Monday, February 24, 2014
Tuesday, February 18, 2014
Sunday, January 26, 2014
So here's something everyone in the optometry field knows but few patients do: some vision places have "private label" contact lenses. It's kind of portrayed as an "exclusive house brand" available only from your eye doctor. Only it's not. They're the exact same...THE EXACT SAME (or super, uber similar) contact lenses that are available everywhere else, repackaged and renamed. Why do this? Why do you think? Money. The optometrists who do this don't want you to be able to buy contacts online or really anywhere else but from them. They portray it as a "safety" issue (because they won't sell you 16 boxes at once, etc) but of course it's really a money issue. As you can probably tell from my tone in this post, I am not a fan. Patients HATE being told where they have to buy their contacts, and rightly so. Does the doctor who prescribes your blood pressure meds sell you those meds? No. Does he/she tell you where to buy them? No. Do they repackage/rename the contacts to FORCE you to buy from them? No. So why do we do it? I don't know. It's stupid. Let me tell you something about contact lenses in 2014: there's not much money in it. When you buy a box of contacts from us, we generally make between $4-$10. The markup is so low thanks mostly to WalMart and 1800-CONTACTS that it's barely worth our time. It's really *NOT* worth our time at all once you factor in our overhead. So why even sell contacts at all? Mostly convenience. Seriously. Back in the 80's optometrists were making big bucks on contact lens sales, but not now. They're a commodity. It's just convenient to sell them so we still do. So why be so controlling and force patients to buy private label lenses? I honestly don't know why docs still do this. Patients hate it, there's no money in it, and the chairtime of explaining the idea to skeptical patients cannot be worth it. We don't do it at our office. When I write a contact lens Rx I tell the patient straight up: "you have the right to buy these anywhere lenses are sold". Sometimes I "lose" the sale because of this. So what? It has to be better than risking having the patient think you're "up to something" by prescribing them some brand they've never heard if. Which, technically the patient is right: you ARE up to something. The big culprit in this scheme is the contact lens manufacturer Coopervision. They repackage and rename their best sellers and make them available as "house brands" at WalMart ("Ultraflex" which is the old Biomedics line and "Equate" which will likely be an entire line of lenses from Biofinity down to Coopervision dailies) and "premier" brands like "Clearsoft" (again, old Biomedics) and AquaClear (Avaira and Biofinity) sold only at Vision Source practices. If it sounds shady, it is IMO. This is one of the reasons I don't fit a lot of Coopervision products anymore...that and I honestly think they do not have a superior product in any of the contact lens modalities (dailies, monthlies, biweeklies, torics, multifocals, etc) right now. Someone has them beat in every category at this moment IMO. I just think the whole thing is shady and too much work/explanation to horde the $4/box contact lens profit for. If you need the money that badly, go up on your fees instead of trying to stick the patient with your "house brand" because you get the sale and will make an extra $28/year or whatever. I had a discussion about this with a friend of mine who is not a patient. His doc (Vision Source) fit him in their private label lens even after he requested a different brand name. When he asked why, the doc apparently couldn't give a great answer. He eventually got the lens he asked for (so it probably wasn't a safety/health or fitting problem), but only after an uncomfortable and awkward exchange with the doc. Here's my thought on this: all of that for the possibility of making an extra $30 a year? Man I don't get it. Just give them what they want (within reason) and don't try to saddle them with your repackaged Cooper private label lens just because it gives you control over where they buy it and how much they buy it for. Optometry and Coopervision: stop the private label game. But I doubt they will stop. It's about the money...for Coopervision.
Wednesday, January 22, 2014
Opened a Tumblr account. Pretty interesting. I might change over but for now I'm just playing with it. So far I like it better than this site. We'll see. http://www.tumblr.com/blog/pflat2 My 1st post over there is an image I took with our new OCT (laser retinal thickness analyser) of a patient I saw a few weeks ago with Central Serous Retinopathy. Basically fluid under the macula of an otherwise healthy person, usually a young caucasian male, often with a high stress profession. Here's the image also posted over here:
Friday, January 17, 2014
Wednesday, December 11, 2013
We medical professionals sometimes take for granted that patients know the differences between viruses and bacteria, and between inflammation and infection. I have come to realise that in actuality very few people who are not in the medical profession understand these differences. Here's a quick rundown (mostly related to eye care since that's what is relevant to this blog): 1) INFECTIONS: caused by a virus or a bacteria or fungus, etc GROWING in, on or near your eye, usually contagious (but not always as in the case of say bacterial ulcerative keratitis), and usually needs to be treated with anitbiotics or antivirals or antifungals, etc. Some common eye infections are epidemic keratoconjunctivitis, microbial keratitis (actually not that "common" but frequently mentioned in the literature), herpes simplex keratitis, bacterial conjunctivitis, etc. There are, of course, a few other rare eye infections that are caused by multicellular organisms like toxoplasmosis or by amoeba as in acanthamoeba keratitis. To "kill" infections we need drugs that KILL these organisms. Infections are out-of-control growths of FOREIGN ANIMALS (technically viruses and fungi are not "animals" but still) that need to be KILLED. INFLAMMATIONS: these are totally different. They are NOT caused by some living microbe GROWING in/on your eye, and therefore do not need medications that KILL bacteria, viruses, fungus, etc. They are reactions that your body has to some insult/irritation/allergy. These are your own body's response and in the case of eyes include swelling ,pain, redness, light sensitivity, etc. Infections can CAUSE inflammation, but an inflammation is not the same as an infection. Therefore inflammation is not treated with drugs designed to KILL MICROBES unless there is an infection. In the absence of infection, inflammation is treated with anti-inflammatories like STEROIDS, not antibiotics to kill bacteria, for example. Some common eye inflammations (not infections!) are pingueculitis, episcleritis, iritis, punctate keratitis, infiltrative keratitis, etc. I realize to a patient these "all sound the same", but they are not, nor are they the same as "infections". The big hang up, of course, has to do with "pink eye". Every patient who comes in with a red, painful, watery, irritated or light sensitive eye assumes it's "infected" and they have been conditioned by most of the medical community to think that they need antibiotics. Some of them are infected, but I find that most of them are not. Most of them are INFLAMED. I Rx way more steroids for inflammation than I do antibiotics and antivirals for infection. "Pink eye" is one of the top reasons for people to go to the doctor, miss work/school, etc and consequently antibiotic eye drops are some of the top selling medications. But a bunch of these "pink eye" cases are, in my estimation, misdiagnosed and mismanaged. One cannot assume that a red eye is an infected one and that antibiotics are warranted. I just stated that I am Rx'ing more STEROIDS than antibiotics, so in my estimation more red eyes are inflamed than infected. Way more. I've said this before but it bears repeating: if you have an eye problem, go to an eye doctor. You know what you're going to get if you go to the primary care doc with an eye problem: antibiotics. But is it an infection? Its probably not. Its probably inflamed.
Tuesday, November 19, 2013
It's rare. REALLY rare. If your eye is red/blurry/painful and you wear contacts most or all of the time...it is UNlikely that you have or will ever have a corneal abrasion. And if you go to a doctor with those symptoms and they diagnose "corneal abrasion" and you are a HEAVY contact lens wearer, you should be skeptical of that diagnosis. People who have abrasions remember exactly when and how it happened. They got hit with a branch while mowing or their dog scratched them while wrestling or something. They can pinpiont the exact moment their eye started hurting. But if you're sleeping in contacts and you wake up with a painful eye, that's not an abrasion. It can't be! A contact lens is a barrier - it protects you from being "scratched". I always joke that diagnosing "corneal abrasion" in a chronic contact lens wearer is like telling someone they skinned their knee under their knee pads. It pretty much can't be done. If you wear contacts and your eye hurts and is red, it is VERY LIKELY that it is a CONTACT LENS RELATED problem (inflammation or infection from wearing contacts). Not "pink eye" and not "corneal abrasion".