Why the Vision Exam is so Confusing

I’ve always said I feel like I should have a mental health professional stationed outside my office to help repair my patients’ damaged psyches following the vision test.  I say this not because of any self-professed deficiency in my exam technique, but rather due to the nature of the exam itself: it is at times frustrating, confusing, or both.

The reason for vision-test-related frustration is mostly two-fold.  First, the best way to refine and pinpoint a glasses prescription is to rule out all of the power options that DON’T work.  For example, to arrive at a prescription of -1.00D (D stands for diopters, but that’s another conversation), I would want to confirm that neither -0.75 nor -1.25 looks as good.  That’s already two different sets of “Which is better, 1 or 2?” right there.  And sometimes – especially for younger patients whose focusing muscles can mask their prescription somewhat – both choices look pretty identical, so we go back and forth a few times and have tough decisions to make.

The second cause of eye exam stress is that certain parts of the test are confusing and/or counterintuitive – I’m looking at you, astigmatism test!  To test for astigmatism, we introduce a lens called the Jackson Cross Cylinder (JCC).  Without getting into too much gory detail (too late?), as we use the JCC to test astigmatism, the goal is actually to EQUALIZE the BLUR between the two choices.  We don’t even care of either/both choices look clear; we just want them to look the same.  I try to prepare my patients beforehand that both choices may look blurry, but inevitably I’ll get patients who uneasily state “they both look pretty bad.”  Yup, they do.  Once I’ve gotten the measurements I need – again, trying to bracket by finding what DOESN’T look better – I remove the JCC and the image is magically a lot clearer.  Hopefully I can get to that point before my patient has a heart attack.

Most patients who have been through this crazy dance before take it in stride and accept that, in the end, they can expect to see well; but I don’t blame anyone who doesn’t look forward to the vision test.  It’s like what people say about most standardized tests, except even more true – you can’t study for it.

Better equipment, better prescriptions

Anyone who comes into my office will know that I’m a bit of a gadget freak.  I believe in technology and its ability to improve the quality of an eye exam.  From a health perspective, I love what the Optomap Retinal Exam allows me to see in the back of a patient’s eye, without even needing to put dilating drops in their eyes.

My love for things that are gadgety and automated extends to checking glasses prescriptions as well.  Whereas many offices are still using equipment that hasn’t been considered cutting-edge for twenty or thirty years, I’m fortunate to have a fully 21st century office.  First, an automated machine measures the power and curvature of my patient’s eye and gives an excellent starting point to refine for the glasses prescription.  At the touch of a button, this measurement imports directly to a small computer in my exam room, which controls the machine that sits against my patient’s face to flip lenses and finalize the glasses prescription.

To be honest, when I first started using the automated refraction equipment, I thought it was really just a dolled-up version of the older equipment.  However, I’ve come to greatly appreciate its accuracy and efficiency when determining my patients’ prescriptions.  By starting with a more accurate initial measurement, not only is the end result more accurate, but it also takes less time to arrive at that prescription.  Not to mention the fact that both the patient and I are saved from the endless “1 or 2” questions (not eliminated, but definitely reduced!).  Also, the computerized controls allow me to refine certain aspects of the prescription more exactly than I could with older machines and their less precise dials.

None of this is meant to take away from other doctors and what they are able to accomplish with their equipment.  I’m just very grateful for my equipment and absolutely believe that it gives me the best opportunity to give my patients glasses and contacts that they will love!

Why We Image Everyone

Anyone who’s been to our office since January 2012 should know that we have a machine called the Optomap, which allows me to examine my patients’ retinal health through a wide-field digital image, generally without the need for dilating drops.  I am a huge fan of the Optomap and absolutely believe it allows me to give my patients a better exam than I could without this technology.

Because of my personal belief in the Optomap, as well as a desire to streamline patient flow, we typically take Optomap images on every patient.  This gives every patient the opportunity to discuss the pro’s and con’s of the procedure with me before deciding yay or nay, without my having to send patients back and forth between rooms to have images taken (roughly 2/3 of my patients choose the Optomap, so that would be a lot of shuffling!).

Along with the benefits of the Optomap, I also discuss that using the images adds $30 to the cost of the exam, and anyone who prefers to avoid this extra cost may opt out of using the images and have their eyes dilated instead.

Every once in awhile, I encounter a patient who gives me the stink eye after my Optomap explanation.  I can tell what they’re thinking, whether or not they actually express it verbally: “You’re trying to force me into using these pictures you already took just so you can charge me extra!”

My blanket answer to anyone who may feel this way: I’m absolutely not trying to force you. I do believe in the technology and would love for all of my patients to choose it, but I try to make it very obvious that dilation is still an option for anyone who doesn’t want the additional charge of the Optomap.  I do want the opportunity to explain the benefits of the procedure before you reject it off-hand, because I believe it’s in your best interest to use the images.  And again, as stated above, it is more efficient in our office to take images on everyone instead of shuffling patients back and forth between rooms.  If you come into my office knowing that you’re 100% not interested in the Optomap, we will be happy to save you and us the two minutes it takes for imaging.  Just let us know!

Cash patients, cash practice

As anyone who has visited our practice already knows, our practice is not heavily involved with insurance (in case you missed it, here’s my article on why you probably shouldn’t pay for vision insurance).  With the exception of Costco employees – and possibly one other insurance that’s in the works – we are what is referred to as a “cash practice,” meaning payment is made at the time of the exam – by cash, check, or any major credit or debit card  🙂

One major reason why I’ve chosen to stay largely free of insurance is that I’ve seen how it can negatively affect both the practice and its patients.  Financially, what often happens is insurances will reimburse according to a percentage of a practice’s usual and customary fees (up to a limit).  As a result, many insurance-heavy practices will increase their fees to maximize insurance reimbursement.  Some practice owners also feel like they need to keep their fees high so cash patients can offset lower reimbursements on insurance patients.

Obviously this has no effect on the insurance patients – they pay their same co-pay and everyone is happy.  However, patients without insurance are now paying the inflated fees out of pocket, and these fees can be pretty outlandish.  I remember when we had our first child (luckily, covered under our medical insurance), they showed us our bill, which included the total amount billed to insurance – I believe it was over $40,000!  For a normal birth with no complications and a one night stay.  Ridiculous.

I know – $40,000 is an extreme example.  In the world of optometry, more realistic comparisons might be something like $69 vs. $120.  Still, that represents a significant difference for what would be considered very similar exams.  Something to keep in mind for those of us without vision insurance (which I also don’t really believe in – see the article).

New Blog Format

Let this serve as a brief heads-up that several new posts will be showing up this afternoon.  I promise I’m not trying to spam anyone; rather, I am changing the format of my Eye Care Tips pages, and as a result I will be moving some of the previously written pages into the Posts section of the blog.

There will definitely be some new material for your reading pleasure, whereas other posts will just be shuffled around the site.  The end goal is to make the blog more useful as a resource for people to find information about common eye conditions as well as their potential treatment options.  Please feel free to forward my site to anyone you feel may benefit from its content!

Get dilated, get a milkshake!

Image via Wikipedia

I was very excited to arrive in the office this morning to find a large stack of cards from our local Chick Fil-A (SUPER close to us, Chick Fil-A at Larkridge), each one good for a free hand-spun milkshake!

I have been truly impressed by the service I receive any time I stop over at the Larkridge Chick Fil-A, so I contacted them to see if we could work together on any sort of promotion for our patients.  The end result?  Free milkshake coupons for anyone who gets their eyes dilated with their comprehensive exam through the end of September!

A dilated exam is still the best standard of care to ensure we’re not missing anything on the eye health evaluation, although I certainly appreciate the inconvenience caused by having blurred, light-sensitive vision for a few hours after.  Maybe at least now people will stop giving me dirty looks when I suggest putting the dilating drops in, if they get a milkshake for their trouble?   🙂

Are you paying too much for contacts?

A friend of mine recently contacted me to ask if I accept a certain vision insurance that will remain nameless at this time 🙂

I replied that I do not, but we often have patients with that insurance come to us anyway because they still end up saving money! This is partially due to our clear, reasonable pricing schedule, but it is also aided by our close proximity to the award-winning Costco Optical.

Since opening my Costco optometry practice, I have been very pleasantly surprised by how inexpensive glasses and contact lenses are through Costco Optical; however, until now I had never actually sat down and crunched numbers for direct comparison to private practice.

I felt pretty confident that Costco would hold up quite well to a price check, but the results of my little study were astounding to me. Using seven of my most frequently prescribed brands of contacts, I compared the cost of an annual supply – including all advertised rebates – between Costco and a local private practice here in the Front Range.

Average savings by shopping at Costco? $100 (ok, let’s not get carried away – it was only $98.26).

Seriously?! On a product that only costs $100-200 total? Crazy savings. One of these days maybe I’ll post some charts breaking down the price difference between us and private practice for exams, contacts, and glasses. Needless to say, the numbers are “eye-opening.” 🙂

Private practices like to justify these higher costs by touting their “higher level of service.” I think those who have had a chance to visit our practice and use the Costco Optical know this simply is not true. We take care of our patients, and Costco absolutely goes the extra mile to ensure their members are happy. Check us out sometime – I’ll be surprised if you don’t save some money and have a great experience.

View from my office chair