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!

My Optometry Turn-ons

When I first graduated from optometry school, I assumed that as I practiced I would find an aspect of optometry that particularly interested me and could turn into somewhat of a specialty.  Now that I’m a few years removed from optometry school, here are a few things I’ve realized I’m passionate about:

1) Communication.  I feel strongly that every patient leaving my office should understand the current state of their eyes and their options for correcting any problems with their eyes.  I try to be very clear about all this during the exam, and if anyone sends me an email after their exam asking questions, I typically send a pretty detailed reply to make sure nothing is left unsaid or under-explained.

2) Good prescriptions.  Whether for glasses or contacts, I want things spot-on.  I was extremely picky about my vision growing up – probably to a fault – and I am picky about my patients’ vision.  This is why if you come in saying you recently got a glasses prescription somewhere else and only want contacts from me, I’ll still remeasure your glasses prescription to make sure things are as exact as I want them (we use the glasses Rx to determine the contact lens Rx).  And yes, I am aware of the fine line between a thorough exam and causing my patients a nervous breakdown from having to answer “1 or 2” too many times 🙂

3) Having options.  My prescribing philosophy is to offer each of my patients any and all options that I would consider for myself if I had their eyes.  If I’m offering you a separate pair of glasses specifically for the computer, it’s because if I had your prescription, I would probably want those glasses.  If I think you would benefit from part-time or full-time contact lenses, or from LASIK, I try hard always to bring up these options and how they could help enrich your life.  Before I had LASIK, I had prescription glasses, prescription sunglasses, and daily disposable contacts for part-time wear.  I had options for whatever came my way.

4) Technology.  I love my optomap because I think it gives me a better view of the back of the eye and a more perfect comparison from year to year to check for change.  I love my computerized refraction system because it makes the process of checking glasses prescriptions more efficient and more precise.  I truly believe the exam I can give you with my technology is better than the tradition exam with all manual equipment and dilating drops in your eyes (which isn’t to say there is never a reason to use dilating drops, just fyi).

Costco Glasses: to buy, or not to buy?

Not infrequently, my patients ask me how I feel about the quality of glasses that are produced by the Costco Optical, which is located approximately 8 feet from the entrance to my office.  I believe the unspoken question  underlying this query is something to the effect of, “How can Costco possibly provide a high quality product when it costs so much LESS than most nearby opticals?”  Glad you asked 🙂

As a disclaimer, I am not personally employed BY Costco or the Costco Optical – I lease space inside of Costco and operate as an independent Doctor of Optometry.  As such, I am not privy to the inner workings of Costco, including but not limited to figures such as costs and margins.  However, I am generally familiar with principles of optical management, macroeconomics, and Costco’s promise to keep margins low.  Upon this knowledge shall I base the rest of this post.

Here’s my short answer to the aforementioned patient question: Costco Optical is fantastic, they have been ranked #1 by Consumer Reports for overall customer satisfaction, and I’m convinced many of my patients really only come to see ME because they want to go to Costco Optical.

As for my answer to the underlying question of “How do they do it?” here’s my take on it.  Everything that Costco Optical makes is great quality, but they do have a limited selection of available products.  Whereas many independent opticals may choose from 10 or 20 different progressive lens designs, Costco uses maybe two or three.  Where some opticals may offer sunglasses in any number of materials and designs, to my knowledge Costco has just polarized polycarbonate (maybe in two different colors?).  Where some opticals have thousands of frames on their boards, Costco has…less than thousands – I actually have no idea how many frames they keep on hand.

The point I’m going for here is that Costco doesn’t have as wide of a selection as some independent optical shops, but the products they do offer are top quality at a fraction of the price of most independents.  Why such a price difference?  Partly due to economies of scale (lower material and production costs when in bulk; and with fewer products to order, each order is bulkier) and partly because Costco’s model is to keep low margins, whereas the standard mark-up at many independent optical shops is in the neighborhood of 2.5 times (as in 250%).

Again, I have no knowledge of Costco’s margins or costs, but assuming an $80 wholesale cost of a Flexon Nike frame, an independent optical may easily mark it up 2.5 times to a retail cost of about $200.  Costco obviously doesn’t go for 200% margins, but maybe something closer to 20% (I completely made up that figure for argument’s sake), which would give a price around $100.  Same frame, very different price.

I’ve already written about the insane price difference between Costco and most independent eye care providers for an annual supply of contact lenses.  Again, economies of scale.

Am I saying there’s no value to independent opticals?  Absolutely not.  If you value a wider selection of more designer frames or want to make sure you’re always getting the latest and greatest lens material or design, you may be better served by an independent optical shop.  But you’ll pay for it.  Through the nose. As a very small example, the premium non-glare treatment that Costco Optical includes on all of its lenses at no additional charge would be a $100 upgrade at most independent opticals.  I’m just saying…

Review of Costco Eye Drops

Periodically, I like to browse the eye care section here at Costco so I know what products are available to the members.  I assume there may be some variability among different locations, but currently the Thornton Costco stocks four different brands of eye drops.  Following are my thoughts on each brand.

Systane Ultra and Refresh Tears

I have these two listed together because they are in the same class of drops – namely, traditional preserved artificial tears without any added pharmaceutical agents.  My personal preference from a comfort standpoint is Refresh, but everyone’s eyes are different, and some people will prefer Systane.  I believe Systane is a slightly thicker drop.  Either one can safely be used up to four times per day as needed for dry eyes or irritation.  Beyond four times per day usage, preservatives from the drops may start to irritate the eyes. 

Refresh Plus Non-Preserved Tears

These are the same general formulation as Refresh Tears, but without the preservatives.  Refresh Plus is indicated for people whose eyes are very sensitive to preservatives in standard drops, as well as individuals who need to use drops more than four times per day.  Instead of a traditional multi-use bottle, these drops come in separate tear-away vials that each contain about 6-8 drops.  The package calls them “single-use” vials, but in reality they are usually ok for multiple applications within the same day (any unused drops should be discarded at the end of the day because they are not preserved against contamination. Of course, open vials should be stored in sanitary conditions to avoid contamination as well). This is what I used after my LASIK, and they were fantastic.  The Costco pack is definitely the way to go – amazingly economical compared to what you would expect to find at a drugstore, for example.

Visine Advanced Redness Relief

I was actually somewhat sad to see this appear on the shelf in recent months, especially considering that here at Costco it comes in a three pack!  Visine should be using sparingly to not at all, given its potentially detrimental effects with long-term use.  Along with any sort of lubricants included, the active ingredient in Visine is a drug that shrinks blood vessels (hence the redness relief – smaller vessels mean whiter eyes!).  After extended use, your eye’s blood vessels may reach a point where they cannot regulate their size properly, and you end up rather dependent on the drug to keep from having red eyes.  Ok to use once in a blue moon to look your best for a job interview?  Sure.  Good to buy in a 3-pack so you are tempted to use it all the time?  Not so much.  Avoid.

Why I love the Optomap (and you should, too!)

I believe I posted on our Facebook page, but perhaps no where else, that we recently brought a new piece of technology to our office – optomap digital retinal imaging.  Here, I just want to briefly discuss why I think this technology is so fantastic, and why I believe you should incorporate it into your next comprehensive eye exam!

Most people don’t realize that with a traditional dilated eye exam, even though your pupils are insanely large, traditional instruments only allow your doctor a limited view into the back of the eye.  This is why we need you as the patient to look left, right, up, down, and every other conceivable direction to piece together the image of the back of your eye.  Even so, we can never see the entire back of the eye as a single picture with a traditional dilated exam.

Healthy Eye Optomap Image

Herein lies what I consider the major advantage of the optomap retinal exam: it DOES give us one wide image of the back of the eye – showing us what we need to see all at once, instead of piecemeal.  We also keep these images on file, allowing us to compare images over time and track any potential deterioration of eye health. 

Of course MY priority as an eye doctor is the health advantage afforded by this technology; however, as a patient, you may have a greater appreciation for the fact that we can generally obtain these digital images without the need for dilating drops, leaving you ready to get on with your day after your eye exam!  Dilation can cause blurred vision, especially up close, as well as significant sensitivity to bright light; and these effects usually last about 3-4 hours after your exam.

Note: it would be incorrect to say that the optomap fully takes the place of a dilated exam.  If a retinal emergency is detected and requires further evaluation, you will need to have your eyes dilated.  However, the optomap retinal exam is a remarkable screening tool that can help us decide if dilation is truly indicated, and most patients are able to avoid dilation with this new technology. 

In my office, which is located inside a Costco, many patients would choose to forego dilation regardless of any new technology – they just want to be able to go shopping afterwards 🙂  Comparing the thoroughness of a non-dilated exam with vs. without optomap, it’s not even close. 

I love this technology because it gives me more information as the doctor, and it makes life easier for my patients.  I recommend it wholeheartedly to anyone as part of their annual comprehensive exam.

 

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WWID? (aka Golden Rule Optometry)

Image via Wikipedia

Some time ago, when I was still working at a stand-alone private practice, I occasionally felt conflicted regarding which vision correction options I should offer my patients.  Especially in that setting, certain options could add a LOT to the patient’s financial obligation, and I was definitely conscious of that.  I feared ever getting into a situation where my recommendations could ever be tainted by a desire to “up-sell” my patients.

Although opening a practice inside Costco has lessened some of my concerns regarding astronomical costs for my patients (see my post on potential savings through Costco), I have continued to abide by a philosophy developed at my previous practice – namely, I recommend to the patient whatever options I would want if I had their eyes.  If a patient’s prescription is so low that contacts aren’t really necessary to enjoy swimming, basketball, etc, I let them know contacts are optional.  If the prescription is incredibly high, I let them know it’s a strong recommendation.  If they abhor the very idea of contacts but have a pretty substantial prescription, we’ll definitely talk about prescription sunglasses or possibly LASIK.

Frankly, I’m somewhat grateful that I don’t profit from the sale of contacts or glasses, because it really allows me to remain objective about what to recommend!  With this golden rule philosophy, I can feel confident that I am offering each patient the best options available without judging their ability to pay; and I let them choose what they can, or want to, afford.

I am an Independent Doctor of Optometry

I recently read an article written by a fellow optometrist suggesting that Costco optometrists are somehow employed and/or controlled by the corporate powers that be. The idea was that my prescribing habits – which contact lenses I fit, for example – are potentially skewed by my association with Costco.

Let me just cut to the chase and say this suggestion is false!

As Costco states on their website, on the sign standing by the warehouse entrance, and on the sign just outside my office (see above), I am an “Independent Doctor of Optometry.” This means that I actually lease office space inside Costco and am free to practice optometry how I see fit. Although I would LOVE Costco employee benefits, I do not receive any, because I am not employed by Costco.

I love it when the contact lenses I recommend happen also to be stocked by the Costco Optical for convenience to my patients, but just as often as not, my patients order their lenses through the Costco Optical and receive them within about a week. They still receive the amazing Costco prices, and I got to prescribe whatever lens was best for that patient, so everyone is happy 🙂

I love working side by side with Costco Optical as a business partner because of the great prices, products, and service they provide my patients; but my decisions are my own.