know they must be worried because a volunteer optometrist from the association called me, and I’m not even a member of the UOA.

It turns out they are rightfully worried because while the title, “Use of Optical Scan Machines,” might seem innocuous, what is really behind the curtain is pernicious.

While there is currently no text on the le.utah.gov website for H.B. 408, sources say that the bill’s sponsor, Greg Hughes, from Draper, UT (home of 1800Contacts) intends to allow the current prescription law to be changed to allow a person to buy glasses based on the reading of an autorefractor.

Apparently, the plan is for a company, like 1800Contacts, to set up a Glasses Kiosk in a popular store, like Walmart. (By the way, 1800Contacts has been selling glasses for a while.) The person puts their head in the machine, the autorefractor spits out some glasses numbers, a pupilometer measures a p.d., the person selects their frame and lens options, then they slide their credit card and wait for their glasses to arrive in the mail. (Maybe a nicer kiosk would measure the Rx in your current glasses and have you look at an eye chart, and factor those measurements into the numbers the kiosk “prescribes” you.)

If allowed, I predict an unintended consequence will be that no optical will adjust your glasses for free, like they currently do. You will have to show a receipt just to get your glasses adjusted, so everyone buying glasses from kiosks or internet sites will walk around looking like goobers and in pain from poorly adjusted glasses.

Other obvious consequences will be that people will walk around with headaches and blurry vision since autorefractors are notoriously inaccurate and will usually over-estimate nearsightedness and underestimate farsightedness. And say nothing of the fact that many people need prism to see straight/avoid headaches.

But here is the biggest reason to forsake this bill: People need eye exams to ensure good eye health. A refraction is only one piece of a complete eye exam. I’ve already written about the woman who only wanted more contacts, but because she had an eye exam, I saw some worrisome findings and referred her for more specialty care which discovered a brain tumor.

That’s just one patient. I’ve actually done that a couple times with brain tumors. Other times I’ve had patients whom I’ve diagnosed leukemia, diabetes, pituitary adenoma, increased cerebral spinal fluid pressure, glaucoma, macular degeneration, eye infections, allergy eyes, and more all just from a “routine eye exam.” None of these people thought there was something wrong- they just wanted new glasses or more contacts.

We can’t ignore that an eye exam is more than just looking at an eye chart and getting a refractive prescription.

But let’s say you wanted to. Let’s say you are simply a consumer advocate who wants to help people buy glasses. Your idea is to waste everyone’s time and money by making a law to separate the refraction from an eye exam. The consumer who values their eye health will simply also get an eye exam in addition to buying a glasses Rx and purchasing spectacles from a kiosk.

Okay, Utah Legislature, why are you stopping there? What if I’m a business that wants to sell antibiotics cheaper, to more people, than the present system of physicians and pharmacies? I want to set up kiosks that take your temperature. If you have a high temperature, you get vended an antibiotic. Sounds great for consumers, right? Why should eye care providers and opticals be the only ones to suffer? Make physicians and pharmacies suffer as well!

If you want to change the system, change it fairly for everyone. Let’s be just like third world countries which don’t require doctor prescriptions at pharmacies or optical shops. If it’s about consumer advocacy, what could be better, right?

Of course, you will essentially be forcing a large portion of health care providers to change professions. And don’t even mention how news reports will be full of people self treating, taking the wrong medicine for the wrong diagnosis, and dying. It’s a small price to pay for consumer choice, but since I have some libertarian leanings, I wouldn’t mind trying it out as long as every medical profession participates and not just optometrists.

However, if you don’t think that all roads should be toll roads and marijuana should be legal, then let’s continue to require prescriptions for medicines and medical devices, like glasses and contacts.

Choose one, Utah Legislature. Just be consistent across all professions to make the playing field level.

If you have an opinion on 2012’s H.B. 408, then contact your Utah lawmaker.

On a side note, I hope the sponsor of H.B. 408, Greg Hughes, is happy with himself. The UOA is burning tens of thousands of dollars (that it can’t afford) on lobbyists that only work for six weeks to fight H.B. 408. Even if HB408 is defeated this year, who knows if it will come up again next year and they’ll have to spend more money again! Mr Hughes, I’m not sure how you can sleep at night. You are causing poor optometrists to spend tons of money fighting legislation that you introduced only because a big business told you to. Even if you said you were sorry and withdraw the bill, you can’t un-burn the cash you’ve caused to be burned.
Please, lawmakers, try to think outside your wallet when making decisions about bills to consider during legislative sessions. I propose we only allow you to meet every two years in order to provide more stability for us business owners.

Tags: 1-800, doctors, economy, Government, optometrist, Organized Optometry, patients, politics

The topic of today’s post is the most searched term that brings people to my little blog, so I thought I would directly answer the question, “How do I become an optometrist.”

Here are the steps as I see them:

1. Go to college and major in any field you want. You will be required to take prerequisite courses before entering optometry school, and most of these courses are taken during a biology-type major. But, you can major in statistics or Spanish, but it will take extra time to graduate AND get all the optometry school prereqs. Don’t let that put you off because if you don’t get into optometry school, you will want a degree that you can use to do something you love. About the only thing you can do with a biology degree besides work for the federal government is work at McDonalds.
2. The summer after your second or third year of college, take the OAT and score well. Make sure you check the option to have your scores released to all the optometry schools that you are considering.
3. As part of your optometry school application, you have to observe a few optometrists in different practice settings (private, government, research/academic, commercial) for around 30 hours. This takes time, so schedule ahead before your application becomes due. It’s also very important because you may discover that being an optometrist is not for you. That’s a good lesson to learn before you spend huge amounts of money becoming one.
4. If you still want to be an optometrist, get your application together and send it in when your fourth year of college starts. There are usually essay questions and a personal statement. Try not to write anything naive. You’ll also need to round up all your official college transcripts. Hopefully you are a fine human being and have cultivated outstanding personal, academic, and work references. I threw in a clergy reference as well. Each optometry school might have a slightly difference process, so please read their website like the careful, well-educated person you are.
5. Interested schools will call you up and schedule an interview usually starting around January. You will have to pay your own travel, food, and accomodations, so if you get a lot of interview requests, you may want to prioritize them if you don’t have unlimited funds and time. By the way, do well at the interview.
6. Wait for all the offers to pile in, and accept the one you want. I would pray about it. It’s a big decision.
7. Spend big money to attend optometry school and pay attention because there is a test later. Spend some more money on your own optometry equipment and reference books.
8. Work with a professor that you respect to plan, execute, and write a thesis project during your second year of optometry school.
9. Pay your money to take the NBEO 3-part testing and do well.
10. During your fourth year of optometry school, you will travel around to different preceptorship sites. You can focus on the type of settings you would like to work in, or better yet, experience several different settings to give you more experience if your preferred setting doesn’t work out right out of school.
11. If interested in specializing, you can do an optional optometry residency. During your fourth year you will apply and then be invited to interview for residencies. They are preferred for several modes of practice like government, academia, and LASIK centers. You’ll learn more about this and be able to make an informed decision after being in optometry school.
12. Graduate from optometry school
13. Apply for optometry licenses in the state(s) you wish to practice in.

Congrats, you would then be a practicing optometrist. For those of you counting at home, that was a minimum eight years of your life after graduating high school. I wish you luck in your quest to find a job and be happy with your career.

Before you can start working, you will need spend money on a license, malpractice insurance, perhaps a DEA number, and apply for all the insurance panels you want to take. If you decide to work for yourself instead of someone else, you’ll need to take care of a whole bunch of business related stuff that is beyond the scope of this post.

Don’t forget you will need to spend a whole bunch of money every year in the racket known as continuing education conventions.

Tags: Answers, doctors, optometrist, optometry school