We have been using this technology in our office since november. I was just wondering what you guy's think about it?
We have been using this technology in our office since november. I was just wondering what you guy's think about it?
Decent technology. Incredibly ridiculous pricing structure by the parent company, imo. It seems you are only making money for the company, and it just plain sucks you can't buy one for a reasonable amount.
I think the biggest draw is the impression that your office is high tech and up to date. I cringe every time I see one though.
They need another company to come up with something similar or better and put them in their place financially. :)
I think a good fundus camera would do a lot more things and be just as effective as a "wow" device to have in an office.
I think another bad thing that I hate seeing is when offices sell it as a "replacement" for dilation. Its not a replacement, from a standard of care/medico-legal perspective.
What are your feelings? feel free to pm me...
Lots of hype, the equipment is just a souped up tricked out fundus camera. The pricing makes it so you are indebted to the company and the machines cost is somewhere in the ballpark of $180,000 which has to be insured in case anything happens to the machine. You have a quota of pictures you have to meet per month as well as you pay almost half of the collected copays to the company for allowing you to take the photo. It does allow a wider field of view, but if it was such a worth while piece of equipment to have why has it not poped up inside retinal specialists offices around the country? You'd think that the company would target these doctors as the first market to exploit. We did a break even analysis some time ago and it would take us about 50-60 images a month for the equipment to make sense, the quota was somewhere in the ball park of 45 so not much margin for error there.
Also as orangezero mentioned whent he company first began offering this equipment they were offering it as a replacement to dilation, they have only recently revised their stance to a screening.
To be honest we do mention that in some cases it replaces dialation, BUT if the doctor see's something concerning then he will go ahead and dilate anyway. The cost is pretty ridiculous, @ 22 bucks cost per patient to us we're charging 35 to the patient, so there isn't much room for profit. Plus their customer service sucks. We were having a problem with the latch underneath that you can unlock with a key. It was popping open and when we called they didn't seem to think it was a big enough issue to send out a repair tech.
Do you guys have to meet a quota? And have you?Originally Posted by ExpressOptical
we have to meet a quota to break even, but not so we can keep the optomap in the office.
i was told somewhere it WOULD be pulled out if they weren't making enough money on it (notice how I phrase that).
there have been some studies attempting to prove this machine could detect peripheral pathology better than certain highly trained and well educated doctors. i'm sure we would have all heard of them if this was the case.
i've heard of doctors dilating one year, and then doing this the next, but that wouldn't fit into their rental agreement very nicely.
harry, isn't it great we agree on something :bbg:?? someone sticky this thread.
Well from what I have been told/read the optomap is also a good indicator for other diseases besides eye diseases. Mainly high blood pressure, diabities and high cholestorol just to name a few. Have you seen any literature on this?? I am a fairly new optician, i've been working as an optician for 4 months, so I'm no expert on any of this by any means. I'm just trying to learn as much as possible to better serve my patients and the practice.
My personal opinion is that it can be a good option for documenting and tracking retinal pathologies, but that is exactly what a good fundus camera is for. The problem with the technology is that the "patented" ellipsoidal mirror provides a distorted i.e. elongated view of the fundus. It also lacks a true stereo view. The price and "lease" is outrageous and outright price gouging. The local optom school uses it after dilation as well as a fundus camera. Certainly NOT a replacement to a dilated BIO exam or if you are billing a 92004,92014 since dilation is required.
My 2 cents
This company is an equal oportunity exploiter. I guess it isn't too hard to agree on that.Originally Posted by orangezero
I know at one point you couldn't even bill it as fundus photos because the dpi was terrible, I have heard that this has changed but still its just a fancy new gimmick.
That's exactly what I was talking about, you have to pay for lets say 45 pictures per month weather you use them or not. I guess what I am trying to get at is, is it orth it?Originally Posted by ExpressOptical
I know when they gave the speal in our neck of the woods they were quoing data from a practice in FL, heaven waiting room. The demographic is totaly different from ours here in MD and we just couldn't justify it.
Sure, I have seen patients with retinal pathology who I can pretty much guarantee have diabetes, hypertension, etc., but fundus evaluations are not the best screening tool. When we had an optomap in the office I tried several times to capture retinal anomalies like microaneurysms with no success. The machine just doesn't have the resolution.
On a side note: Once we cancelled our contract with them, the machine still sat in our office for months before they sent someone to remove it. I guess there just isn't the demand for these things like they would have us believe.
Our office is guilty of saying it can replace dialation, which I now don't think is a good idea. I'm going to bring it up in our next meeting.
We've had the Optomap for about 4 years now. In a commercial setting sometimes this is the only way I'm going to get to see any of the peripheral retina. I tell each of my patients everytime that I recommned that they be dilated or at least have the Optomap. Most of my patients think that because we're in a mall that we don't dilate. I do, but I also can't force patients to be dilated. Also, a lot of people come in during their lunch break, so it's difficult to send them back to work as a presbyope. Even with the Optomap, it's sometimes difficult to get patients to agree to it, let alone agree to dilation. I just make sure with everyone that I document that I educated them on the importance of Optos/ DFE, and that they refused. Ideally I'd like to dilate one visit, Optomap at the next and keep rotating. My BIO skills are adequate, but it's also nice to have a photodocument, I'll admit that I might not always get a full 360 degrees out to ora everytime! And with kids, Optos can actually be better! We charge $35 for it, and we're averging around 200 patients a month. It's $22.50 for the first 125, then drops significantly to $7.50 for each one after that, or something give or take that. It's still rough though when that bill comes in!
I really can't talk about it's effectiveness, not my place, but given your figures you are paying out 48% of what you earn with this equipment and the company shares very little risk for essentially becomeing a 50/50 partner. You pay to insure the equipment (cost), you work the equipment (time and labor), and you sell and collect the fees (time and labor). They share in the spoils and if you don't meet their monthly minimum they still share in the spoils. Just sounds like a bad business deal to me.Originally Posted by scograd
as far as the high resolution goes, I thought that the Optomap Plus took higher resolution pics than just doing the regular opto map pictures. You can focus it on the periphery, or central etc.. I'm not a big fan of it. Mainly because of the technical problems. It has to be practically broken down to get a tech to come and look at it.
We are watching optomap with a cautious eye. It certainly has a wow factor for patients, but our doc has doubts about it as a replacement for a DFE, and of course the pricing schedule is outrageous. Maybe if they would change their business model we would be more interested.
I had an optomap done on me once - I was not impressed. First of all, it took about five trys to get an image that wasn't completely obscured by lashes. Second, I did not appreciate having my face shoved into the instrument, nose squished and bent up against the soft ring pad thing (and my nose really isn not that big). And third, the image quality sucks, equivalent to about 1.2 megapixels I last heard - NOT impressive at all, I mean my cell phone has better resolution.
Our two-year lease of the Optomap recently ended. I would definitely NOT recommend this product to anyone. As far as I am concerned, it’s a bad product with bad customer service. My complaints mirror those that others have touched on:
I remember getting the letter and e-mail which stated something like: “It’s come to our attention that many of you (i.e. doctors using the Optomap) are placing too much emphasis on the Optomap’s non-mydriatic capabilities.” I remember thinking, “That's specifically how they sold it to me. Why on Earth would anyone want this if not for its non-mydriatic capability?”
I agree. When our machine was working at its best, the resolution of the optic nerve head was too poor to be useful for screening for glaucoma and the peripheral retina was always too dark to view any pathology that might be out there. On this second point, Optos’ suggestion was to increase the illumination during image capture which served only to make viewing the optic nerve head more difficult by washing it out. The Optomap in our office routinely failed to catch peripheral lesions that I already knew existed or was able to view with a BIO through non-dilated pupils. As I expressed to my rep, if the machine isn’t any good for detecting peripheral pathology and it isn’t any good for documenting the appearance of the optic nerve head, what use is it? He stopped staying in touch shortly after that.
Similar experience here. After our contract ended, it took Optos about eight weeks to get someone out to remove their machine from our office. I was not going to be in the office on de-installation day, so I left specific instructions for the technician NOT to disconnect our router and DSL modem (which were near the Optomap). Still, the technician de-installing the machine disconnected all of the cables to our office’s internet router (rather than just the cable to the computer used by the Optomap) as well as everything hooked to our DSL modem and everything else on the power cord that the Optomap was using. On top of that, I keep getting monthly bills (with an interesting fee increase) from Optos. I’ve left messages, e-mailed them, and faxed copies of my e-mails, but they don’t respond.
One final comment: Read the find print before signing. My rep never mentioned that we would be responsible for an annual property tax bill of around $750.
Interestingly enough, we just got a FedEx letter today to purchase the system for $155,000. My favorite is that they will continue to provide support as long as there is a "service agreement in place". Well who the hell else is going to be able to service it?? It may not always be the best way to look at a retina, but it's better than only plain old 90D thru undilated pupils.
Was it printed on toilet paper?:DOriginally Posted by scograd
That said, I must disagree with some of the comments.
Many of the comments come from "master Opticians". Meaning no disrespect, but if you aren't the doctor, it is hard for me to take seriously your opinions as to the validity of the instrument.
Another point....profitability. Since you pay only for the images taken, its a cash cow. If you do 200 per month at 15 dollars profit that's $3000/month with no actual cost of goods sold.
Property taxes...yep! that's a real sticking point. I asked day one about this since it comes with every lease. I was Lied to by the rep. Oh well...
I still make a ton with it and when someone has a retinal detachment or Branch Vein occlusion following the initial photos, you are pretty happy to show the patient that you didn't miss something.
Finally- Time! We all aspire to see more patient in the same time frame. This instrument really helps in that respect.
Yes, it does miss obvious peripheral lesions, but compared to the patient "refusing" dilation and seeing absolutely nothing, its a breath of fresh air.
Allan J. Panzer, O.D.
And if you really wanted to get fancy, you could always use some image integration program and make those nice looking geographic fundus photos, where 5-15 pictures are spliced together.
I still believe a nonmyd is better in almost all regards... have you seen the newer models lately? seriously consider then before you sign the next optos lease. they make out way better than you do.
Even if you could buy the optos, for the same cost you could get two fundus cameras, a slit lamp photo system, an OCT, a pachymetery, an extra lane, and probably a much nicer car than I currently drive. Not even a comparison. IF there is an OD or MD willing to actually buy the optos, give me his name and I bet I could sell him some ocean front land in nebraska :)
When they realize I am willing to perform the optomap instead they say thank you and that they will be back next year. And guess what? They pay cash for it. My penetration rate is as close to 100% as it can get.
And yes, I actually do know a doctor who just bought two of them. Why? Because he was paying the company $9000 per month in fees. So, it was cheaper to buy it. Since I only do 175 to 200, they aren't as anxious to sell me one. I would have happily bought it day one if they offered.
In the three and one half years I have had it, I have paid them about $100K, so yes I am one of those stupid doctors you seem to think are so dumb.
Secondly, it's great that you caught a hole without having to dilate that patient. Given your earlier comment that "it does miss obvious peripheral lesions", I'm wondering how many other holes are being missed. How do you address this with your patients?
Finally, the trouble with the Optomap is that your patients don't know what you're missing. It is difficult for me to take seriously their opinions as to the validity of the instrument.
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