Actually I heard Pat Caroline say a decade or so that Shrirmers had been shown in it's last 19 clinical trials that it was a useless test and not a real indicator of "dry eyes." Of course he went on to say that they still did it at his clinic because they got $40 for it and the patient was impressed. After he made the last statement, I stopped listening to him.
Chip
I reserve Schirmer testing for those patients whose symptoms greatly exceed clinical signs at the slit lamp (fluorescein, lissamine, rose bengal, tbut, tear prism, etc..). I've had a handful of patients with what they would describe as severe symptoms show no of the typical signs other than a Schirmer score of 0-1mm.
Schirmer testing just takes too long if you're actually following the protocol.
No insurance company that I know of pays for this test. We must be getting our information from different sources.Originally Posted by chip anderson
Fidge: There is an ancient custom that seems to be rapidly disappearing especially in O.D. practices. It's having the customer pay out of their own pocket.
Believe it or not some do. And some practioners will do proceedures for this whether they are needed or beneficial to the patient or not. Others will do useless proceedures only if they can bill the insurance company. Doesn't cost the patient, so it must be O.K. right?
What are you trying to say in the above ramble?
Seriously, you're way off again. Look at reimbursements, not listed by Odyssey Medical. Look at the costs of plugs, then the reimbursement.
And I didn't know that silicone punctal plugs are replaced on a weekly or even monthly basis...please tell me more.
This doesn't even warrant a response. Ramble on. Tick, tick, tick.
Although your arrogance offends me I will answer your question. I was referring to the collagen plug which usually dissolves in 5 to 7 days. In the other plugs used they are removed for irration, uncomfortable, or just to be changed for another better fitting one. :bbg:
Collagen plugs are generally not used for longterm treatment. They are used diagnostically to determine if a longer term plug is a good idea or not, and to treat a very limited short term problem, such as right after LASIK. So the concept that ODs re-install them every week for a profit is hogwash. But there are apparently some here who engage in giving medical advice and that they know better than an OD or OMD as to when punctal plugs should or should not be used. And it seems, of course, ODs only use punctal plugs to line their pockets. It's just not in their vocabulary that an OD might actually use them for legitimate purposes.
If you would have read the post instead of jumping in just to make a statement then you
would have realized I was giving no medical advise what so ever. I once worked for a
prominent MD ( and if I mentioned his name all would know ) who routinely changed
collagen plugs for many of his corneal patients he had. Why he changed them or because they were collagen the patients needed new ones I was never privy to that info only too know many patients came back for more. Some of us have been in the field long enough that we do have some medical knowledge, not practicing medical knowledge but knowledge gained along lifes path. But you OD's are so arrogant you think no body is as
smart or has as much knowledge as you do.
:hammer:
American King James Version
For in much wisdom is much grief: and he that increases knowledge increases sorrow.
Last edited by jediron1; 01-21-2011 at 05:49 PM.
Well...I wasn't even referring to you. My, isn't that the height of arrogance. I can't help if the OMD you worked for overdid collagen plugs.
Again (MD's name ) if I mentioned his name I think you would take back what you said. He has more experience for doing corneal implants, grafts and punctual plugs in his little finger then you have in all your years. But enough of this pi--ing in the air, you believe what you want and I will do the same. As said "your arrogance offends me and for that I will end this silly conversation! :hammer:
I don't get it? In one post you criticize this MD's over zealous use and billing of punctal plugs, and in the next you hold him as a wonderfully skilled doctor we should all be in a awe of?
That doesn't make you an expert in punctal plugs, corneal grafts or billing for medically necessary procedures. Amen.
I don't believe he ever said he was an expert.:finger:
Jana Lewis
ABOC , NCLE
A fine quotation is a diamond on the finger of a man of wit, and a pebble in the hand of a fool.
Joseph Roux
Well, he was quoting large prices for insertion and reinsertion of plugs. Turns out he was talking about collagen, while saying silicone, two different beasties.
DragonlensmanWV N.A.O.L.
"There is nothing patriotic about hating your government or pretending you can hate your government but love your country."
This might be a good time to " take five" and reflect on the fact that there are 2 sides to every argument and there is no need to talk down to anyone, or name call. Courtesy can be contagious!
"Always laugh when you can. It is a cheap medicine"
Lord Byron
Take a photo tour of Cape Cod and the Islands!
www.capecodphotoalbum.com
Again if you had read my original quote on the subject you would not have been misled like the OD's were. I was using an example in the original post to support Chips claim of larger reimbursements of plugs. I never mentioned collagen or silicone until one of the OD's said "I never knew silicone to be on a weekly or biweekly basics." he jump to that assumption I never said that. I then had to clear up his misunderstanding on the matter. Because he doesn't want to believe some MD's do change collagen because they usually dissolve in 4 to 7 days so technically they are not changing them but replacing them, OD's are always stuck on semantics. :hammer:
Castor oil and medical uses ...............................
Low-concentration homogenized castor oil eye drops for noninflamed obstructive meibomian gland dysfunction☆
Abstract
Objective
We developed low-concentration homogenized castor oil eye drops for the treatment of patients with noninflamed obstructive meibomian gland dysfunction (MGD), a major cause of lipid-deficiency dry eye, and assessed the safety, stability, and efficacy of the eye drops.
Design
Randomized, double-masked, placebo-controlled crossover clinical trial.
Participants
Forty eyes of 20 patients with noninflamed MGD.
Methods
After a preliminary study of eye drops containing castor oil, 2% castor oil and 5% polyoxyethylene castor oil (emulsifier) were mixed to formulate homogenized oil eye drops. The patients were assigned randomly to receive oil eye drops or placebo six times daily for 2 periods of 2 weeks each.
Main outcome measures
At the end of each treatment period, we assessed symptoms, tear interference grade, tear evaporation, fluorescein and rose bengal scores, tear break-up time (BUT), and meibomian gland orifice obstruction. Safety and stability tests were also performed.
Results
Symptom scores, tear interference grade, tear evaporation test results, rose bengal scores, tear BUT, and orifice obstruction scores after the oil eye drop period showed significant improvement compared with the results after the placebo period. No complications attributable to the eye drops were observed. The oil eye drops were stable when stored at 4°C.
Conclusions
The results indicate that castor oil eye drops are effective and safe in the treatment of MGD. The possible mechanisms of this treatment are improvement of tear stability as a result of lipid spreading, ease of meibum expression, prevention of tear evaporation, and the lubricating effect of the oil eye drops.
http://www.ophthalmologyjournalofthe...262-9/abstract
Last edited by Chris Ryser; 01-23-2011 at 03:31 PM.
Other medicals uses for Castor Oil............................
Chip does have a valid point as a short searech has brought to daylight............
1. Castor Oil is a mild and effective laxative
A half ounce of castor oil taken internally will have a quick and mild laxative effect, giving relief for constipation. To improve the taste, take the oil by floating in a glass of warm milk or mixing it with a fresh egg yolk.
2. Castor Oil expels tape worms and other intestinal worms
Castor oil taken internally has been documented to discharge tape worms successfully. Take a tablespoon of castor oil in a glass of warm milk in the morning and at night. The worms will be passed out of your system.
3. Castor Oil relieves arthritis, back pain and muscle aches
Castor oil applied topically can give immense relief from arthritis, back pain and general muscle aches and soreness.
You can improve its effectiveness by applying a cloth soaked in castor oil over the painful joint and covering it with plastic (such as cling film). Place a hot water bottle over this (this method is also known as a ‘castor oil pack’). The heat will help the castor oil to penetrate your inflamed tissues and joints.
Even without external heat, a castor oil pack will still work wonders. Just leave it on for longer. You can do this easily by putting the castor oil pack on before going to bed, leaving it to work overnight.
4. Castor oil cures sleeplessness and insomnia
If you suffer from insomnia, rub a little castor oil over your eyelids before going to bed. Castor oil applied this way will bring about a feeling of deep relaxation for a peaceful slumber without the use of drugs.
5. Castor Oil treats skin infections
To treat small skin infections, apply a few drops of castor oil onto a plaster or bandaid and apply it over the area you wish to treat each day. For a larger skin infection, use a piece of clean cloth soaked in castor oil instead.
6. Castor Oil relieves stomachaches and colic in babies
To relieve stomachaches, warm some castor oil by rubbing it between your palms and massage this gently over the abdomen and the bellybutton area (the navel). This relieves stomach pain and helps to expel trapped gas. Castor oil used this way also helps relieve colic in newborns and helps them sleep.
7. Castor Oil alleviates period pain and menstrual cramps
You can similarly massage some hand-warmed castor oil over the lower abdomen to relieve period pain and menstrual cramping. Using the castor oil pack method over the lower abdomen can also help reduce menstrual irregularities and uterine and ovarian cysts. It’s not unusual to feel some ‘fluttering’ over the ovaries (either side or both) when a castor oil pack is applied.
8. Castor Oil shrinks swollen lymph nodes
Rub castor oil over the swollen lymph nodes each day and it will gradually shrink in size. Castor oil works by speeding up the circulation of the lymphatic system.
9. Castor Oil cures vaginal infections and urinary tract infections
Apply castor oil directly to the skin, and cover with a warm washcloth or hot water bottle for half an hour to an hour.
10. Castor Oil shrinks hemorrhoids
Soak a cotton ball with castor oil and apply it to the hemorrhoid. Lie down to do this. However, if the cotton ball stays in place, you can also walk around with a towel wrapped around your waist.
11. Castor Oil relieves gallbladder pain
Pain from gallstones can be relieved by using hot castor oil packs. Place a castor oil pack over the area to relieve pain from gallbladder attacks.
12. Castor Oil relieves aching feet
If you have the type of job where you’re standing on your feet the whole day, you can use castor oil to soothe your tired and aching feet. At the end of the day, simply massage some hand-warmed castor oil over your feet. You should feel immediate relief.
For greater comfort during the day, rub a generous amount of castor oil over your feet and put on cotton socks before leaving the house. You will experience greater comfort while standing on your feet or walking all day.
For severe foot pain, apply a generous amount of castor oil over your feet’s problem areas, wrap it up in some plastic (such as cling film) and finish this off by putting on socks before going to bed. Your foot pain should lessen by morning. Repeated application of this for a few weeks will eventually resolve most foot pain completely.
I was able to heal my very painful heel spurs (calcium deposits) using castor oil, so this is something I can attest to personally. (p.s: using castor oil like this will also get rid of corns and soften thick calluses.)
13. Castor Oil boosts the immune system, increases lymphocytes
Castor oil has the remarkable ability to increase our body’s lymphocytes. Lymphocytes, or white blood cells, regulate wound healing. Studies have shown that T lymphocytes may play an important role in healing.
This boost in the body’s lymphocytes could also be why castor oil applications appear to be helpful for anyone weakened immune systems.
A 1999 paper ‘(Immunomodulation Through Castor Oil Packs’ by Harvey Grady, Journal of Naturopathic Medicine) showed that a 2-hour topical application of castor oil (castor oil packs) produced a significant increase in the number of T-11 cells.
- Those dealing with viral infections, such as shingles. (One commenter, Denise, talked about how castor oil seem to be the only thing helping soothe the pain from her shingles here.)
- Cancer patients undergoing chemotherapy.
- People who have AIDS/HIV, lupus or other autoimmune diseases.
Amazingly, the number of T-11 cell lymphocytes continued to increase for 7 hours after the treatment
see whole article: http://skinverse.com/castor-oils-many-forgotten-uses-part-1-medicinal-values.html
There is no misunderstanding. Your example to support Chip's claim of larger reimbursements is incorrect. There is only real world reimbursement for punctal occlusion. Repeated collagen insertion does not fly with insurances.
Take Aetna for example: http://www.aetna.com/cpb/medical/data/400_499/0457.html
Read section "II" part "A": "The repeat use of temporary (collagen) plugs for ongoing therapy for dry eye syndrome has no proven value;"
So no reimbursement = no $$$. Your numbers cannot justify Chip's amount. Realistically, do your math with initial collagen...10 to 14 day waiting period...then silicone insertion...MAYBE silicone insertion 6 months later... Subtract your cost of silicone plugs. Not even close to Chip's amount.
Every so often, there is a thread where some people like to tell a story or anecdote about how "what they heard, or what they saw at work" was wrong or dishonest or unethical. Fine, but then the inference is made that all members of that class of provider, usually ODs as this is an optician dominated forum, are dishonest or unethical.
There are dentists that fill cavities that never existed. There are optometrists that use too many punctal plugs. There are OMDs that take out cataracts that are not ready...and there are opticians that push upgrades that would be better left undone. No one single group holds the prize.
So how 'bout we all recognize each others good and bad points without making statements meant to make another class of provider look bad, or stupid, or dishonest. Our public is listening.
+1
Very much agree with you on this last point.
B
I had an old friend that described ready as that point when you could no longer see to do what you needed to see with that eye alone. Which of course would have a different defintion for watchmakers and housewives.
I seem to know others that describe ready as when the patient complains enough to make me do it.
I also seem to know some that feel ready as when the money is available and beating some other doctor to the job.
Still others feel 20/40 is right, others that 20/70 is right.
Me, I just hope they will send them back to me for whatever is needed afterward.
Chip
There are currently 1 users browsing this thread. (0 members and 1 guests)
Posting Permissions
Reply With Quote
Bookmarks