Out of Mind, Out of Sight

After a particularly challenging day in my Daly City office, I was half-way through a snail-paced commute to my Hercules office, then home, punching through the pre-set FM buttons, praying for a tune that would set my mind free of the miserable traffic.  My prayer was answered when I landed on Live 105 airing a new Incubus tune.  As a drummer, I instantaneously recognized and fully appreciated the stylings of their drummer, Jose Pasillas, seamlessly guiding and traveling through 6/4, 11/4, and finally 8/4 time signatures.  Yeah baby.

Incubus drummer, Jose Pasillas

Traffic finally loosened up after the “S-Curve” on the Bay Bridge, so I rolled down the windows, opened the sun roof, and turned up the volume.  Now my mind was clearing, that pressure feeling in my shoulders and the back of my neck dissipating.  Thank you Live 105!  Thank you Incubus!  Was this song called Out of Sight, Out of Mind, I thought, as the chorus lyrics suggest?  I tagged it with my Shazam app.  I was wrong.  Adolescents.  Thank you Shazam!  

That whole out of sight, out of mind deal reminded me of what I tell my patients who experience vitreous floaters.  You know, those little black spots or lines you see in your peripheral vision.  You try to swat them away as they squiggle out of view when you move your eyes and realize . . . they’re happening inside my eyes.  What the?!

Vitreous Floaters against a blue sky

The vitreous humor is a gel-like substance that fills the back chamber of the eye.  It’s surrounded by a thin, transparent membrane.  The gel and membrane slowly pull away from the retina over time.  Due to the optics of your eye, little clumpings of the vitreous and the membrane will cast a shadow onto your retina.  The shadow is projected into real space and is perceived to be floating in front of you – especially under certain lighting conditions.

Is there anything you can do about it, Doc?  That’s when I say, Out of Mind, Out of Sight.  Fortunately, our brain treats floaters like background noise.  Just like our sense of hearing, when we free our attention to focus on other things, our brain ignores the floaters, and wala, they disappear from our perception.  It’s one of those takeaways from the Psychology & Perception upper-div course I took at UCSD back in the day.  What we see and what we perceive can be two different things.  Trippy, I know.  So was the whole UCSD thing, and so too was the disappearance of a day’s misery and stress by merely listening to a great song.  Thank you brain!  I made it home in one piece, with a clear head, leaving work at work, and enjoying the evening with my wife and kids.  Life really is . . . grand.

Eye Exam III: The Refraction – Zig Zag

How does the average person know . . . I mean, really know . . . that they are getting a good eye exam?  This is the third entry in a series of blogs to give you lucky readers an insider’s point of view.  I can ramble on and on, and the long version of each subject would probably allow you to pass an Optometry national board exam.  Not my purpose here.  What I present is . . . the abridged version.

This time, we’ll address . . . THE REFRACTION.

The what?!  Simply put, the refraction is the part of the eye exam in which we determine your eyeglass prescription.  AKA the better-one-or-two part.   Traditionally, we actually perform two refractions . . . objective and subjective.

The objective refraction can be done with a hand-held instrument or by machine . . . automated is what we like to call that . . . performed by a technician during pre-testing.  Either way, you don’t have to say a word as we measure what it takes to focus distant light rays onto the retina – the length of your eyeball(s).  Why is this done?  One, it gives the doctor a starting point – a ballpark measurement – from which to perform the subjective refraction.  Two, assessing the light reflecting off your retina is one way to check for cataracts; and three . . . , well this is now sounding like a boring board exam review, so two reasons are all you need.  Trust me!

A subjective refraction

The subjective refraction is where you get involved, and it’s really cool, because what the doctor is measuring is NOT your eyeball but actually how your BRAIN “sees” the chart . . . ewwwwwww . . . is right.  This is the which-one-is-better-one-or-two part that some people either love or hate.  Love because dang that chart is clear!  Hate because dang I think I failed!  And it is true . . . you could zig, when you should have zagged.  But remember, it’s you and the eye doctor that are doing this together.  SO, an astute eye doctor will take the time to double or even triple-check that you’re not straying into refraction no-man’s land, and keep you on the straight and narrow towards your best spectacle prescription.

Ask any eye doctor, and they’ll tell you that performing a refraction, determining your visual correction, is an art form.  Heck, one of the must reads of any optometry student or ophthalmology resident is The Fine Art of Prescribing Eyeglasses Without Making a Spectacle of Yourself by Milder and Rubin.  It’s been around forever.  Check out the cover, you’ll see what I mean.

A late night Optogeek classic

No two people are alike.  We all have unique demands on our vision; Each of us has a different tolerance to blur.  So, eye doctors are continually trained to look at the whole picture . . . your current glasses, your visual difficulties, how you use your eyes, the results of the objective and subjective refraction, the status of your eye health, how your eyes coordinate together . . . and come up with a final eyeglass prescription.

Like any form of art, beauty is in the eye of the beholder.  When you put the new glasses on for the first time, yes . . . you will have to adapt, but yes, you should be able to see as clearly as you possibly could.  But, let’s say you did zig when you should have zagged, and you did end up in no-man’s land.  You gave the glasses a fair chance, and you still are not satisfied with your vision.   Go back and do it again.  Eye doctors would actually prefer that.  It happens.  In fact, the industry is built to accommodate this problem.  We call it a “RE-DO” policy.  The optical labs and suppliers, vision insurance plans, eye doctors all have allowances to re-do the glasses if need be without any further financial obligations on your part.  No worries.

Familiarity Breeds Complacency

Yesterday, I took the office staff of my Optometry practice in Hercules to my favorite Chinese restaurant, Dragon Terrace, also in Hercules, CA.  Most of my staff are locals, and they were frequent flyers at Dragon Terrace as well.  We all agreed that when we dine in out-of-town Chinese restaurants, the food “just doesn’t taste the same”.  And don’t even ask about what we Bay Area folks think about Chinese food when we travel OUT of the Bay Area.  Anyway, we made a conscious effort to recognize how tremendously lucky we were to have Dragon Terrace in our backyard.  We’re comfortable there.  Eric and the staff are like family.  So, no complacency there.

Ask any eye care professional, and they will recommend annual eye exams.  Most people fortunate enough to have vision insurance have annual exam coverage.  Yet the average person comes in every 2.5 – 3 years for routine eye care.  So, I’m starting a series to tell you some clinical stories – true stories – about patients who made the unfortunate mistake of becoming complacent about their vision.

JC was an energetic, pleasant 22 year old who just landed a great job doing lab work in a local teaching hospital.  It was Labor Day Saturday, and she came in because she felt that her left, 2-week disposable contact lens was dirty, old and blurring her vision.  I asked her when she first noticed this blurriness, and she surprised me with, “since last July.”  July?!  JC didn’t seek care for two months because she “was waiting for her vision plan benefits to kick in”.  Complacency due to economic conditions.  Oh no.

I tried as hard as I could to suppress a hard gulp and dove head first into the eye exam – hoping for the best for JC.

She read the chart with her right eye . . . 20/25.  Not bad.  Then she covered the right eye and read with her left eye . . . 20/200.  Bad.  “If it’s the contact lens, then it’s going to be the dirtiest lens I’ve ever seen,” I thought.  Oh yes, I’ve seen some really pathetic lenses way past their last leg.  So, I looked at it.  It was relatively clean.  Not good.

No matter what lenses I put in front of her left eye, her vision did not improve from 20/200.  Immediately, I grabbed a hand-held ophthalmoscope to look into her left eye.  I’m not sure if I gulped, but I had terrible news for JC.  She had a very large retinal detachment in her left eye, and I made an immediate referral to a retinal specialist on call at her teaching hospital.

When retinal tissue is detached long enough, it is separated from it’s underlying blood supply and necroses – or dies.  Unfortunately for JC, her vision loss was permanent.  Fortunately, she had two eyes, and saw well with her right eye.  However, she could no longer wear contacts as contacts increased risk for infection.  She now has to do everything in her power to protect her better eye.

The moral to this story is . . . don’t be complacent about blurry vision.  Have it checked out as soon as possible.  If you’re worried about cost, have it evaluated anyway.  Most medical professionals are compassionate and willing to work something out.  JC made a dangerous assumption that her contact lens was to blame.  Our visual system is wonderfully complex.  It takes at least 8 years to become a doctor of optometry, and continuing education never ends.  If you need professional advice . . . , go to a professional.

Top 10 LASIK Myths – Demystified

Besides glasses and contacts, I also recommend LASIK to patients who may be good candidates.  Almost everyday, I find myself in a deep conversation about LASIK, and I’ve set out to demystify what I consider to be the top 10 LASIK confusions or myths.  Enjoy.

1.        The effect of LASIK will go away over time.

Studies have shown that if you go into LASIK with your glasses prescription unchanged or stable for 12-18 months, then the likelihood of needing an “enhancement” within 10 – 15 years is unlikely.  Conversely, if your prescription is always changing year after year, then it is likely that it will continue to change – even after LASIK.

 2.        LASIK is painful.

A topical anesthetic is used during the procedure, so virtually no pain is felt.  You may feel pressure on the eye, and one can hear (and smell) the laser doing its work.  After the anesthetic wears off, most people experience a feeling like there is an eyelash stuck on your eyes.  This usually goes away after 3 – 5 hours.

 3.        If your vision changes, you can always have an “enhancement” done.

Not necessarily true. . . .  Most LASIK surgeons offer an “enhancement” package.  One year, five year, or a lifetime package can be purchased.  However, you will have to go through another consultation, and it is the surgeon that decides whether or not an enhancement surgery is can be done.

 4.        Everybody who wants LASIK, is a good candidate.

Not True.  There are many factors involved when determining if you are a good candidate.  A LASIK surgeon may turn someone away for something as simple as expectations that are too high.  There are conditions of the eye like active glaucoma, severe dry eyes, and a “lazy eye” that can make one a poor candidate.  Also, there are certain anatomical attributes of the eyes that make one a “bad” candidate; e.g., pupils that are too large, corneas that are too thin.  That’s just the tip of the iceberg.

 5.        LASIK is expensive.

In the Bay Area, for an A+ surgeon with the latest technology, expect to pay between $3000 to $5000 for both eyes.  You can find “deals” like $999, but be sure read the fine print.  It will probably be for the older “Traditional” LASIK technology, administered by a surgeon of lesser experience, and there may be limitations in the type of refractive disorder being treated.  The technology employed and surgeon skill play a huge roll in successful outcomes.

Dr. Johannes Hartmann

6.        Having astigmatism and/or farsightedness makes one a bad candidate for LASIK.

The newer “Custom Cornea” or “Wavefront” LASIK technology allows for correction of astigmatism and farsightedness.  A “Hartmann-Shack Aberrometer” scans your visual system for “higher order abberations”.  There are limits to how strong of a correction could be treated, and corneal thickness may be a limiting factor.  You’ll need a LASIK consultation to determine that. 

Dr. Ronald Shack

7.        After LASIK, I won’t need glasses.

If you’re young enough so that you do not need reading glasses, then this could be true.  However, most people will need reading glasses at some point in their life (usually when you’re past the mid-forties).  This is true whether you’ve had LASIK or not.  Also, some people who need to have their distance vision enhanced – but decide against it – may need glasses especially for night driving  in unfamiliar places.

 8.        20/20 vision is guaranteed.

In the hands of an A+ surgeon with Wavefront LASIK technology, a 20/20 outcome is achieved 93 – 95% on a given eyeball.  So although 20/20 is not guaranteed, the odds are in your favor (if you’re a good candidate).  Many surgeons report that approximately 95 – 99% of their patients are “happy” with their results.  So a proper expectation would be “20/Happy”.

 9.        Once you’ve had LASIK, you no longer need vision insurance and annual eye exams.

Absolutely false.  Whether you’ve had LASIK or not, an annual eye exam is necessary to ensure optimal vision and proper eye health.  Therefore, it is a good idea to keep your vision plan, and have annual eye exams.  Some “enhancement” packages actually require an annual eye exam.

 10.     Optometrists go out of business because of LASIK.

Not true.  Many Optometrists, like myself, have partnerships with LASIK surgeons.  This allows him to “co-manage” and perform pre and post-op evaluations.  Give me a call – (510) 724-3937 for Optometry by the Bay in Hercules, CA or (650) 756-4000 for Daly City Optometry – to schedule your complementary LASIK consultation.  You’ll have plenty of time to get good objective answers to all of your LASIK questions!

Eye Exam Part II: Visual Acuities – Mura Mura

How does the average person know . . . I mean, really know . . . that they are getting a good eye exam?  Well, I’m embarking on a series of blogs to give an insider’s point of view . . . THE ABRIDGED VERSION.  I can go on and on and on, and THE LONG VERSION would allow you to pass an Optometry national board exam.  So I won’t go there.

In this second installment, we’ll address . . . VISUAL ACUITIES.

After the case history (see Eye Exam Part I), one of the most basic measurements taken is your visual acuity; that is, how well each eye sees a chart – at distance and near, with or without corrective eyewear.  You know the drill . . . .  “Can you read these letters for me?”  It seems mundane.  A lot of eye care professionals actually delegate this task to a technician.  But, I learned early in my career that visual acuities – well taken – are critical to ensuring an accurate spectacle correction.  And isn’t that what we all want?  Glasses that are just right?  Not too strong.  Not too weak.

As a patient, it is good to realize that a good visual acuity result is a threshold measurement.  That means that the tester is looking for the finest detail your visual system can resolve.  She’s probably even going to push a little and ask you to guess at something you’ve already stated you cannot see . . . , and that’s okay.  That is one clue that you’re getting a good eye exam.

During my rookie year of professional Optometry, I was having trouble keeping up with the 20 minute appointments, so I asked for advice.  One of my mentors and a colleague at Kaiser Permanente in Vallejo, CA – Dr. Peter Catanich – spoke fondly of his early career as a WWII Army Optometrist and the rapid-fire eye exams he performed in a high volume, severe time constraint situation.  “All I needed was a good case history, a measurement of their current glasses, precise visual acuities, and I pretty much knew what to prescribe . . . .  It’s amazing how you can make do with the time you’re given, Grasshopper.”  No, he didn’t say Grasshopper.  Well . . . maybe he did.  But the point is . . . to an astute clinician, visual acuities are pretty darn important because they actually reveal more information than one would expect.  And as I learned from Dr. Pete, take the time to do it well, and accurate results will be your reward.

Incidentally, the other advice Dr. Catanich gave me was for marketing glasses.   It turns out he spent ample time in the Philippine Islands during WWII, so he picked up some nuances of our language and culture.  “Gabe, you need to put up a huge neon sign . . , Eyeglasses Mura Mura“, he exclaimed with jazz hands emphatically opening to the rhythm of each Mura.  (Pronounced MOO rah . . . Tagalog for “cheap“.)      Every time we crossed paths, it was Pete fading in or out, coming or going down a long corridor – repeating the neon sign – sprinkled with chuckles under his breath.   Eyeglasses Mura Mura.  Hmmmmm . . . ?  Kinda has a nice ring to it.  I miss that guy.

Vintage Army Glasses

Multifocal Soft Contact Lenses 101: 20/Happy

For most people, Presbyopia (the age-related need for reading glasses) is a certainty somewhere between taxes and death.  Besides bifocals or progressive spectacles, contact lenses can also correct for presbyopia.  With Baby-Boomer demographics blowing through the roof, it was inevitable that soft contact lens manufacturers spend time and money on multifocal contact lens R&D.  Lately we’ve been hit by aggressive marketing of such lenses, and I have patients ask about them at least once or twice a day.

At my practices in Hercules and Daly City, CA , I’ve had many happy patients that consider these lenses to be modern miracles.   We’ve come a long way since Benjamin Franklin invented the bifocal.  Are you a good candidate for soft multifocal contact lenses?  Here’s the inside scoop.  I’ve identified 3 pre-determining characteristics of a successful multifocal contact lens wearer.

Firstly, you need to be a good candidate for contacts – in general.  That is, no dry eyes, ocular allergies, nor a strong blink reflex (otherwise, you can’t get ‘em in).  Additionally, you must have better-than-average hygiene habits; No slobs allowed (otherwise, you are at a high risk for eye infections that can, yes, permanently rob you of vision).  As a clinician, among other things, I also look for immaculate cornea and eyelid health.

Secondly, most successful multifocal contact lens wearers do not have Olympian demands for distance, reading, computer use, or any other near task that requires hours of fine focusing at any distance – like a telemetry RN staring at medical equipment indicators for 12 hours, or a US Postal Service employee casing addressed envelopes and packages flying by at 55 mph, or a motorcycle police officer who mostly works the graveyard shift..  If you do have high near or distance vision demands, then consider an occasional or part-time wearing schedule; i.e., for special occasions, working out, days off, etc.

Thirdly . . . and maybe most importantly . . . expectations, expectations, expectations.  A soft, multifocal contact lens is designed like a donut.  The most successful design I prescribed involves an inner portion (subtended by your pupil, the donut hole so to speak) comprised of optics that focuses light coming from far away, and an outer portion (the donut) that focuses light from intermediate and near objects – in the dominant eye.  Conversely, the non-dominant eye is fit with a lens with the inner optics focusing near objects, and an outer portion focusing distant and intermediate objects.  So each lens contains optics that focus distance, near and intermediate objects – at the same time!  We call it “simultaneous vision”.  And guess what?  It’s a compromise.  Unlike, spectacle lenses, not all of the light focusing on your retina is coming from one distance, so the quality of your vision may not be ideal; ergo, you need to have proper expectations.  A good candidate does not expect 20/20 or better vision at all times and at all distances.  A good candidate is someone who expects what I call, “20/Happy”.

Our individual tolerance to blurriness is very subjective – similar to how tolerance to pain differs from person to person.  I actually do have successful soft multifocal contact lens wearers who happen to be a telemetry RNs or motorcycle cops working graveyard, but they are more of an exception rather than the rule.  So you never know how well a contact lens works for you until you try it.  You’re officially invited.  If you have more questions, please ask.

Eye Exam Part 1: The Case History

How does the average person know . . . I mean, really know . . . that they are getting a good eye exam?  Well, I’m embarking on a series of blogs to give the lucky few who read this an insider’s point of view . . . THE ABRIDGED VERSION.  I can go on and on and on, and THE LONG VERSION would allow you to pass an Optometry national board exam.  So I won’t go there.

We’re going to break it down, boys and girls.  This time, we’ll address . . . THE CASE HISTORY.

As a clinician, I take seriously the trust my patients bestow in me to provide the highest standard of care and ensure their wellness within the capacity of my profession.  I always strive to keep up with technological advances that allow me to do so.  Both of my practices, Optometry by the Bay and Daly City Optometry, are equipped with diagnostic instruments that garner ewws and ahhs from the patient gallery.  After years of practice, however, it is the less technological aspects of the eye exam that continue to impress me for their diagnostic powers.

Take, for instance, the case history.  It’s the case history that drives the rest of the exam.  There should be conversation about the main reason for the visit, aka the chief complaint, and follow up questions that dissect your problem into pieces like onset, duration, aggravating factors, is it getting better or worse, and previous episodes.  You should be asked about your visual demands, overall health condition, medications, family history, and who your primary care provider is (as well as secondary providers) in case further communication or consultation is needed.

Not only are we gathering facts, but a good clinician, consciously or subconsciously, is also making gross observations about things like the patient’s overall state.  True story:  In early November, 2007, a 49 year-old Asian male, J.G., walked sluggishly into Optometry by the Bay.  It was close to noon.  He had recently noticed some blurred vision, was having some headaches and generally felt weak. It turns out that he was also a martial arts instructor in generally good health.

Something about him just did not make sense to me.  Most martial arts guys I knew – especially instructors – were usually full of energy and enthusiasm ala Jackie Chan movie bloopers, but J.G. was the complete opposite that morning.

Among other findings, his vision was not correctable to 20/20, and his pupils were not quite reacting the way they should.  After taking a close look at his swollen optic nerves, I took digital images of them, carefully explained to him what I was seeing, and sent him straight to an ER.  Two days later, he had a golf-ball sized tumor removed from the right side of his brain.  Two weeks after that, J.G. walked into my office – aided by his son. . . .  big smiles on both faces.  His head was shaven and a bandage covered the staples in his scalp.  He and his family “just had the best Thanksgiving – ever.”  I’ve been lucky enough to see J.G. every six months, and I’m happy to say he’s got his swagger back and is doing very well.

I Love My Maui Jim’s

Love is a real strong word, isn’t it?  The past couple of days in the office were spiced up because we got a new shipment of Maui Jim Sunglasses!  Our rep, Vic White, was kind enough to revamp our inventory with some new styles.  These things are so hot that we sold one of them – the Palms -  right out of the box to a patient who is leaving for – you guessed it – Hawaii . . . tomorrow!  She’s gonna love ‘em!

I am always preaching about how great polarized sunglasses are to just about every patient I see.  Simply put, polarized lenses filter out light bouncing off flat surfaces; i.e., water, the pavement, other people’s windshields and hoods, even the reflection of your dashboard on the inner-windshield.  When it comes to the best polarized technology, Maui Jim’s Polarized Plus® 2 is there above the rest.  Their patented nine layers are comprised of an outer, waterproof shell, back-side anti-reflection coating, front-side double-mirror gradient, front and back-side anti-scratch coatings, and a polarized filter in the lens itself.  All of this leads to color-enhanced, glare-free, comfortable, 100% UV protected vision.

I practice what I preach!  I wear a prescription Maui Jim sunglass, the Lanai, in Gunmetal with a Maui Evolution® lens in a Maui Rose® tint.  It’s a “double-bar, aviator made of Flexon material, and I can’t go anywhere without them.  Yes, you can view the world through rose-colored glasses!

It’s not the darkness of a sunglass lens that cuts glare . . . .  It’s whether or not they’re polarized.  Our brain gets spoiled when we wear polarized sunwear.  Go spoil yourself.

Power Lunch, Power Partner

Three years ago, I joined a group of local business owners to launch a chapter of BNI (Business Network International).  We called ourselves the Dynamic Referral Group,   and we met every Friday morning from 7:00 to 8:30 a.m. at our local public library.  Basically, we taught each other about our type of business, how we add value to what we do, and what makes a good referral.  Most importantly, we developed deep relationships with each other – especially with Power Partners – and passed referrals.  What makes someone successful in BNI is holding to their philosophy . . . Giver’s Gain.

Due to the recent birth of my third child, Zane Lucas Respicio (left), I had to leave the group because I could no longer attend the meetings.  However, I consider myself to forever be a networker, because the BNI lessons and concepts are deeply engrained.  But look at that smile!

Last Thursday, I had the privilege to lunch with a member of the group, Dr. Jonathan Uy.  He is a highly trained, highly skilled foot and ankle specialist, the President of the San Francisco/San Mateo County Podiatry Society, and one of his practices happens to be upstairs in my building.  I would consider him to be a Power Partner.  In BNI-speak, that means we look out for each other’s business and have given numerous, quality referrals to each other.

Dr. Jonathan Uy

The more we learn about each other’s scope of care, the more we realized the commonalities of our patient bases.  For instance, one of Dr. Uy’s sub-specialties is treatment and prevention of diabetic foot wounds and the dispensing of diabetic footwear.  My diabetic patients see me at least once per year.  The leading cause of permanent vision loss in the U.S. population 19 – 65 years of age are the effects of diabetes on the retina.  During the course of any eye exam, I always ask about diabetes.  “How easy would it be for me to routinely ask about foot or ankle problems”, I thought?

Dr. Uy picked up the lunch tab.  (Thanks, Jonathan!)  As soon as I returned to the office — and thoroughly flossed, brushed, and gargled the remnants of garlic fries from my oral cavity — I modified the patient history portion of my practice software to include foot and ankle problems.  It literally took one minute.  To kick it up a notch, I scheduled Dr. Uy to be my guest and speak during our next staff lunch meeting.  I’m sure more epiphanies are on the way.  Lunch – sans the garlic fries – will be on me.

One of the joys of self-employment is networking and developing relationships with other business owners.  I’ve learned that there is a Karmic dynamic out there.  You help yourself the most by genuinely and sincerely working to help others.

The Adventures of a Hungry Optometrist

Eye Yie Eye. . . .  It’s 1:45 a.m., Monday, May 24, 2010.  I tried to sleep – actually laid my head down for 30 minutes.  Did not even get close to falling asleep.  I guess I got excited about my very first blog.  What am I going to call it?  The Adventures of a Hungry Optometrist, I thought, laying there.

“Stay Hungry” was Jamie Foxx’s final piece of advice to the American Idol contestants a few weeks ago.  I am hungry.   After 13 years of private practice Optometry in Daly City and almost 5 years in Hercules, I’m hungry for knowledge, technology and products to share with the thousands who bestow trust in me for their well-being.  I’m also hungry to see my practices grow the way I know they can.  I’m hungry for innovative ideas to offset diminishing vision plan reimbursements and increasing costs.  Yes,  these are “hard times”, but I refuse to participate in a recession.  So, yes, I’m hungry. . . , and participating in this blogging community is one way to feed that hunger.

I got excited because I found a great Optometry blog by Dr. Al Cleinman  (http://alcleinman.typepad.com/al_cleinmans_blog/) with lots of stuff on how to manage the business of Optometry.  What I found to be the most eye-opening was the idea of dropping out of vision plans as a provider.  Yes, even the big daddy of vision plans. . . VSP.  I’d heard other practice management gurus say it’s the thing to do, and I’d always thought, “huh”?

So I left myself a phone message on my office voicemail.  If I didn’t, I’d probably be wandering around the office tomorrow thinking, “What was that great idea I had at 2 a.m?”  The message went like this.  Yeah.  Note to self.  Look into how to process Davis, EyeMed and, yes, even VSP as a non-provider. Here’s a note:  I dropped Spectera after I received a reimbursement check for $0.50.  I didn’t even deposit it.  I pinned it up next to my desk. Another note:  VSP is HQ’ed an hour-and-a-half from here, so it is likely that I will keep it.

Now, I’m sleepy.