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Since October 16, 2020 I have had to take an extra step at the end of the exam to explain to patients they they need to sign a statement saying that they received a copy of their contacts lens Rx. Firstly, some people get a bit apprehensive when asked to sign any kind of legalese- as they should. Second, the question “why?” pops up when they’ve been wearing contacts for years and never had to do this rigmarole before.

So, obviously, the Contact Lens Rule was created to punish all optometrists for the sins of a few. No doubt that online retailers were behind this. You would think the proper way to handle a complaint that your optometrist didn’t give you a finalized prescription would be to tell your state optometry board and let them correct the issue as their rules dictate. But that wasn’t good enough for the Feds, so now we live in a county where the FTC has requirements for optometrists- although the punishment for not complying isn’t spelled out clearly.

So if we’re going to take away power from the states regarding their administration of licensed professions, then let’s just be consistent and have a national optometry license and tell the states that they can take their boards and throw them in the septic tank where they also think all the optometrists belong.

Tags: 1-800, Comics, contacts, doctors, Government, patients

[scrippet]Title: The Air Puff
Author: David J. Langford
Contact: editor@optoblog.com

Fade in.

INT. – OPTOMETRIST PRE-TEST ROOM – DAY

DR. LANGFORD, an optometrist that smiles like a clown, tosses his clipboard on the adjustable table behind three items of ophthalmic instruments. He lowers the table as JANAE, pretty and wholesome, sits down on the stool on the other side of all the machines.

DR. LANGFORD
So…Jay-Nay? What brings you in for an eye exam today?

JANAE
Juh-Nae. Oh, just a check up.

DR. LANGFORD
Okay, then. Let’s start with this machine.

JANAE
Oh, no. Is this that puff of air thing?

DR. LANGFORD
Yeah. This one is not too bad.

JANAE
Really?

DR. LANGFORD
It’s the most gentle non-contact tonometer on the market.

JANAE
‘Kay…

Janae puts her forehead on the rest. The doctor clicks the button. The machine whirs, and we hear a PUFF of air.

JANAE
(high, almost squeal)
Oh!

She sits back and rubs her eye.

DR. LANGFORD
Ready for the next one?

JANAE
I guess…

The machine whirs again then PUFFS. Janae recoils the same way.

JANAE
(rubbing second eye)
I’m glad that’s over with. What does that machine do, anyway?

Dr. Langford tries to repress his wierd smile.

DR. LANGFORD
It checks eye pressure, which is important to know because if it’s outside the normal range, you could have a serious eye condition.

Janae blinks a lot.

JANAE
My eyes feel dry now.

DR. LANGFORD
Okay, let’s move on to this machine. It gives me a close idea of any glasses prescription you might need. Chin on the chin wrest.

She puts her head up to the autorefractor. It beeps and then-PUFF!!

JANAE
Ah! Hey! I thought we had already finished the puff of air thing!

DR. LANGFORD
Did that puff at you?

JANAE
Yes!

DR. LANGFORD
Huh, let’s try the other eye then.

She puts her head back to the machine, but the monitors shows that she’s squinting in anticipation.

DR. LANGFORD
Okay, for the machine to take the measurement, you’re going to need to open your eye wider.

JANAE
But I don’t want it to puff at me.

DR. LANGFORD
Just a little wider…

Janae’s eye opens just barely more and…PUFF!

JANAE
Ow! It did it again.

DR. LANGFORD
(holding up the print-out)
Well…it printed out these glasses prescription numbers, so it can’t be broken.

JANAE
But it blew air at my eye!

DR. LANGFORD
I’ll have a look at it later. Let’s move on to the last machine in this room.

He holds out a clicker for her to take.

DR. LANGFORD

It’s going to test your peripheral vision. Every time you see a flicker in your side vision, just click on the button. It takes about a minute per eye.

JANAE
Okay, that doesn’t sound so bad…

She takes the clicker from Dr. Langford and puts her forehead up to the machine. She SEES THE FLICKERING SQUARES on the screen.

JANAE
So when I see those dealies I just click?

DR. LANGFORD
Yup, but don’t move your eyes around just look straight ahead. Okay…begin.

She presses the clicker and- PUFF! She sits back.

JANAE
What the…

DR. LANGFORD
Keep clicking!

She gets in the the machine again. She clicks, and…

.MONTAGE OF GETTING PUFFED

PUFF! Janae clicks, puffs, and yelps over and over. Dr. Langford looks on with a sly grin.

INT. – OPTOMETRIST PRE-TEST ROOM – DAY

JANAE
Doctor, every time I clicked on the button, it gave me a puff of air in the eyes!

Dr. Langford looks at his display.

DR. LANGFORD
Oh, you know what? I had it set to the serial tonometry setting. Sometimes it’s helpful to take multiple readings to see what your eye pressure is over time. Oh well, no harm done. Let’s go into the exam room.

INT. OPTOMETRIST EXAM LANE – DAY

Janae enters rubbing her eyes and sets her things down. As the doctor enters, she looks in the mirror on the wall to see that her eyes are *bright red*.

JANAE
My eyes are really red!

DR. LANGFORD
Don’t worry, that will go away in a minute. Have a seat on that dentist-looking chair.

JANAE
I hope you’re right.

DR. LANGFORD
Of course I’m right.

He scoots a big Phoropher up to her head.

DR. LANGFORD
Now, which is better? One or two?

We see an eye chart, and switching between one or two, WE DON’T NOTICE ANY DIFFERENCE.

JANAE
Um..

Black Screen

SUPER: 20 MINUTES LATER…

INT. OPTOMETRIST EXAM LANE – DAY

DR. LANGFORD
And now which is better, one or two? One or two?

JANAE
I don’t…uh..

Dr. Langford pulls the machine away.

DR. LANGFORD
Okay, it looks like you don’t need glasses still.

JANAE
All *that* just to find out-

DR. LANGFORD
Okay, one last thing, I’m going to look inside your eyes with my microscope.

He swivels a slit lamp over. It looks kinda’ like those other machines in the pretest room.

JANAE
Doctor, look…I’d rather not do this one.

DR. LANGFORD
Well, I need to look inside your eyes to complete the exam.

JANAE
But couldn’t you do it with something…else?

He pulls out an ophthalmoscope, an innocent-looking flashlight.

DR. LANGFORD
I guess I could use this.

JANAE
Let me see that.

He hands it over. She twists it apart, looks, and reassembles it.

JANAE
Yah, I guess that’s okay.

He takes it back and gets…uncomfortably close to her face.

JANAE
(pushing back)
Whoa, whoa!

DR. LANGFORD
With the ophthalmoscope, I have to get in close. You chose this one. Don’t worry. Nothing touches you.

Janae still has a defiant look of doubt.

DR. LANGFORD
Just a quick thing, and then we’re done.

JANAE
(a look that says don’t cross me)
Real quick.

DR. LANGFORD
Yes.

JANAE
It won’t hurt.

DR. LANGFORD
No.

JANAE
Fine. Get it over with.

He brings the “flashlight” in again, still uncomfortably close.

We SEE ALL THE BRIGHT LIGHTS that she sees.

And then… PUFF! She recoils.

JANAE
That’s it! I’ve had it!

She stands up from the exam chair.

JANAE
I’m not paying for this!

She starts to walk out.

A BLACK SPOT BLINDS her central vision and full view of the doorway.

Janae hits the wall. She holds her forhead.

JANAE
You are sick!

As she exits she has fire in her red, red eyes.

EXT. PARKING LOT – DAY

Dr. Langford strolls to his car. As he gets out his keys.. WHACK! A force of nature- a flash, which vaguely looks like Janae, body checks him onto the car. His limp body then slides to the ground.

Janae brings around the car a big air compressor on wheels. She holds open his eyes while pressing the trigger. Air whooshes his hair and then her aim corrects to his eyes.

JANAE
(as she alternates the aim between his eyes)
Which is better now, doctor? One! or Two!

Dr. Langford whimpers, eyes red. Now Janae has the weird smile.

FADE TO BLACK and ROLL CREDITS

INT. OPTOMETRIST EXAM LANE – DAY

Dr. Langford gets really close to Janae with an ophthalmoscope…and steals a kiss.

FADE TO BLACK
[/scrippet]

Tags: air puff, comedy, movies, patients, revenge, scripts

I posted on my practice website the information that I wrote for a patient handout on allergy eyes. There’s some new stuff in there reflecting the current research on intestinal flora and allergy symptoms.
See also:

• http://www.nature.com/nm/journal/v20/n2/full/nm.3444.html
• http://www.marksdailyapple.com/seasonal-allergies-treatment/
• http://www.marksdailyapple.com/leaky-gut/
• http://www.ncbi.nlm.nih.gov/pubmed/24690419
• http://www.ncbi.nlm.nih.gov/pubmed/3745938 (Asmtha, Eczema, Allergies are all closely related)

It appears that most of America’s health problems could be solved by ceasing the Standard American Diet and implementing the Paleo/Atkins/LowCarb diet. I’m betting research will someday show it helps with glaucoma, AMD, dry eyes, MGD, and many other eye conditions related to inflammation and blood vessel pathology.

Tags: allergies, eye drops, eye health, paleo diet, patients

This is the e-mail I just sent to BlueCross:

Dear BlueCross,

It is with regret that I inform you that I wish to terminate my contract with BlueCross and no longer be in your network. I understand that I have to continue seeing BlueCross patients for 90 more days.

If you are interested in why I am leaving you, my accounts receivable with BlueCross patients is unacceptably high.

Since I am an optometrist, I need fast, easy access to whether a member has a routine eye exam benefit (S0620, S0621) and whether a contact lens evaluation is covered (92310).

For non-Regence plans, I have to make lengthy phone calls and navigate through terrible phone trees before finally talking with a representative. This process takes longer than performing the actual exam.

While Regence has a nice website for explaining benefits and is good about paying what I expect, every other BlueCross association is unpredictable about paying what I’m expecting. I often have to send out statements or refunds. Usually statements. Hence the high accounts receivable.

I know this will hit you in the wallet as well since I am the lowest-fee eye doctor in Cache Valley. If in the future BlueCross comes out with a website that allows an optometrist to see vision benefit details for any BlueCross member from any state/association, then feel free to let me know, and I’ll reconsider. I would also reconsider if a new rule allowed one to participate only with Regence and exclude all other BlueCross associations.

Sincerely,
David J. Langford, O.D.

I find it unacceptable in this day and age that I can’t look up vision benefits for an entire insurance company in one place. This probably has something to do with BCBS being independent associations instead of one giant insurance company. It is still ridiculous and a big pain in my side that won’t be there in 90 days.

I feel sorry for my BCBS patients. If it’s any consolation, the Utah State University BlueCross beneficiaries can send in their receipt and get 70% reimbursed for a routine eye exam done out-of-network. Not bad.

Tags: doctors, Income, insurance, patients

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

If it’s the law that I have to give them the Rx, then can it be the law that they have to keep it? Or pay for another one? Or pay to have it faxed or verified by a third party?

I have seen contact lens Rx’s on the black top of the Walmart parking lot. Can’t people at least take it home before throwing it away?

I wouldn’t be so annoyed, but lately lots of people have been asking for copies of their Rx, and every time I feel like asking, “What happened to the one I already gave you?”

I don’t get paid to fill it out the second time, you know.

Tags: Comics, contacts, doctors, Government, patients

I would like to propose that someone perform a series of studies regarding living a low carbohydrate/high fat diet and its effect on inflammation-related eye disease.

I read The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable by Drs. Stephen Phinney and Jeff Volek. An interesting conclusion is how our bodies become carbohydrate intolerant as we age, which pushes many people into metabolic syndrome, diabetes, and hyperlipidemia. It turns out that carbohydrates, by taxing our insulin response, cause inflammation.

Hence, the American Heart Association’s war on fatty food is misguided (see Good Calories, Bad Calories by Gary Taubes) because dietary fat is only bad in the presence of too much carb intake.  While there are some high omega-6 oils which increase inflammation, it is easy for people on Very Low Carbohydrate (VLC) diets to intake the good fats like olive oil, canola oil, high-oleic safflower oil, butter, animal fats, and coconut oil. In VLC diets, your daily Caloric intake is approximately 80% fat, 15% protein, and 5% carbohydrate.

Recent research, CE lectures, and trade articles have been advising us to tell our patients to increase their omega-3 fatty acid intake via Fish/Flaxseed oil pills.  With the latest research coming from Dr. Phinney et al, wouldn’t it be more responsible to educate them regarding the New Atkins/Paleo/VLC diets?

VLC diets are already proven to tighten diabetes control which we know decreases incidence of diabetic retinopathy. Logic tells me that Atkins/Paleo/VLC will soon be proven to reduce incidence and/or severity of macular degeneration, dry eye syndrome, and any eye condition related to inflammation.

So, anybody want to do some studies?

I’d start by visiting this helpful website and reading these books:

DISCLOSURES:

In 2010 I lost 35-45 pounds using the hCG diet, but could never keep off the last 10 lbs, so in 2012 I switched to the New Atkins. Now I easily maintain a 50 lb weight loss (221 to 170), and my body doesn’t even crave things like pizza and popcorn.
Also, if you click on the links above and actually buy a book, I get a tiny referral bonus from Amazon.

Tags: AMD, DES, diabetes, diet, disease, nutrition, patients, weight

A urologist posted a sign at his office, and some people are going nuts.

So…I’m not sure I would pick that fight because I just want money in exchange for services, but if I felt that a certain person or entity were actively fighting against me obtaining patient volume and deserved fees, then yes, I would have to push back.

This doctor also put some literature in his waiting room about the negative effects of Obamacare and its timetable. Holy cow, imagine the left’s vitriol if you stuck a Bible in your waiting room! I put NRA magazines in my waiting area, and guys love them! I also put National Geographic in there too. You know, just to keep it balanced. I think it’s the doctor’s right to put any decent reading material he wants in the waiting room. No one is forcing them to read it. They can take their business somewhere else if they want.

I’ll bet 80% of my patients don’t even know what magazines I have in my waiting area since I don’t like to keep people waiting.

I’m still participating in Medicaid until it doesn’t make it worth my while. I don’t really agree that there is such a thing as government sponsored-medicaid, but for now I think of it as getting my own tax dollars back.

Anyway, I reserve the right to express my political, economic, and religious views to anyone who will listen, inside or outside the clinic. Just because I’m a doctor doesn’t mean I can’t be active in causes I believe in. However, I don’t think people pay me to preach to them. I’m pretty sure they came in for an eye exam. Plus I don’t have time to go off on political or religious rabbit trails because I hope the next patient is almost done with their paper work.

I don’t care what a patient’s political/religious/etc philosophy is. I don’t care if I have to speak to them in English or Spanish or through a family member interpreting, I just want a fee in exchange for a service, and I want to perform as many exams per day as possible.

Tags: doctors, Free Speech, Government, insurance, patients, politics

Is there anything I can do to not get that gunk buildup by the nose pads?
An ultrasonic cleaner will take out the gunk. To help it not build up, try cleaning your glasses daily under the sink with dish soap that doesn’t contain lemon.

Yesterday I didn’t have to bill a single insurance. I love no insurance days.

New phones chirp like the phones in IHS used to. They also chirp louder and more frequently if no one picks them up quickly.

Lately people are confusing the non-contact tonometer with dilation. “Okay, I’m going to put some drops in your eyes to dilate them.”
“Didn’t we already do that with the puff of air?”
“No, that was just an eye pressure measurement.” (I already explained that when doing it, BTW.)

AlwaysCare website is down, probably due to hurricane Isaac since the call center is apparently in Baton Rouge. Earlier in the day, the website just timed out. Later it has this message: “AlwaysAssist website is currently having technical difficulties.. Please check back later to access any information. Thank you for your patience. For immediate assistance, please call [toll-free and local numbers] in Baton Rouge. ”

Of course all circuits are busy when you try to call that number. I think it’s ridiculous that they don’t have redundant servers across the country available. I guess these hurricanes inconvenience everybody…

Tags: @optotrician, air puff, eye drops, insurance, patients, phones