overtested to death

[eyeballmadness]

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I am a college student who wanted to post something to see if this is commonplace..I was interested in getting contacts so I went to the local optometrist in Westfield NJ for a check. Well when I went there he gave me a prescription for contacts and then told me that I had a normal eye exam but that I needed to get a screening visual field test and photos of my retina. Also he wanted me to get an OCT(not sure of spelling) to check if I had macular degeneration. The field test, photos and OCT were not covered by my insurance so he wanted me to sign a form saying (and I quote) "I herewith am refusing a complete eye exam and recognize the consequences of my actions". I was very scared by the form I had to sign so I asked my father who is a family practice doc in the area to ask some of his ophthalmologists what the story is and they said the tests were completely unnecessary without eye pathology. Is this commonplace for optometrists to do? I have been seeing another eye doctor who is an ophthalmologist for years and he never had me do any ancillary testing for no reason. This is fraudulent behavior and I am very upset. This is no different than telling a patient they need a screening MRI and oh yeah my insurance won't pay for it (because the insurance company knows better and won't pay for it) so I will have to pay myself and if I don't I have to sign a waiver saying I am refusing a full physical exam. What is my recourse? The state optometric board I contacted said they would look into it and never contacted me back.(big surprise) Its a f*()ing scam. My brother went to him a day later just for a routine check and he wanted him to do the same thing and sign a waiver even though he didn't need glasses and had a completely normal exam. I would like to know 1. What is my recourse here or is this so called "doctor" allowed to just scam people because his "board" won't do anything 2. Is this commonplace for optometrists to do? Is it considered a way to supplement income by ordering unnecessary tests?

 

[Meibomian SxN]

I am a college student who wanted to post something to see if this is commonplace..I was interested in getting contacts so I went to the local optometrist in Westfield NJ for a check. Well when I went there he gave me a prescription for contacts and then told me that I had a normal eye exam but that I needed to get a screening visual field test and photos of my retina. Also he wanted me to get an OCT(not sure of spelling) to check if I had macular degeneration. The field test, photos and OCT were not covered by my insurance so he wanted me to sign a form saying (and I quote) "I herewith am refusing a complete eye exam and recognize the consequences of my actions". I was very scared by the form I had to sign so I asked my father who is a family practice doc in the area to ask some of his ophthalmologists what the story is and they said the tests were completely unnecessary without eye pathology. Is this commonplace for optometrists to do? I have been seeing another eye doctor who is an ophthalmologist for years and he never had me do any ancillary testing for no reason. This is fraudulent behavior and I am very upset. This is no different than telling a patient they need a screening MRI and oh yeah my insurance won't pay for it (because the insurance company knows better and won't pay for it) so I will have to pay myself and if I don't I have to sign a waiver saying I am refusing a full physical exam. What is my recourse? The state optometric board I contacted said they would look into it and never contacted me back.(big surprise) Its a f*()ing scam. My brother went to him a day later just for a routine check and he wanted him to do the same thing and sign a waiver even though he didn't need glasses and had a completely normal exam. I would like to know 1. What is my recourse here or is this so called "doctor" allowed to just scam people because his "board" won't do anything 2. Is this commonplace for optometrists to do? Is it considered a way to supplement income by ordering unnecessary tests?

Just sounds like a greedy doc. Just like there are greedy MDs, greedy dentists, greedy airlines, greedy plumbers, etc.....

 

[eyeballmadness]

Yeah but that is just ridiculous. My dad never orders tests that he profits from and then gets people to sign s#it like that. None of his friends do that or anyone I know..THat is no different than the docs in Florida who bill for patients that dont exist or claim they did breast surgery on male patients. What is my recourse? I want this Mfer to go down. What he is doing is illegal and highly unethical. I spoke to one of my dad's opthalmology friends and he felt that "screening" field tests and retinal photos are something that optometrists try to order to pump up the bill even when not needed...is that true? He feels they are more in the retail state of mind so "upselling" etc.. is more part of their work.. If it is..it is a freaking outrage..I feel like calling one of those news teams that do shame on you bits and bring this guy down...I expect a doctor to do the right thing...not to try to pad the bill so he makes more money and then makes me sign something to imply that I am deviating from standard of care. I expect that from my autoshop guy....not a doctor...maybe my expectations were too high going there..

 

[thiaeyemd]

Dude..you need to chill....he didnt hurt you..it isn't malpractice...I understand your frustration. Just don't go to that guy anymore...go back to your dad's friend the ophthalmologist...end it there. Your recourse is probably to contact the state medical board or the overall licensing board that oversees the optometry board if you are really pissed about it etc...if you want to get that guy in trouble that bad but sounds like it is a total waste of time. Anyone who is doing that is not a "real doctor" anyway just someone given a license and now is trying to maximize profits like a circus ringleader and wants you to do as many rides as possible...let it go..

 

[Tippytoe]

These tests, the visual field screening, retinal photos and the OCT (probably an automated macula stress test), are legitimate 'screening tools' that could be justifiably charged as optional services (but I never would).

Think of them as the x-ray the dentist does on your teeth.

The automated visual fields (cost $20,000) is certainly better than a hand confrontation field (looking for unlikely neuro-eye disease).

The retinal photos (camera cost: $25,000) are nice to have as a baseline to better judge changes over the years (and fun to look at and post on your facebook page : ).

The macula stress test (don't have one but probably another $20,000) can help determine possible changes related to future macular degeneration (maybe?).

But they are all optional in my book. I'd never have the GONADS to try to scare someone into getting them as a screening.

But hey, with a $39 eyeglass sale down the street and a 2-for-1 down at Walmart, the guy was probably just trying to pay his rent.........as sleezy as it is. Hey, was he wearing a shirt upbuttoned down to his hairy naval with gold chains hanging low?

I agree with thiaeyemd, you were not harmed. You just went to a bad apple. Some salesguy with the equipment companies gave him a big salespitch on how easy it will be to pay for his $60,000 worth of equipment.

Just give him a bad internet review and don't go back. He won't be doing this silly stuff for long. Patients are smart like you. They can tell when someone is trying to screw them.

 

[speyeder]

I am a college student who wanted to post something to see if this is commonplace..I was interested in getting contacts so I went to the local optometrist in Westfield NJ for a check. Well when I went there he gave me a prescription for contacts and then told me that I had a normal eye exam but that I needed to get a screening visual field test and photos of my retina. Also he wanted me to get an OCT(not sure of spelling) to check if I had macular degeneration. The field test, photos and OCT were not covered by my insurance so he wanted me to sign a form saying (and I quote) "I herewith am refusing a complete eye exam and recognize the consequences of my actions". I was very scared by the form I had to sign so I asked my father who is a family practice doc in the area to ask some of his ophthalmologists what the story is and they said the tests were completely unnecessary without eye pathology. Is this commonplace for optometrists to do? I have been seeing another eye doctor who is an ophthalmologist for years and he never had me do any ancillary testing for no reason. This is fraudulent behavior and I am very upset. This is no different than telling a patient they need a screening MRI and oh yeah my insurance won't pay for it (because the insurance company knows better and won't pay for it) so I will have to pay myself and if I don't I have to sign a waiver saying I am refusing a full physical exam. What is my recourse? The state optometric board I contacted said they would look into it and never contacted me back.(big surprise) Its a f*()ing scam. My brother went to him a day later just for a routine check and he wanted him to do the same thing and sign a waiver even though he didn't need glasses and had a completely normal exam. I would like to know 1. What is my recourse here or is this so called "doctor" allowed to just scam people because his "board" won't do anything 2. Is this commonplace for optometrists to do? Is it considered a way to supplement income by ordering unnecessary tests?

I'm an ophthalmologist so I'll chime in here. The above sounds kind of shady to me. First, if you had a normal eye exam why would you need to have a photo of your retina taken? Second, you're a college student so why would the optometrist be concerned about macular degeneration (a disease predominately of the elderly)? Third, an OCT is not used to diagnose macular degeneration. Macular degeneration is a clinical diagnosis made my examining your retina with the aid of ocular lens. OCT is sometimes used to follow patients with macular degeneration but these patients already have an advanced form of the disease. Finally if your optic discs and eye pressures were normal there is no need to perform visual field testing.

 

[blazenmadison]

I smell a troll. His first post on SDN was to complain about ODs. Seriously your brother went a day later after your scam eye exam?

I seriously doubt the OD would do an OCT on a college student to check for macular degeneration.

 

[caitsiex]

Tread carefully there buddy, as you should realize you are in an optometry forum. With that said, however, an ophthalmologist could have very easily done the same thing. Let's not stir the pot.

p.s. you are a college student, yet also an attending? oh no, I smell a scam. I want my money back.

 

[KHE]

I am a college student who wanted to post something to see if this is commonplace..I was interested in getting contacts so I went to the local optometrist in Westfield NJ for a check. Well when I went there he gave me a prescription for contacts and then told me that I had a normal eye exam but that I needed to get a screening visual field test and photos of my retina. Also he wanted me to get an OCT(not sure of spelling) to check if I had macular degeneration. The field test, photos and OCT were not covered by my insurance so he wanted me to sign a form saying (and I quote) "I herewith am refusing a complete eye exam and recognize the consequences of my actions". I was very scared by the form I had to sign so I asked my father who is a family practice doc in the area to ask some of his ophthalmologists what the story is and they said the tests were completely unnecessary without eye pathology. Is this commonplace for optometrists to do? I have been seeing another eye doctor who is an ophthalmologist for years and he never had me do any ancillary testing for no reason. This is fraudulent behavior and I am very upset. This is no different than telling a patient they need a screening MRI and oh yeah my insurance won't pay for it (because the insurance company knows better and won't pay for it) so I will have to pay myself and if I don't I have to sign a waiver saying I am refusing a full physical exam. What is my recourse? The state optometric board I contacted said they would look into it and never contacted me back.(big surprise) Its a f*()ing scam. My brother went to him a day later just for a routine check and he wanted him to do the same thing and sign a waiver even though he didn't need glasses and had a completely normal exam. I would like to know 1. What is my recourse here or is this so called "doctor" allowed to just scam people because his "board" won't do anything 2. Is this commonplace for optometrists to do? Is it considered a way to supplement income by ordering unnecessary tests?

You have no recourse because....

a) You haven't been harmed
b) You haven't spent any money needlessly
c) What they are doing isn't illegal. They offered you some extra testing. You refused. It's no different than asking "do you want to biggie size that?"

I don't do those things in my office but I see no recourse for you.

 

[Meibomian SxN]

Tread carefully there buddy, as you should realize you are in an optometry forum. With that said, however, an ophthalmologist could have very easily done the same thing. Let's not stir the pot.

p.s. you are a college student, yet also an attending? oh no, I smell a scam. I want my money back.

Exactly. Maybe he should report himself along with the greasy upselling OD.

 

[optsuker]

I smell a troll. His first post on SDN was to complain about ODs. Seriously your brother went a day later after your scam eye exam?

I seriously doubt the OD would do an OCT on a college student to check for macular degeneration.

+1

Has a pretty good mastery of the terminology for someone claiming to be naive about everything else.

 

[eyeballmadness]

What is a troll? The idea that I was offered services and refused is nonsense (like offered to supersize)...to have to sign a waiver implies that I am giving up basic care...(In fact that is what the consent said) IT is an attempt to make me think that by refusing I am giving up basic care...

The idea that those tests make pick up something so it should be done is absurd. I ran that by my dad who said " Why don't I get everyone to have a screening CT scan of the chest" It may pick up something the physicial exam doesnt? Because it isn;t indicated...he added...and that is exactly why health care expenditures are going through the roof..People ordering completely unnecessary tests...that fact the guy profits from it makes it even worse.

I already put an eval on yahoo.

My brother went the next day because the appointment had been made a couple weeks ago.

To answer the last question.....I just rapidly created the name/profile on this site so I could ask rapidly a question..didn't realize it would be examined so closely. The idea that my first post was this question so I must be an imposter is preposterous. What was I supposed to do? Make small talk about eyeglasses before asking the question? Get real. This will be my first and last post. Thanks for nothing...freaking eye chiropractors....

 

[Shnurek]

Go see an ophthalmologist next time. I'm sure they loooove to do subjective refractions.

 

[speyeder]

I smell a troll. His first post on SDN was to complain about ODs. Seriously your brother went a day later after your scam eye exam?

I seriously doubt the OD would do an OCT on a college student to check for macular degeneration.

Why is the OP a troll? Because he questions the necessity of ancillary tests and motives of one optometrist that he happened to have an encounter with? I don't think he was attempting to paint the entire profession of optometry in a negative light.

 

[KHE]

Why is the OP a troll? Because he questions the necessity of ancillary tests and motives of one optometrist that he happened to have an encounter with? I don't think he was attempting to paint the entire profession of optometry in a negative light.

I don't think he's a troll. I think his reaction is a bit over the top though.

 

[yushin]

Why is the OP a troll? Because he questions the necessity of ancillary tests and motives of one optometrist that he happened to have an encounter with? I don't think he was attempting to paint the entire profession of optometry in a negative light.

Let’s say an OMD did a Lasik on an eye that has contraindications (don’t tell me this never happens). Is it correct to question that this is a common practice for all OMDs and that unnecessary surgeries are commonly done to supplement income as the OP had questioned based his one encounter with an OD. The OP is a troll.

 

[Jwalker]

Thanks for nothing...freaking eye chiropractors....

Troll is mad

 

[speyeder]

Let’s say an OMD did a Lasik on an eye that has contraindications (don’t tell me this never happens). Is it correct to question that this is a common practice for all OMDs and that unnecessary surgeries are commonly done to supplement income as the OP had questioned based his one encounter with an OD. The OP is a troll.

All patients have a right to ask if the care they receive falls within commonly accepted standards. The fact that you took the OP's questions as an affront to your profession doesn't automatically make him or her a troll.

 

[mintyjulep]

What is a troll? The idea that I was offered services and refused is nonsense (like offered to supersize)...to have to sign a waiver implies that I am giving up basic care...(In fact that is what the consent said) IT is an attempt to make me think that by refusing I am giving up basic care...

The idea that those tests make pick up something so it should be done is absurd. I ran that by my dad who said " Why don't I get everyone to have a screening CT scan of the chest" It may pick up something the physicial exam doesnt? Because it isn;t indicated...he added...and that is exactly why health care expenditures are going through the roof..People ordering completely unnecessary tests...that fact the guy profits from it makes it even worse.

I already put an eval on yahoo.

My brother went the next day because the appointment had been made a couple weeks ago.

To answer the last question.....I just rapidly created the name/profile on this site so I could ask rapidly a question..didn't realize it would be examined so closely. The idea that my first post was this question so I must be an imposter is preposterous. What was I supposed to do? Make small talk about eyeglasses before asking the question? Get real. This will be my first and last post. Thanks for nothing...freaking eye chiropractors....

Eye chiropractors? So optometry is based on pseudoscience, eh?

Yeah, I've never heard of any quack MD trying to sell snake oil, promoting some hogwash weight loss/anti-toxin/bogus mumbo jumbo product. 🙄 In any profession, there are those bad apples who don't represent the whole well, but you are a downright troll for comparing an optometrist to a chiropractor.

 

[yushin]

All patients have a right to ask if the care they receive falls within commonly accepted standards. The fact that you took the OP's questions as an affront to your profession doesn't automatically make him or her a troll.

May be we are not reading the same post. The tone of the OP’s post clearly shows that he was not interested in knowing what commonly accepted standards are. He knows the standards already. He’s insincerely asking whether unnecessary tests are routinely done by all ODs. Once again, it would be similar to a patient asking if all OMDs routinely do unnecessary surgery to supplement their income. If you were asked this question from someone who calls your profession ‘freaking eye chiropractors’, would you feel that the question is legitimate?

 

[thiaeyemd]

I think it is obvious that the OP was frustrated and not only wanted to ask a question but more so to vent.I don't think any advice he wouldve recieved on recourse or on what the standards are for optometrists would be sufficient.

To be frank, what probably happened is that he spoke to his father who wouldve been floored by those actions and then the father wouldve said some disparaging statements etc. about ODs which didn't help the situation. Normally, if a family member is a physician and questions the judgement he or she would place a call to the other doctor which sounds like didn't happen. He got on here as a recourse in itself since the optometric board didn't do anything.

Sounds like this guy just wanted to vent...On other physician message boards there are tons of people who vent and say "I was diagnosed with throat cancer in 2005, I can't believe my physician didn't get a routine neck MRI every year on me since I was 22." I can see how this guy would be pissed by this doctor's actions however. The family member being a physician magnified everything. The fact that very few people here acknowledged this as a valid concern and some people got very defensive (and accused him or her of being a fraud) made things worse. Just like when a patient has a complaint and you don't acknowledge it, they get more pissed. Sometimes all they need to hear is "Im sorry".

To the actual concept, I think overtesting can be a function of having a piece of equipment and not enough patients to use it and thus mentally "justifying" why it is necessary to use it even when not needed. In our practice if we got a screeening visual field on everyone our tech who does fields would be booked with total waste of time visual fields. It isn't helpful for our patients and us. Someone who really needs the visual field because of pseudotumor or optic neuritis or glaucoma would get boxed out for weeks by a "screening visual field" and it would compromise their care. As an oculoplastics person I will say I have had patients sent to me with ectropion or tearing that are accompanied by a visual field and a retinal photo (without indications of retinal or optic nerve). Why that is..I don't know and don't try to get involved with that for obvious reasons.

People getting lasik with contraindications has obvious repercussions...complications and potential lawsuit. No one signs a waiver saying " I understand by not getting lasik I am potentially hurting my own eye". Also if you order daily visual fields on someone they can't really sue you for malpractice.I am pretty sure no ophthalmologist who does lasik wants to do it on someone with forme fruste keratoconus or dry eyes. I think they overlook it or essentially mess up. The 5 million dollar lawsuit is not worth the 2000 bucks or whatever they charge...Only a fool would do that. Field testing and photographs on people unnecessarily doesn't blind anyone.

 

[speyeder]

May be we are not reading the same post. The tone of the OP’s post clearly shows that he was not interested in knowing what commonly accepted standards are. He knows the standards already. He’s insincerely asking whether unnecessary tests are routinely done by all ODs. Once again, it would be similar to a patient asking if all OMDs routinely do unnecessary surgery to supplement their income. If you were asked this question from someone who calls your profession ‘freaking eye chiropractors’, would you feel that the question is legitimate?

Call me naive but I read his original post and took the questions at face value. True there was frustration in the tone of his comments but why can't a patient be both frustrated and want to know if he received standard care? He did not use the term 'eye chiropractors' in his original post, but in his second post after several in the forum called him a troll. And if someone asked me if OMDs routinely do unnecessary surgery to supplement our incomes, I would say no and that that practice deviates from the standard of care.

 

[speyeder]

No one signs a waiver saying " I understand by not getting lasik I am potentially hurting my own eye".

The 5 million dollar lawsuit is not worth the 2000 bucks or whatever they charge...

Excellent points.

 

[JMK2005]

These tests, the visual field screening, retinal photos and the OCT (probably an automated macula stress test), are legitimate 'screening tools' that could be justifiably charged as optional services (but I never would).

Screening tools mean to do it on everyone that are at risk, like mammograms and such. Can you justify doing photos and OCT and a young 20/20 non-diabetic eye. It's not illegal, but highly unethical and unprofessional.

 

[KHE]

Call me naive but I read his original post and took the questions at face value. True there was frustration in the tone of his comments but why can't a patient be both frustrated and want to know if he received standard care? He did not use the term 'eye chiropractors' in his original post, but in his second post after several in the forum called him a troll. And if someone asked me if OMDs routinely do unnecessary surgery to supplement our incomes, I would say no and that that practice deviates from the standard of care.

These are the issues that I see with his postings:

He makes the first post, another OD agrees with him that it's just some stupid greedy OD and he ramps it up.

From the first post:

This is fraudulent behavior and I am very upset.

A college student making a judgement that a professional is engaging in fraudulent behavior on the opinion of their daddy is a little over the top.

The state optometric board I contacted said they would look into it and never contacted me back.(big surprise) Its a f*()ing scam.

Again....the use of the word "scam" is a little over the top and the tacit implication is there that the state board is also complicent in that so called "scam."

From the second post:

I want this Mfer to go down. What he is doing is illegal and highly unethical.

Calling someone a "MFer" and then making a claim that it is illegal and unethical? This college student doesn't know if it's illegal or not. (It's not.) He doesn't know if it's unethical or not. (The offering of the tests is not, the wording of the form is probably in darker shade of grey.)

If it is..it is a freaking outrage..I feel like calling one of those news teams that do shame on you bits and bring this guy down

Little (a lot) over the top there.

Suddenly he's David Horowitz or John Stossel? I'd hate to see how this college student reacts if they give him 19 Mcnuggets in his 20 pack.

 

[JMK2005]

And if someone asked me if OMDs routinely do unnecessary surgery to supplement our incomes, I would say no and that that practice deviates from the standard of care.

Don't be surprised with ophthalmologists either. Some of them have very low thresholds for surgery and the new 'premium' is ripe for abuse with patients getting a hard sell.

 

[MR1]

These tests, the visual field screening, retinal photos and the OCT (probably an automated macula stress test), are legitimate 'screening tools' that could be justifiably charged as optional services (but I never would).

Think of them as the x-ray the dentist does on your teeth.

The automated visual fields (cost $20,000) is certainly better than a hand confrontation field (looking for unlikely neuro-eye disease).

The retinal photos (camera cost: $25,000) are nice to have as a baseline to better judge changes over the years (and fun to look at and post on your facebook page : ).

The macula stress test (don't have one but probably another $20,000) can help determine possible changes related to future macular degeneration (maybe?).

But they are all optional in my book. I'd never have the GONADS to try to scare someone into getting them as a screening.

These are NOT legitimate if there is NO indication. A 20 year old college student 99% of the time will never need a screening OCT, VF, fundus photos. VF in asymptomatic is not necessary to screen for "unlikely neuro issues". Fundus photos in a normal fundus are not needed to look for changes over the years. ?macular stress test (what is that anyway) is not needed to help determine anything in a normal fundus, nor would an OCT be needed in a normal retina. They aren't even optional, they aren't needed.

Now I am not going to say ophtho's dont' do surgery when it is softly indicated or sometimes not indicated at all but that is subject to a lawsuit. Testing like this is just unethical no matter how you look at it and ridiculous.

Lastly you can't compare them to dental X-rays that are needed to look for cavities than anyone can have with a normal exam.

 

[Hello2011]

When I went to America's Best they tried to sell me those services for 15 extra bucks. Although, they made it clear my insurance wouldn't cover it, but they tried to scare me into having it done by using the B word (blindness!). The tech also dropped the C word (cancer). They really try to scare the shat outta you by telling you certain things these procedurs can detect. I did have to say 'no thanks' 3 or 4 times, but eventually I signed the refusal form, but dang it was a hard sell on their end. I'm never going back there again!

 

[Tippytoe]

These are NOT legitimate if there is NO indication. A 20 year old college student 99% of the time will never need a screening OCT, VF, fundus photos. VF in asymptomatic is not necessary to screen for "unlikely neuro issues". Fundus photos in a normal fundus are not needed to look for changes over the years. ?macular stress test (what is that anyway) is not needed to help determine anything in a normal fundus, nor would an OCT be needed in a normal retina. They aren't even optional, they aren't needed.

Now I am not going to say ophtho's dont' do surgery when it is softly indicated or sometimes not indicated at all but that is subject to a lawsuit. Testing like this is just unethical no matter how you look at it and ridiculous.

Lastly you can't compare them to dental X-rays that are needed to look for cavities than anyone can have with a normal exam.

Pretty much what I said genius!

But your wrong is saying this in black or white. A screening VF CAN pick up things that are otherwise missed (but I agree I'd never waste time doing it on an routine 20 year old exam). But I do know many ODs that include it during the pre-test work up. Medicare requires at least a confrontation field and usually a 1 minute screenig field by a tech is easier on both the patient and doc.

Macular test- something like this:
http://www.optos.com/en/Products/Diagnostic-instruments/Densitometer/MPOD/ (Nope, don't have one and probably never will)

A cool retinal photo should be done on everyone in my opinion (as part of the normal routine exam fee). Instant view and great practice builder and something to compare the working parts of the retina to in 2 or 20 years down the road. Nobodys memory or drawing is as good as a photo.

 

[JMK2005]

Pretty much what I said genius!

No, you said you wouldn't do it, but supported it as "screening tools."

 

[PBEA]

I'm an OD and I think that testing is a bunch of crap. Stupid, non-indicated, puffery to make the exam "look cool". I F%^&*(& hate it. To be fair the corporate retail mall optical where this OD works is probably requiring him/her to sell these tests to boost profitability, so it isn't neceasrrily "optometry" at fault, but "Big Optical" (which I guess is really opticianry) who is putting the screws to the OD (as in "sell this test or lose your employment/lease here").

 

[VA Hopeful Dr]

I'm an OD and I think that testing is a bunch of crap. Stupid, non-indicated, puffery to make the exam "look cool". I F%^&*(& hate it. To be fair the corporate retail mall optical where this OD works is probably requiring him/her to sell these tests to boost profitability, so it isn't neceasrrily "optometry" at fault, but "Big Optical" (which I guess is really opticianry) who is putting the screws to the OD (as in "sell this test or lose your employment/lease here").

Agreed. None of the 4 ODs I've seen (all private practice) ever pushed any of this, although 2 of them had screening VF at no additional cost.

My fiance goes to Lenscrafters and has to decline retinal photos every time, usually the tech is trying to sell this not the OD.

 

[mclem222]

In response to: Tippytoe;11353885]Pretty much what I said genius!

But your wrong is saying this in black or white. A screening VF CAN pick up things that are otherwise missed (but I agree I'd never waste time doing it on an routine 20 year old exam). But I do know many ODs that include it during the pre-test work up. Medicare requires at least a confrontation field and usually a 1 minute screenig field by a tech is easier on both the patient and doc.

- just because a lot of people do it..doesn't mean it is indicated. We have all seen people do visual field tests and make mistakes because they have never done one before. The first field test I ever did looked terrible. On repeat testing it was normal. Does that mean that we would have repeat the field test on some people twice? The screening FDT machine picks up all sorts of crap when a person is doing a field for the first time. A confrontation can be much better than an automated field. There is NO DATA to back this up.


Macular test- something like this:
http://www.optos.com/en/Products/Diagnostic-instruments/Densitometer/MPOD/ (Nope, don't have one and probably never will)


- Has this been studied? The website says it shows pigment that MAY lead to vision loss. How is this justified.


A cool retinal photo should be done on everyone in my opinion (as part of the normal routine exam fee). Instant view and great practice builder and something to compare the working parts of the retina to in 2 or 20 years down the road. Nobodys memory or drawing is as good as a photo

- your opinion is great but taking normal photos of someone just increases costs of health care. The concept of it being a "good practice builder" is not ok. It is scay that you would openly say this. Our procedures or tests we want patients to do should be based on clinical evidence NOT on practice building. Why don't dermatologists just take a photo of your face when you come in and then can compare it through the years for skin cancer? Because it doesn't show any benefit.

In summary without a study to prove it effective and needed none of those tests as screening tools have been show to be effective. Why not photo everyone's pupils so if they think they develop anisocoria one day we can see if it is a true change or the patient just noticed it? Because there has been no study to show it reduces healthcare costs, improves outcomes. If you have that information I would love to see it. My brother and father are ophthalmologists and I have had long discussions with them about doing these tests and I agree that we should do stuff when indicated and evidence based. Otherwise we are no better than chiropractors who recommend rolfing and unproven physical therapy.

I think you can offer these things but have to say "I think these tests are cool however are no way indicated. iF you would like a photo to see what your retina looks like or a scan to see your central retina that option is there but it is not indcated and there is no reason you need one. However I think the pictures are cool to look at and so may you".

 

[speyeder]

Macular test- something like this:
http://www.optos.com/en/Products/Dia...itometer/MPOD/ (Nope, don't have one and probably never will)

I freely admit that I know nothing about the above machine, but if it's a legitimate medical device, why isn't it marketed to ophthalmologists? We're eyecare providers too right? I have never heard of it before and I doubt many ophthalmologists have either. And if it does what it says it does, is it better than the gold standard at diagnosing macular degeneration, which is a simple dilated retinal exam? If it's not, then why have patients pay for a test which is inferior?

 

[speyeder]

In response to: Tippytoe;11353885]Pretty much what I said genius!

But your wrong is saying this in black or white. A screening VF CAN pick up things that are otherwise missed (but I agree I'd never waste time doing it on an routine 20 year old exam). But I do know many ODs that include it during the pre-test work up. Medicare requires at least a confrontation field and usually a 1 minute screenig field by a tech is easier on both the patient and doc.

- just because a lot of people do it..doesn't mean it is indicated. We have all seen people do visual field tests and make mistakes because they have never done one before. The first field test I ever did looked terrible. On repeat testing it was normal. Does that mean that we would have repeat the field test on some people twice? The screening FDT machine picks up all sorts of crap when a person is doing a field for the first time. A confrontation can be much better than an automated field. There is NO DATA to back this up.


Macular test- something like this:
http://www.optos.com/en/Products/Diagnostic-instruments/Densitometer/MPOD/ (Nope, don't have one and probably never will)


- Has this been studied? The website says it shows pigment that MAY lead to vision loss. How is this justified.


A cool retinal photo should be done on everyone in my opinion (as part of the normal routine exam fee). Instant view and great practice builder and something to compare the working parts of the retina to in 2 or 20 years down the road. Nobodys memory or drawing is as good as a photo

- your opinion is great but taking normal photos of someone just increases costs of health care. The concept of it being a "good practice builder" is not ok. It is scay that you would openly say this. Our procedures or tests we want patients to do should be based on clinical evidence NOT on practice building. Why don't dermatologists just take a photo of your face when you come in and then can compare it through the years for skin cancer? Because it doesn't show any benefit.

In summary without a study to prove it effective and needed none of those tests as screening tools have been show to be effective. Why not photo everyone's pupils so if they think they develop anisocoria one day we can see if it is a true change or the patient just noticed it? Because there has been no study to show it reduces healthcare costs, improves outcomes. If you have that information I would love to see it. My brother and father are ophthalmologists and I have had long discussions with them about doing these tests and I agree that we should do stuff when indicated and evidence based. Otherwise we are no better than chiropractors who recommend rolfing and unproven physical therapy.

I think you can offer these things but have to say "I think these tests are cool however are no way indicated. iF you would like a photo to see what your retina looks like or a scan to see your central retina that option is there but it is not indcated and there is no reason you need one. However I think the pictures are cool to look at and so may you".

I agree with everything you wrote.

 

[yushin]

- your opinion is great but taking normal photos of someone just increases costs of health care. The concept of it being a "good practice builder" is not ok. It is scay that you would openly say this. Our procedures or tests we want patients to do should be based on clinical evidence NOT on practice building. Why don't dermatologists just take a photo of your face when you come in and then can compare it through the years for skin cancer? Because it doesn't show any benefit.

In summary without a study to prove it effective and needed none of those tests as screening tools have been show to be effective. Why not photo everyone's pupils so if they think they develop anisocoria one day we can see if it is a true change or the patient just noticed it? Because there has been no study to show it reduces healthcare costs, improves outcomes. If you have that information I would love to see it. My brother and father are ophthalmologists and I have had long discussions with them about doing these tests and I agree that we should do stuff when indicated and evidence based. Otherwise we are no better than chiropractors who recommend rolfing and unproven physical therapy.

I think you can offer these things but have to say "I think these tests are cool however are no way indicated. iF you would like a photo to see what your retina looks like or a scan to see your central retina that option is there but it is not indcated and there is no reason you need one. However I think the pictures are cool to look at and so may you".

In Tippytoe’s defense, I think he was saying that a retinal photo can be used as a good practice builder, but this is done as part of the normal routine exam fee, and he does not charge more for it. Tippytoe’s providing an extra service to patients at no cost because he thinks that this will attract more patients to his practice. Could anyone tell me what is wrong with this? I think that his way is much better than spending money on advertisement.

 

[thiaeyemd]

I looked up some studies to see if there was anything out there for the macular pigment testing machine and there is not on pubmed. I would love to see some data if anyone has any because I haven't heard of the machine.

Not sure what one would do with the information anyway. Since less pigment is associated with increased risk for ARMD what would one do with that information? The indications for the ARED vitamins are for much more advanced stages of the disease (though tons of optometrists and ophthalmologists unfortunately) sell them to people when it is not needed. Would you treat it any different than having a + family history? I am curious what the odds ratio of decreased macular pigment is for ARMD risk? Any retina person here know? If it is like smoking then probably not worth it.

 

[Tippytoe]

- your opinion is great but taking normal photos of someone just increases costs of health care. The concept of it being a "good practice builder" is not ok. It is scay that you would openly say this. Our procedures or tests we want patients to do should be based on clinical evidence NOT on practice building. Why don't dermatologists just take a photo of your face when you come in and then can compare it through the years for skin cancer? Because it doesn't show any benefit.

In summary without a study to prove it effective and needed none of those tests as screening tools have been show to be effective. Why not photo everyone's pupils so if they think they develop anisocoria one day we can see if it is a true change or the patient just noticed it? Because there has been no study to show it reduces healthcare costs, improves outcomes. If you have that information I would love to see it. My brother and father are ophthalmologists and I have had long discussions with them about doing these tests and I agree that we should do stuff when indicated and evidence based. Otherwise we are no better than chiropractors who recommend rolfing and unproven physical therapy.

Hey, if you are too cheap to buy a retinal camera.......I'm okay with that.

But how on earth does taking a (free) retinal screening photo increase health care cost??? Does me owning a direct ophthalmoscope also increase cost?

If I want to go out and wash the patient's car for free, does that also increase health care cost? (Don't laugh, it may come to this one day).

 

[Tippytoe]

In Tippytoe's defense, I think he was saying that a retinal photo can be used as a good practice builder, but this is done as part of the normal routine exam fee, and he does not charge more for it. Tippytoe's providing an extra service to patients at no cost because he thinks that this will attract more patients to his practice. Could anyone tell me what is wrong with this? I think that his way is much better than spending money on advertisement.

Thank you. This is exactly what I was saying.

Back to the beginning post........this is one of the things I HAVE to do to attract patients. People (most) love to see their big fat retina image zoomed right into the exam room. Some want it emailed to them to put on Facebook (go figure). The dentist beside me has a lady giving foot and hand 'spa' treatments to patients while having dental procedures. ( BTW, I was able to drop my $1,000 PER MONTH yellow page ad years ago and never looked back.......total waste of money, it is).

I know some clowns try to charge extra for a photo. I have never done that. It's part of the routine exam. In additon to the 'wow' factor, it increases efficiency greatly for me (automatically zoomed into their electronic medical record)--- Another thing that is very important in today's health care enviroment (which is code for: Crappy insurance reimbursement).

In case anyone is confused, I, in no way, agreed with the excessive tests presented to the original poster. Totally unnecessary. (But to those of you going into optometry, may be tempting when the bills begin to pile up).

 

[mclem222]

Thank you. This is exactly what I was saying.

Back to the beginning post........this is one of the things I HAVE to do to attract patients. People (most) love to see their big fat retina image zoomed right into the exam room. Some want it emailed to them to put on Facebook (go figure). The dentist beside me has a lady giving foot and hand 'spa' treatments to patients while having dental procedures. ( BTW, I was able to drop my $1,000 PER MONTH yellow page ad years ago and never looked back.......total waste of money, it is).

I know some clowns try to charge extra for a photo. I have never done that. It's part of the routine exam. In additon to the 'wow' factor, it increases efficiency greatly for me (automatically zoomed into their electronic medical record)--- Another thing that is very important in today's health care enviroment (which is code for: Crappy insurance reimbursement).

In case anyone is confused, I, in no way, agreed with the excessive tests presented to the original poster. Totally unnecessary. (But to those of you going into optometry, may be tempting when the bills begin to pile up).

It is probably ok ethically to offer it for free but it can easily slippery slope into something that the OP described. I think also doing something nonmedical (giving a calendar, key chain) is different than augmenting the exam with other tests for free. It sets a bad tone for insurance companies and creates a new standard that is not indicated. Finally, I think it demeans our profession to do other tests to wow the patient when it isn't needed...why do we need to impress anyone? OMDs don't do it. Why should we? Do I really need to show a patient a retinal photo for him to think this is a "real doctor" or "my doctor is better than the one down the street". I hope not.

 

[Tippytoe]

I looked up some studies to see if there was anything out there for the macular pigment testing machine and there is not on pubmed. I would love to see some data if anyone has any because I haven't heard of the machine.

Not sure what one would do with the information anyway. Since less pigment is associated with increased risk for ARMD what would one do with that information? The indications for the ARED vitamins are for much more advanced stages of the disease (though tons of optometrists and ophthalmologists unfortunately) sell them to people when it is not needed. Would you treat it any different than having a + family history? I am curious what the odds ratio of decreased macular pigment is for ARMD risk? Any retina person here know? If it is like smoking then probably not worth it.

This is the only one I'm familiar with (just seen it at shows). I don't know anyone that has one. http://www.macuscope.com/

 

[speyeder]

I looked up some studies to see if there was anything out there for the macular pigment testing machine and there is not on pubmed. I would love to see some data if anyone has any because I haven't heard of the machine.

This is exactly my concern. Why would an optometrist, or any health care provider for that matter, utilize a diagnostic test (one that patients are charged for) that is not proven to do what it claims to do, or that is not better than current existing diagnostic modalities? It seems like the antithesis of evidence-based medicine.

 

[Tippytoe]

It is probably ok ethically to offer it for free but it can easily slippery slope into something that the OP described. I think also doing something nonmedical (giving a calendar, key chain) is different than augmenting the exam with other tests for free. It sets a bad tone for insurance companies and creates a new standard that is not indicated. Finally, I think it demeans our profession to do other tests to wow the patient when it isn't needed...why do we need to impress anyone? OMDs don't do it. Why should we? Do I really need to show a patient a retinal photo for him to think this is a "real doctor" or "my doctor is better than the one down the street". I hope not.

What? Have you not read my other post: ' Optometry is Dying'.

It's not about being a 'real' doctor. It's about getting the few patients that are left, into my office to meet my payroll. As I said, I may be also washing their cars, giving them foot rub and cooking them a hotdog for their business if we keep opening more OD schools.

I'm highly ethical. Don't worry about me. I'm not talking old grannies into AR coated progressives, trying to milk an extra $4,000 for a Restor multifocal IOL out of a monocular patient with macular degeneration (true story), or doing unnessary tests. Just not my style. I'd probably be richer and on here telling everyone how great optometry was if I did.

But I am not responsible for other ODs or ophthalmologists. I just monitor my own back yard.

 

[PBEA]

This is the only one I'm familiar with (just seen it at shows). I don't know anyone that has one. http://www.macuscope.com/

I believe lenscrafters has some kind of equipment deal with them and has them in some or maybe all their stores now. The kicker, as if performing dubious tests wasn't enough, is that if the pigment levels "are low" then they try and sell some half-assed proprietary vitamin combo. Guess where you have to buy said vitamin? No surprise really as corporate opticals entire business model is based on the unecessary.

I also saw some reference to that company putting self serve style kiosks in pharmacies (in Europe) so people can self assess their "pigment level" and purchase the vitamins they "need" based on the inevitably low read-out. Not sure if that's rolled out but.....it sure is some kind of gimmick.

 

[PBEA]

This is exactly my concern. Why would an optometrist, or any health care provider for that matter, utilize a diagnostic test (one that patients are charged for) that is not proven to do what it claims to do, or that is better than current existing diagnostic modalities? It seems like the antithesis of evidence-based medicine.

on another chat board for ODs there is a consultant retina doc who chimes in on various issues. I believe he stated some validity for MPOD (and there are some studies), but he wasn't advocating its use in the above manner (or selling stupid vitamins). I did a bit of research a while back and found those studies to be less then desirable, and only mildly interesting. No way its ready for widespread use, IMO.

 

[speyeder]

I believe lenscrafters has some kind of equipment deal with them and has them in some or maybe all their stores now. The kicker, as if performing dubious tests wasn't enough, is that if the pigment levels "are low" then they try and sell some half-assed proprietary vitamin combo. Guess where you have to buy said vitamin? No surprise really as corporate opticals entire business model is based on the unecessary.

I also saw some reference to that company putting self serve style kiosks in pharmacies (in Europe) so people can self assess their "pigment level" and purchase the vitamins they "need" based on the inevitably low read-out. Not sure if that's rolled out but.....it sure is some kind of gimmick.

All the more reason to hate corporate optical shops.

 

[mclem222]

not attacking you at all..just the whole testing thing....this is not a personal attack..just my opinion of the retinal photos

 

[thiaeyemd]

Monocular monofocal refractive lens? That ophthalmologist who did that deserves to get his license revoked...(unless the patient was really into it for some remote reason, which I doublt)....if he "upsold" her..its embarrassing and goes against everything we learn in training. Unless the person was given the option, knew the risks etc.. and not "guided" to the lens that is just as bad if not worse than the testing...only difference is that the patient can sue the eye surgeon if she suffered a complication from the lens. Its a huge risk for a monocular patient with ARMD in my opinion..what was the patients Va out of curiosity?

 

[MR1]

Pretty much what I said genius!

But your wrong is saying this in black or white. A screening VF CAN pick up things that are otherwise missed (but I agree I'd never waste time doing it on an routine 20 year old exam). But I do know many ODs that include it during the pre-test work up. Medicare requires at least a confrontation field and usually a 1 minute screenig field by a tech is easier on both the patient and doc.

Macular test- something like this:
http://www.optos.com/en/Products/Diagnostic-instruments/Densitometer/MPOD/ (Nope, don't have one and probably never will)

A cool retinal photo should be done on everyone in my opinion (as part of the normal routine exam fee). Instant view and great practice builder and something to compare the working parts of the retina to in 2 or 20 years down the road. Nobodys memory or drawing is as good as a photo.

I was just responding to what you said about them being screening tools. It is black and white, HVF, retinal photos, OCT, etc are NOT screening tools. If you do a ret photo to build your practice, great I understand that. I am not accusing you of being unethical and pushing this crap on patients. But to say a someone needs a screening HVF that has no other signs\symptoms is wrong and wasteful.

 

[thiaeyemd]

Thank you. This is exactly what I was saying.


I know some clowns try to charge extra for a photo. I have never done that. It's part of the routine exam. In additon to the 'wow' factor, it increases efficiency greatly for me (automatically zoomed into their electronic medical record)--- Another thing that is very important in today's health care enviroment (which is code for: Crappy insurance reimbursement).

QUOTE]

I disagree with the statement that it is part of the routine exam..It isn't. When you do it "routinely" you set the tone for insurance companies to not reimburse a retina doc, optometrist or ophthalmologist when a patient truly does need a retinal photo. More so it isn't indicated. Getting a hand massage is not related to the teeth. It is non medical. If you want to provide free medical services for your patients that is your call of course but I think it does you and your profession a disservice. I don't irrigate every patient's nasolacrimal system that I see as routine or photo their face unless it is needed. If I am doing a blepharoplasty, a patient needs to pay for it. I don't haggle the price or make "discounts". As doctors we should do what is necessary, no more and no less. I understand that things may be different in optometry as I have read the oversupply threads but then you wonder why VSP and those other providers can get away with what they do. It is because people undervalue their own services. Soon insurance companies will say you need retinal photos on each exam and if you don't do it, we wont pay you.