optoblog.com

I shine light in eyes,
as a watchman for disease.
Patient might punch me.

I get photophobic patients sometimes, so this haiku is for them. If you liked this one, read more Optoblog poetry.

Tags: optometrist, patients, Poetry

I tried billing corneal topography (92025) to Utah Medicaid as part of managing a patient’s keratoconus, and I was shocked to have it denied. The reason?

The procedure code is inconsistent with the provider type/specialty (taxonomy).

So I called Utah Medicaid, and confirmed that 92025 is the code for corneal topography, and they confirmed that optometrists are not allowed to be paid for corneal topography because only physicians and hospitals are allowed to bill this procedure code. I pressed that optometrists manage conditions like keratoconus with corneal topography and that their policy definitely needs to be changed. The UT medicaid worker said she would bring it up at their meeting, but that meeting isn’t until next week, and she had several other issues that weren’t address at the last meeting.

So, I think she was telling me that she couldn’t guarantee that anything regarding my issue would be addressed in the near future. Even if they do discuss it sometime this month, they might not change their mind.

THIS IS COMPLETELY RIDICULOUS!!!. Hospitals? Hospitals can bill for corneal topography? How often do they do that? Can we name even one hospital that even owns a corneal topographer? The only physicians who use corneal topographers are ophthalmologists, but if I were a pediatrician they would allow me to bill for it?

Attention Utah Medicaid Taxonomy-Procedure-Provider-Type Committee: I hereby declare that you should immediately allow optometrists, provider type 31, to bill and be reimbursed for computerized cornea topography, CPT code 92025. Blue Cross allows it. I am trained to perform and analyze this test in optometry school. I need it to manage conditions like keratoconus, irregular astigmatism, pterygium, pellucid marginal degeneration, and transplanted cornea. All of these conditions I see in my practice.

Until now, I am willing to grant that the taxonomy/provider-type thing is an oversight- a snafu with the computer database. Now that this error has come to light, the only reason I can think that Utah Medicaid would continue in this erroneous policy is that the committee members making that decision are a bunch of anti-optometrist bigots. I don’t want to think that, so please reverse your policy as quickly as possible and allow optometrists to bill corneal topography.

Tags: doctors, Government, insurance, Medicaid, ophthalmologist, optometrist, patients, politics

Kentucky now joins Oklahoma as the only states that explicitly allow optometrists to perform laser surgery on/around the eyes and even lumps and bumps removal.  (Read the article here.  H/T to kevinmd.  Also see a news article here.)

When people ask me what’s the difference between an ophthalmologist and an optometrist, I always like to say, “Optometrists do everything an ophthalmologist does except surgeries.”  (By the way, I don’t consider foreign body removal a surgery. Chalazion removal- yes, definitely a surgery.)  Even one of the ophthalmologists in the feature story seems to agree with that statement:

“We draw the philosophical line in the sand with surgery,” says Dr. David Parke, chief executive officer of the American Academy of Ophthalmology.

Of course, proponents of the bill think that allowing ODs to perform laser surgeries is good for people because, as Governor Beshear explains:

“I signed Senate Bill 110 to give Kentuckians greater access to necessary eye care.”

Now, I would probably refute that it gives people, particularly rural people, greater access to eye care. For a doctor to buy all the necessary equipment to perform a YAG capsulotomy, he would need to invest in a pretty expensive piece of equipment. To keep up payments, he would have to do a lot of procedures. How many YAGs does a rural optometrist usually see a month? Probably not a lot. How far away is the surgeon who did the patient’s cataract surgery in the first place? Probably not that far.

Optometrists are already trained in school to do periocular injections, but can an optometrist be trained to do YAGs? Absolutely. It’s an easily learned skill that is widely studied for potential complications and side effects. This stuff is not magic- it just needs training. But it’s also a skill that, if not done regularly, can get lost. If I had a patient tomorrow that needed a subtenon’s injection, I would have to refer them out because I haven’t had to do one since leaving optometry school. No way would I feel comfortable. I also think that it’s in the patient’s best interest to have a procedure done by someone who does that particular procedure regularly.

Anyway, I kind of like my definition of optometrist. What do you all think?

Tags: doctors, Government, law, OMD, ophthalmologist, optometrist, Organized Optometry, patients, politics

Over at Student Doctor Networks – Optometry Forums some undergrad started a thread about me.

Am I real? Yes. Maybe you could have read more than just one of the 340+ posts on my blog? Maybe you could have looked at the side bar and seen the link to my twitter feed and my practice website?

Do I hate optometry? Nope. I like it fine. Sure, I’d rather be a rock star, but that will have to wait for now.

Did I make a whole bunch of inflammatory blog posts? Yes. But I can’t please everybody. I like Walmart optometry more than private practice for numerous reasons, but not the least of which is I feel like less of a salesman and more like the doctor I was trained to be. I think you can get that in other settings too, but I don’t want to work for the government anymore. I’m not academic enough to be a professor, and I don’t want to be an OMD’s “super-tech.”

In private practice, everyone else got paid…except me. The frame reps, the contact lens distributors, and labs, the staff, the landlord, , the bank, the equipment vendors…they all get their money up front or first thing. You, the doctor, get paid last…if at all. Risky.

if you like taking risks, then why not take a better bet in a different profession selling or manufacturing widgets with less restriction on maximum possible income?

Undergrad, if you really want to be a private practice optometrist, go ahead. I won’t stop you. I would ask you why you would gamble so much when you could practice in a setting with MUCH less risk. It does work out well for lots of O.D.’s, but that doesn’t mean it will work well for you.

By the way, I don’t think pointing these things out should be labeled “negative.” It’s reality. There are pluses and minuses to every profession. Undergrad, I don’t want to sugarcoat your potential career choice. I once thought I was going to be an architect because I wanted to design houses. I actually talked with an architect and found out very few architects design houses because most people buy their plan from a catalog. Most architects design banks and rest-stop bathrooms and other utilitarian buildings. That’s not what I would be happy with, so I switched majors. I’m thankful that architect shot straight. If you don’t believe me, then I hope you talk with an optometrist that you can trust who will also shoot straight.

Now, knowing more of the risks and potential negatives, if you still want to be an optometrist, then at least you’re not going into this blind. You won’t be able to say, “Why didn’t anyone tell me it would be this way?”

Anyway, I’ve spoken enough about this subject. I need to get back to writing/selling the next great screenplay so I can have a retirement.

Tags: optometrist, private practice, Wal-Mart

Flurisafe comes in a 6 mL dropper manufactorered by AL-ROSE Enterprises and is composed of Fluorexon disodium with benoxinate. Fluorexon’s heavier molecular weight makes it “safe” for use with soft contact lenses since it won’t permanently dye it yellow like fluorescein will.

If you don’t use Flurisafe, then you should try it out. I’m confident that you and your patients will like it better than fluorescein sodium/numbing drop combinations (benoxinate or proparicaine).

Here are my reasons:

1. My patients report less stinging with Flurisafe compaired to FluorBenox and especially proparicaine.
2. The mild stinging from Flurisafe seems to have a few seconds delay after installation, so that allows me to get the drop in both eyes easier for the little kids.
3. Most older patients report NO stinging with Flurisafe.
4. I can use it on any patient and not worry about rinsing it out with eyewash if they happen to want to try soft contact lenses later.

On the downside, it is a little more expensive than FluorBenox, but not significantly more. Also, I turn up my light level a little more using the blue light compared to using a Fluorette or BioGlo Strip; however, Flurisafe still lights up nicely while using a yellow Wratten filter (my slit lamp has one integrated; I just lower a pin.)

I get mine from Wilson/Hilco, but your usual ophthalmic supply company should have it also.

Try it! You’ll like it.

Disclosure: I have to financial interest in any companies or products mentioned above, and to date none of them have ever given me any free stuff.

Tags: eye drops, optometrist, pharma

I just got word that Ciba will discontinue O2Optix soft contact lenses. The time line appears to be:

• 7-1-2011 Doctors will no longer get trials for O2Optix
• 1-1-2011 Product availability not guaranteed
• 7-1-2012 O2Optix lens discontinued.

Ciba has been pushing strongly the one month replacement modality which flies in the face of the two week replacement schedule philosophy of their competitor, Vistakon. Ciba’s recommended alternative for those who have been in O2Optix lenses is to have their doctor refit them in Air Optix Aqua.

Tags: contacts, optometrist, patients, Wal-Mart

UPDATE 2-26-2011: Ciba and Walmart came to an agreement, and ClearCare will soon be available at your nearest Walmart very soon if it’s not there already.

Walmart will sell out their existing stock of ClearCare, but won’t be reordering more. Here’s from the memo dated 1-24-2011:

• Jan 1, 2001 Ciba Vision has incorporated a substantial cost increase to their Clear Care items throughout the industry.
• We take any and all cost increases very seriously especially if the supplier is unable to justify the significant increase completely.
• In the interest of our customers, we will not carry Clear Care until this matter is resolved.

They go on to suggest that the V.C. associates can ask the Doctor Partners to recommend a suitable alternative product.

Isn’t this what happened to Rubbermaid?

Tags: CL Solutions, contacts, optometrist, patients, Wal-Mart

So I have OfficeMate in my practice. I started using them in 2006 with release 7.x, and I currently have 8.x. It uses an access database which never really needed a server because it’s just a file that you could put on one computer and share it peer to peer. At the time I went ahead and bought an expensive Windows/Dell server because they recommended it, but I found out later from working with it that I could have just put the OM db file on cheaper network attached storage.

Anyway, along comes progress. OM with release 9 has implemented the famous, awesome SQL database. What makes it famous and awesome is that SQL is opened source and cross platform. So of course OM implements a Microsoft only version of SQL. The Windows Server Small Business that I’ve been using isn’t supported, so now I am faced with paying a whole bunch of money for a new edition of Windows Server standard. If I upgrade to that, I might as well update my client machines to Windows7. If I do that, my current video cards don’t support it, so I’ll have to either buy new video cards or just a new box.

So now, with all that plus the yearly, over $1K fee for OM, I’m wondering if I shouldn’t start over with some other solution. To tell you the truth, the only thing I use OM for is electronic billing. I just scan my paper charts with my awesome and fast Fujitsu Fi-6130 document scanner.

I really wish OfficeMate would have implemented a cross platform implementation of an SQL db. I could have just used a free Linux server to host the db.

Tags: EHR, insurance, management, optometrist, PIM

I’m instituting a new feature: Hate Comments. You know, the comments that don’t get published because they fail my unapologetically arbitrary moderation process.

It turns out there could be gems of literary wisdom for the ages in some of these unpublished comments. Let’s read the nuggets and gems just pouring out of this deleted comment:

Author : Johnny (IP: 66.142.***.*** , adsl-66-142-***-***.dsl.crchtx.swbell.net)
E-mail : forgetyou19@hotmail.com
URL :
Comment:
first of all, David Langford is a sore loser in optometric field…..”happily rents a place in Wal-Mart” ????……after 8 years of school (maybe more for you, who knows), and works “happily” in the cubicle of Wal-Mart ??!!!…you’re embrassing !!!!……having opticians watching your every move and determining your working hour ??!!!….take title OD off of your last name Langford….biggest loser like you don’t deserve it…..if you can’t encourage people into OD career, then don’t lead them to your sorry ending ways.

Wow. First, I didn’t lose in the optometric field. It was private practice. And if a bright, nice guy like me can fail in opening cold, you young pups coming out of optometry school could also. It should give you pause because while I don’t think I’m any better than you, why would you assume you are better than me? Your O.D. degree doesn’t guarantee anything. And that loss was just a single battle in my life. I’m winning everywhere else (family, church, hobbies, current job, etc), so I don’t think you can fairly call me a loser.

Second, Johnny, look in your local phone book and see how many commercial vs. private practice optometrists there are. Your comments are disparaging almost 1/3 of the optometrists in the nation. Your use of cubicle is interesting because almost 99% of all optometrists work in a room about 11’x13′ (and in the dark half the time). You don’t even know that I set my own hours. What’s embarrassing is your spelling of the word embarrassing.

Let me address who I think Johnny is. His IP address from Southwestern Bell indicates he’s probably in the states of Arkansas, Kansas, Missouri, Oklahoma, or Texas. So, it’s possible that he could be an optometry student in Houston, Tahlequah, or St. Louis. Judging by the maturity and knowledge revealed by his writings, I would guess that it’s more likely he’s an undergrad, possibly high school student, planning on becoming a private practice optometrist.

Johnny, I would say that you should go for it. Go big or go home. I’m sure you can do it, Johnny, because I have faith in your ability to communicate and win friends and influence people.

To the rest of you undergrads that are asking yourself, “Should I be an optometrist?” Let me ask you some questions:

1. Do you like sitting in the dark half the day?
2. Do you like explaining the same thing over and over and over again to everyone you meet?
3. Do you like to wear slacks and collared shirts all day, everyday?
4. Do you like to work Saturdays? (More and more private practices are now in addition to commercial.)
5. Do you want to pay more in school loans than it’s worth to be in said profession?
6. Do you have a favorite town you want to settle in? Because I’ll bet it’s already saturated with eye doctors.
7. Do you like having shortened lunch time because the last patient went long?
8. Do you like getting scowled at whenever you run a few minutes behind?
9. Do you like knowing you could be sued and maybe your career over if you mess up even once? (Not that you will, but it’s possible.)
10. Do you like to whine at ODwire.org? (But seriously, check out this link for more considerations in choosing optometry as a career.)

Tags: Hate Comments, optometrist, optometry school, Organized Optometry, private practice

Here’s an article by Dr. Frank Won about working for another doctor who rents from Lenscrafters. Part 1 and Part 2.

Tags: commercial, optometrist