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Thread: Fundus Photos

  1. #51
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    Slice and dice

    Shoot Dr. Stacy:

    We got a "surgeon" over on da' river that does catracts when you ain't got no cararact a taul. Does such good refractive surgery that he can say: "I've been sued so much, I can't get malpractice insureance anymore so I put everything in my wife's name so they can't touch me."

    Chip

    Didn't they used to have a term: "Knife Happy?"
    Last edited by chip anderson; 03-05-2006 at 06:13 PM. Reason: Fo' Got da quotation marks

  2. #52
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    Quote Originally Posted by chip anderson
    Shoot Dr. Stacy:

    We got a "surgeon" over on da' river that does catracts when you ain't got no cararact a taul. Does such good refractive surgery that he can say: "I've been sued so much, I can't get malpractice insureance anymore so I put everything in my wife's name so they can't touch me."

    Chip

    Didn't they used to have a term: "Knife Happy?"
    There is a continuum of iol surgery that runs from purely cosmetic (say a +4.00 20/20 hyperope age 35) to purely cataractous (say a plano 20/60 catacract patient, age 65). You can argue that the hyperope should wait around 20 years or so until he develops cataracts, but I say go ahead and pre-empt that development at the same time giving him 20+ more years of clear vision without strong glasses than he would otherwise have had, with very little risk. Sure, it's partly cosmetic, but partly functional, and I think often worth it if you can find a surgeon who's up to it. Certainly better than LASIKing the same hyperope.

  3. #53
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    Dr. Stacy:

    I know of at least two cases where the patient was a near plano, see by another ophthalmologist just weeks before, and evaluated as having no cataract, and an uncorrected acuity of 20/20. Post surgery acuity also 20/20.

    Now you ask why did see see the good knive happy doctor after seeing the first?
    She saw the first for a medical eye which cleared with treatment (seems to me I remember when ophthalmologist treated these).
    She saw the second after being intriged by all the adds he was running on the airways stating how he was one of "top 100" in the country.

    Never underestimate the power of advertising. Especialy if you are practiceing medicine for wealth alone.

    Chip

  4. #54
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    Quote Originally Posted by Karenrp1956
    We offer the Optomap in our office. It is 25.00 extra. The patient reads about photo and signs if they want it or not.

    It takes a 200 degree image of the back of they eye. We are able to save photos and compare the pics yearly.

    We have found early retina tears, blockages and other problems. Pretty interesting. Anyone else have one?:D
    We have the optomap and love the Optomap. It is a great tool in our office.

  5. #55
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    Quote Originally Posted by chip anderson
    Dr. Stacy:

    I know of at least two cases where the patient was a near plano, see by another ophthalmologist just weeks before, and evaluated as having no cataract, and an uncorrected acuity of 20/20. Post surgery acuity also 20/20.

    Now you ask why did see see the good knive happy doctor after seeing the first?
    She saw the first for a medical eye which cleared with treatment (seems to me I remember when ophthalmologist treated these).
    She saw the second after being intriged by all the adds he was running on the airways stating how he was one of "top 100" in the country.

    Never underestimate the power of advertising. Especialy if you are practiceing medicine for wealth alone.

    Chip
    I can even see a case where 20/20 undaided would be a candidate. Say the person has a 2 mm dense central opacity that he can "see around" in dim illumination, but when he goes out into the sunlight, is blinded when his pupils constrict down to 2 mm. The BAT test would easily demonstrate this.

    Another reason to do 20/20 eyes? What if the patient were 20/20 at distance and 20/80 at near due to presbyopia, and wants to be myopic because of a demanding near point job where glasses are intolerable. At least doing one eye monovision (or both, if the need is there) would solve the problem.

    I'm not denying there are unscrupulous docs out there, but I seem to only run into the conservative ones who are scared to death to do a refractive lens exchange. Having said that, I'm so far totally against all the multifocal and "focusing" iols. They are all either bad optically, or just don't work. I admit my sample is small, but I saw a crystallens implanted by my own surgeon (world class), and she's getting 0.00 accommodative function out of that turkey.

  6. #56
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    I am not an eye care professional, but a patient. I have been troubled by the fact that my former optometrist routinely told each patient that they needed to have a retinal photo done every year at a charge of $55. I have observed this while sitting in the waiting room. Patients (both young and old) have been informed that they MUST have this picture taken. It wasn't even presented as an option. I have never seen a single person say no. I'm sure there was no medical indication to do so in the majority of patients. I've had mine taken 3 years in a row. My teenage daughter just had her second one taken.

    Reading these postings has just confirmed what I suspected. That this is being done to increase revenues. I can't believe I was so naive to agree to pay for 5 needless photos at a total cost of $275!! :angry:

  7. #57
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    Quote Originally Posted by ilanh
    I am very ambivalent regarding the routine visual fields and fundus photos that are so prevalent in optometric practices. Let me assure you, as a board certified fellowship trained glaucoma specialist, that there is absolutely no reason whatsoever to do a visual field on a normal individual who has normal IOP's and optic nerves. I don't see any justification for it other than the billing. Occasionally the visual field will catch an homonymous hemianopia or some other neurological defect which usually represents an old stroke. I have never seen it detect glaucoma that I wouldn't have detected otherwise. However, I have seen numerous cases in which a "suspicious" field was sent for exhaustive workups which never benefitted anybody. I simply don't feel that they're necessary and would suggest that optometrists stop doing them.

    Secondly, I cannot see any justification for routine fundus photos either. I dilate every new patient that I see, every patient with pathology and any patient coming for an annual visit. If the patient is young, is there only for refraction and has big pupils I will use my small pupil BIO to get an adequate look without dilation. Therefore, I can't really justify doing and charging for a fundus photo which will not help me in any way.
    Dear ilanh,

    I agree that routine visual fields or photos yield very little. We should be honets with ourselves and say that these routine tests are mainly to be competitive or to increae revenue and isn't yield.

    npdr

  8. #58
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    Quote Originally Posted by beach57
    I am not an eye care professional, but a patient. I have been troubled by the fact that my former optometrist routinely told each patient that they needed to have a retinal photo done every year at a charge of $55. I have observed this while sitting in the waiting room. Patients (both young and old) have been informed that they MUST have this picture taken. It wasn't even presented as an option. I have never seen a single person say no. I'm sure there was no medical indication to do so in the majority of patients. I've had mine taken 3 years in a row. My teenage daughter just had her second one taken.

    Reading these postings has just confirmed what I suspected. That this is being done to increase revenues. I can't believe I was so naive to agree to pay for 5 needless photos at a total cost of $275!! :angry:
    Needless?

    I disagree ~ What I would tell patients about optomap in the practice I worked at where it was optional, it that it is a digital record that is a permanent part of your medical file ~ can be transferred with your file to a new office ... and can be tracked and compared thru the years ...

    I go to a dental practice that not only takes "regular" xrays but also has a new digital picture device that they use to take a different type of picture.

    I think there is "basic" about having the DR look at your eyes for a few minutes, charting notes about what he sees and then moves on compared to being able to exam a picture of your eye from 1-2 years previously to NOW ... side by side to see what if any changes are going on ~

    I think technology is a good thing ~

  9. #59
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    Quote Originally Posted by GOS_Queen
    Needless?
    Quote Originally Posted by GOS_Queen

    I disagree ~ What I would tell patients about optomap in the practice I worked at where it was optional, it that it is a digital record that is a permanent part of your medical file ~ can be transferred with your file to a new office ... and can be tracked and compared thru the years ... "


    Dear GOS_Queen,
    Are you posting your rationale because you yourself think that is useful in clinical decision making?

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