optoblog.com

I was an Indian Health Service optometrist for two years, but my dad was one for 34, beginning in 1971. I believe he was the first PHS-IHS optometrist to join and then serve a full 30 years. (There may have been others that actually retired before him, but they had previous military time-in-grade.)

One of his contemporaries was Dr. Les Caplan, OD, MEd, FAAO. Dr. Caplan is an award-winning optometrist of historical significance. He was the first optometrist assigned as the Clinical Consultant for Optometry to the director of the Indian Health Service. Back in the early 70s, optometrists were barely being integrated into the IHS healthcare system as real eyecare physicians, so Dr. Caplan traveled around the country to help make this monumental transition, paving the way for increased scope of practice for optometrists in all modes of practice.

In June 2015 at the AOA meeting in Seattle, there was a presentation sponsored by the Optometric Historical Society that Dr. Caplan gave, and I got a hold of his presentation. The powerpoint file was 128 MB, so I condensed it to an 18 MB PDF, which you can view here with Dr. Caplan’s permission.

On page 39 there is a picture of some wetlands viewed through an airplane window. That is actually a 5 minute silent video filmed in 8mm that shows highlights from Dr. Kaplan’s trip to Alaska in 1971.

Anyone interested in Indian Health Service optometry should go through the entire presentation. It is also of significance to anyone interested in optometry’s advancement in scope of practice.

To learn more about the AOA’s optometric history initiative, read this.

There is an award given to PHS optometrists named after Dr. Caplan.

Tags: History, Indian Health Service, Organized Optometry, Scope of Practice, Travel

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 reported in an e-mail to its members on Friday Feb. 17, 2012 that the UOA’s lobbyist has word from Rep. Hughes that he will not run HB408.

Of course, they state that they have no guarantee someone won’t try to run it in a future year, so they suggest donating to the UOA-PAC.

As of today, the official Utah.gov site for HB408 doesn’t have any status updates since Feb. 4, 2012, but if lobbyists and politicians are to be believed, we can give a little sigh of relief.

Tags: Government, Organized Optometry, politics

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

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

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

I would just like to ask every Walmart optometrist reading this blog to please nominate me to go to the Health & Wellness Conference May 3-5th, 2010 in Bentonville Arkansas. I want to be one of the 250 optometrists in attendance.

To nominate me, find the e-mail that was sent to you from Walmartod.com on 1-8-2010 and click on the link. Here is the information you will need:

David Langford
Store # 1888
North Logan, UT

Why should you nominate me?

• Because I guess you can’t nominate yourself.
• I’m a cub scout Wolf den leader. I go to church every Sunday
• The associates in my vision center like me- we’re even friends on Facebook.
• I’m all techie. I even have a Humphrey Matrix VF and HRT2 in my office.
• I recently raised my fees and no longer charge extra for dilation.
• I was featured in the Review of Optometry with an article highlighting Walmart optometry.
• I’m like one of the original optometry bloggers. ‘Nuff said. I’ll blog the whole thing so it’s just like you being there (except without having to lose money while not doing exams at your office.)

There you have it. All the reasons you need.

Tags: Continuing Education, Organized Optometry, Wal-Mart

InfantSee: Optometry’s Contribution to Socialism!
InfantSee: The AOA loves BIG GOVERNMENT!
InfantSee: Baby Steps towards Communism!

Earlier I discussed InfantSee here and here.

Now, it turns out the AOA has secured federal tax dollars for InfantSee.

I don’t mind charity, but let me choose the charities to which I desire to give of my property. Giving all my money to the government and letting them redistribute it is the opposite of freedom. I am not going to participate in InfantSee. If I were a member of the AOA, I would demand that Optometry’s Charity™ – The AOA Foundation return all tax dollars to the government.

Tags: InfantSee, Organized Optometry, politics

I’ve come across some websites you may be interested in:

• Local Eye Site

Interesting because it allows all people who work in the eyecare field to use the same site for forums, job search, and buy/sell equipment or practice. I especially like how it is open so that anyone can read what has been posted without being registered. Registration is free if you want to post something.


• Wal*Mart OD

See what your main competition is up to. You won’t be able to post anything, though, because registration is limited to Wal-Mart doctors like me.

• Association of LensCrafters Leaseholding Doctors (ALL Docs)

See what the Lenscrafters eye doctors are up to at this website. From the looks of it, half the site is dedicated to their National Meeting which includes “recreational and social events to help unwind.” A.K.A. providing plenty of booze so you can get hammered and make funny faces while being photographed for their website.

But seriously, what professional organization doesn’t spend all your dues and sponsors’ donations in support of this glorified purpose?

Tags: Links, Organized Optometry, Wal-Mart

The Utah Optometric Association held their annual meeting in Park City at the Canyons Resort last week. The whole thing was a four day meeting, Thursday-Sunday, which is puzzling since the total CE hours offered was a mere twenty-three. The first two days only offered four hours and the last two days offered seven and then eight.

So why did the first two days only offer four hours? Well, of course you have to have the golf tournament which I overheard the same people win every year so they have to change the scoring rules to give others a chance. Then there’s all the luncheons, vendor fairs, dinners, parties, receptions, and association business meetings that take up more time.

Personally, I wish they would do all that other stuff on one day so that I could skip that day and still get all the CEs I need in just 2-3 days instead of four. I especially dislike having to go to CE on Sunday when I should be going to church instead. I mean, we live in Utah for Heaven’s sake! More than half the optometrists at the meeting are LDS church goers who normally wouldn’t work on Sundays, so you’d think someone could change the schedule to allow for more CE on Friday and Saturday and then I could skip out on the partying on Thursday and Sunday.

The Canyons is a nice resort. In the winter, it looks like you could ski out of your hotel onto the lift. But hey, all resorts in Park City are nice. The Canyons staff took good care of the conference room set-up, and there was plenty of pop, water, food, and hot chocolate.

Park City is great, but May is the off season. It’s neither winter nor summer, so you can’t ski and you can’t ride the alpine slide. Part of me would like to see the conference done in either the summer or winter when a lot more is available for the family to do; however, that would only serve to increase the rates of the convention and its hotel stay, so maybe it’s just fine in late May.

Really, it’s a great meeting, but the time lost in an extra day away from the office and the whole disrupting my Sunday routine has me thinking I might go to the NROC, SECO or AAO next time.

I’m sure I’ll still go to the UOA Park City conference occasionally in the future because it’s great to talk with other O.D.s in the state, but I’m never going to stay for a Sunday CE lecture again.

Tags: CE, Organized Optometry