Not Wearing Varifocal Glasses During Outdoor Activities May Lower Seniors' Fall Risk.

Not Wearing Varifocal Glasses During Outdoor Activities May Lower Seniors' Fall Risk.

BBC News (5/26) reports that, according to a study published in the British Medical Journal, "many falls could be prevented if older people do not wear varifocal glasses while out and about." In a study of "600 people aged either over 80 or over 65 with a history of falls," half of whom "were given single lens glasses for going out" and half of whom were not, Australian researchers found that those who went outdoors regularly while wearing single focal lenses experienced 40% fewer falls. Therefore, the study authors advised seniors to wear single focal glasses while performing outdoor activities in spite of the inconvenience of having to change glasses.

Great Customer Service.......

From Neil Gailmard, OD good advice:

I made the point just two weeks ago in tip # 431, but I'll repeat it here. Great customer service is very hard to deliver when the fee schedule is value oriented.

Raise your fees in general and you'll find it is much easier to let patients win these scenarios. If vision plans are very dominant in your practice, raise the fees anyway.

What are business cards for?

Speaking with Chris Padgett, OD at the Doctors meeting he shared with me what he uses his business cars for.  He gives one to each of his patients ("I go through a lot of business cards!") and asks them to refer their friends and family.  They might do that anyhow but asking may make this more successful.

I've been an advocate of giving each patient a business card at the conclusion of an examination saying something like this:

"I am personally responsible for everything that happens (or does not happen!) in this office.  And we try hard to make certain that we meet or exceed your expectations.  If for some reason we ever fail to do that I'd like you to contact me personally so that I can correct whatever it is that has occurred."

My business card has both my DVC E-mail address as well as my cell phone number.  I want any patient with an issue to be able to contact me directly.  If a patient is unhappy with anything in my office I am confident that I can correct the problem about 99% of the time.  I am not going to worry about the 1% that I can't help -- but I WILL try.

Who is the captain of your ship, the CEO of your office?

Words to Live By

"Don't tell me what my fun is."

"Don't tell me what I can afford."

Normal Macula, Normal Fundus Image = Normal Eye? Not so fast.

As I have said may times before when vision is less than 20/20 it is our job to determine the cause.  What we have grow accustomed to over the years when the macula appears normal on fundoscopy or imaging is that we can rule out the macula as being involved.  Wrong.  As Jerry Sherman has revealed over and over in Retina Revealed when vision is down and the macula looks normal we if we have no other cause that explains the reduce acuity we should get out the OCT.  Cross sectional imaging which gets below what we can see with a scope or an image will often reveal an abnormality deeper in the retina. 

A paradigm shift is necessary.  A normal fundus image of the macula does not necessarily mean  that the macula is normal.  Without another explanation for reduced acuity we should always order an OCT scan of the macula.

Zeiss Updates OCT and HFA Software

Cirrus™ HD-OCT Optic Nerve Head Analysis 
The new Cirrus™ HD-OCT Optic Nerve Head Analysis software provides automated identification of the optic disc and cup boundaries. The analysis is generated using the existing Optic Disc 200 x 200 data cube and a new proprietary ZEISS algorithm. This algorithm is designed to precisely measure the neuro-retinal rim, while accounting for tilted discs, disruptions to the RPE and other challenging pathology. Optic nerve head calculations are presented in a combined report with RNFL thickness data. Key parameters are displayed in table format. In addition, the boundaries of the cup and disc are displayed on the en face image integrated with the RNFL thickness deviation map.

“Doctors always are on the alert for improved ways of managing glaucoma,” said Douglas Anderson, MD, Professor, Douglas R. Anderson, Chair in Ophthalmology at Bascom Palmer Eye Institute, University of Miami. “Recent improvements in OCT imagery of the eye provided such an opportunity, and I was pleased to collaborate with Carl Zeiss Meditec in the development of a new method for quantifying optic nerve damage commonly seen in glaucoma.”

Humphrey Field Analyzer with Guided Progression Analysis (GPA) Software 
The world’s most widely used automated perimeter is now the only perimeter with GPA software that has received clearance from the FDA to specifically assess both change from baseline and the rate of change of visual field loss over time. With GPA, doctors can see at-a-glance whether vision has changed for each individual patient and they can subsequently identify how rapidly visual field loss is progressing. Understanding each patient’s rate of progression helps the doctor to adjust the therapeutic regimen with the goal of preserving vision throughout the patient's expected life.

Humphrey Field Analyzers are used by more eye care providers than any other automated perimeter today, and more than 60 thousand units have been sold since the first models were introduced in 1984. In addition to FDA cleared GPA software for the HFA, GPA software also is FDA-cleared for the Cirrus HD-OCT.

The Five-20 Rule for Dietary Sodium Intake

This article may be helpful for your patients -- and yourself:

Sodium Intake Could Be Managed Using Five-20 Rule.

NBC Nightly News (3/4, story 8, 2:20, Williams) reported in its "Personal Best" series that sodium "has a way of sneaking into the American diet in some of the most unlikely places," in what NBC (Thompson) called "a blizzard of salt." NBC examined how sodium is present in unlikely foods -- such as toasted wheat cereal and tomato juice -- and pointed out "an easier way to keep an eye on your sodium intake. Just remember two numbers, five and twenty. Then look at the label for the daily value or DV percentage." Barbara Schneeman, FDA Nutritional Labeling Director, told NBC, "Five percent or less of the daily value is considered low. Twenty percent or more of the daily value is considered high."