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Optometrical Practice Management Newsletter-Tips & Reviews. Volume 3. August 2005

 

 

Business Tip: Pre-Appointing Patients
This month we will focus on pre-appointing your patients.  It is a fantastic service, which is not only appreciated by your patients, but guarantees more timely eye examinations and less dropouts from your database.  Read on for more.  


 

 

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Therapeutic Review: Glaucoma (Beta-Blocker side effects)

Beta-Blockers have been the main stay of glaucoma treatment for nearly 30 years.  Lipid receptor agonists (such as Xalatan) have now taken over but the Beta-Blocker class is still used frequently as first choice by many practitioners.  They have potential for significantly more side-effects.

More Detail.



Product Review:

Zeiss GDxVCC (Glaucoma Diagnostic Device)

Looking at the optic nerve from an objective structural perspective now complements the stereoscopic view through a dilated pupil.  We trialed this great instrument side by side with our OCT.
Read on and find out what we think of it:


Next month we will discuss in detail the new ruling by Medicare.  It is no longer a grey area to charge separately and privately for imaging.  Finally you can be confident in purchasing new technology and know that you can afford to provide excellent care to your patients.  They deserve it!


Business Tip: Pre-Appointing
This service is dependent on having a computerised appointment book that is directly linked to your practice management software.  We have used the Sunix Program - Vision since 1996.  One of it's many, many features is the computerised appointment book.  There are other systems, which probably are quite good, but I will keep the discussion to Sunix as I am very familiar with the program.

Pre-appointing your patients to a future date is a fantastic service.  Let's face it we are all extremely busy these days.  The less we have to remember,  the less stress we are likely to face.

Here are the nuts and bolts of how I approach pre-appointing from my consulting room:

  1. I have finished my consultation but I am still in the consulting room with the patient.
  2. I recommend a review in a certain time frame eg. 3 years time. Obviously the same technique will apply to other time frames, whether it is 3, 6, 12 or 24 months.
  3. The patient agrees that review at your nominated time is good for them.
  4. I then say, "I am going to make a tentative time for you in August 2008 for review.  I realise that there is no way that you will know what you are doing then, but remember, the time is tentative. We will contact you about a month ahead of schedule as a reminder and if the time does not suit you, we will reschedule it to a time that does."
  5. Invariably the patient is very happy with this arrangement, so straight from the patient record I hit the button "Make Appointment" and literally within two more key strokes I have made an appointment for the patient in 3 years time.
  6. In our practice we have a person that is responsible for appointing and reminders.
  7. Every week they look forward 4 weeks in our appointment book and find all the patients that have been scheduled.
  8. Currently we send each patient a letter that asks them to call back and confirm whether the appointment is fine or whether they would prefer to reschedule. We are looking at changing this to email for those that have email addresses as it costs us a few dollars per reminder by snail mail.
  9. If they have not called to confirm, we will call them a week from the tentative appointment to confirm.
  10. We will also call or SMS or email (depending on patient preference) the day before.

By implementing this simple system we achieve a recall rate of around 70%. In years gone by our recall success was around 25%.  What is also amazing is that many patients request that we recall them yearly to take advantage of their health fund rebate. The hardest part of constantly growing your practice is the loss of patients to other optical outlets.  Pre-appointing is one very powerful technique to keep them returning.

Register your interest for Business 2005. We will concentrate on staff and take home business tips that are bound to increase your efficiency and your bottom line. Pre-appointing will be discussed in detail as will other techniques to help grow your practice.

 

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Read our recent review


   

Therapeutic Review: Beta-Blockers & their Side-Effects

The mainstay of glaucoma treatment from 1978 to a few years after the release of Xalatan (prostaglandin analog) was Timoptol.  This topical beta-blocker can reduce IOP by about 20% and for most patients can be used once a day in the 0.25% concentration or the 0.25% concentration in the gel (Timoptic XE).  Another common beta-blocker is Betoptic-S.

Timoptol is non-selective blocking both Beta1 and Beta2 receptors, whereas Betoptic-S blocks Beta1 receptors.  Timoptol is better at reducing IOP, whereas Betoptic-S is less likely to cause side-effects and possibly preserves the visual field more effectively. Studies confirming that Betoptic-S preserves the visual field more effectively that Timoptol are very thin though.

The main side-effects that topical beta-blockers can cause are:

  • Breathing difficulties and therefore are contraindicated in asthmatics.  Watch out for breathing difficulties in non-diagnosed or borderline asthmatics.
  • Decrease in heart rate and therefore contraindicated in patients that have a low heart rate and or congestive heart disease.
  • Other less common side-effects can be depression and sexual dysfunction.

The following are things to keep in mind when prescribing or comanaging patients on topical beta-blockers:

  • Some patients are still using Timoptol 0.5% twice a day.  Rarely is this required clinically if punctal occlusion is used after drop instillation.  By changing them to 0.25% once a day you basically can reduce the exposure systemically to the drug by at least 75%.
  • Over a period of time, IOP can increase.  A common mistake at this point is to just add another drop.  Before this is done, it is better to use no drop in the less damaged eye for a few weeks, but keep treating the more damaged eye.  This is called a monocular trial.
  • In cases where another drop needs adding you will find that the non-treated eye IOP will increase, whereas the treated eye will be significantly lower but not at an acceptable level.
  • Often though the beta-blockers stop being effective and by taking away one of the drops nothing significant occurs to either eye.
  • In these cases it is best to discontinue the beta-blocker altogether and then introduce another class, but again with a monocular trial.

Monocular trials can be confusing.  We will be discussing these further in future newsletters but will also expand on them in upcoming seminars:

Glaucoma 2005 (Sunday 11 September) Download your registration form now and fax it to (02) 9553 0028.

Ocular Therapeutics 2006 (date to be confirmed)

These seminars will concentrate on merging clinical excellence with profitability.  Your patients can not afford for you not to be financially successfully in providing clinical care.

 

 

 

 

 

 

 

 

 

 

Advertising

http://www.rodenstock.com.au

Porsche frames position our practice to the business professional.
Get your patients to test drive this premium product.  It's success in our practice has amazed us.


Instrument Review: GDxVCC (Glaucoma Diagnostic Device) by Carl Zeiss

Glaucoma is one of the most commonly recognised eye diseases by the general public and will affect at least 2% of a general optometric database.  Approximately 10% of your database will be glaucoma suspects.

About 8 months ago we trialed and bought the Zeiss StratusOCT, to manage our glaucoma suspects, and our macula pathology patients.  Last month we trialed the Zeiss GDxVCC Nerve Fibre Layer Analyser and compared it head to head with our Zeiss Stratus OCT (see our previous review).

The GDxVCC measures the phase shift (retardation) of polarized light passing through the eye. Retardation is affected by the arrangement and density of microtubules or other directional elements and tissue thickness.  An excellent explanation of this amazing technology can be found at the Zeiss Website.

A lot of the latest discussions on glaucoma have centred around "structure vs function".  The GDxVCC and the StratusOCT are objective measures of "structure", whereas threshold visual fields is a subjective measure of "function".  There is no doubt in my mind that to manage glaucoma properly we require both modalities. 

"Structure vs Function" was discussed in detail this month around Australia by Murray Fingeret (Glaucoma specialist).  Call Zeiss on (02)9020 1333 or email for further details on: med@zeiss.com.au.  Download his recent publication if you missed his great seminar from here.

We have found that the objective measurement of "structure" has allowed us to differentiate the suspicious looking nerves.  This in turn has made us more efficient in categorising who we need to see at the appropriate time and thus refer for treatment in a more timely manner.  Glaucoma is not a black or white diagnosis, there are significant grey areas.  Introducing optic nerve head imaging has raised our level of care.

This comparison is not a discussion about the clinical validity of these instruments.  There are umpteen references in the literature supporting their relevance.  This discussion will revolve around the decision making process in purchasing this instrument.  Is it right for your practice or not?

Normal RNFL                  Early RNFL changes        Moderate RNFL changes

Advanced RNFL changes

Technological advance in our industry is growing exponentially.  Every year we look at new instruments and follow a simple decision making process:

  1. Can we provide better patient care?
  2. Can we fund the leasing cost by charging the patient?
  3. Can we fund the staff time and optometrist interpretation time by charging the patient?
  4. Can the instrument be used outside of the consultation room?
  5. Do we have space for it?
  6. Can our staff be easily trained to use the instrument?

If the answer to all questions is YES, then guess what?  We will normally purchase the technology.

When comparing the GDVCC to the StratusOCT I found the following:

  • GDxVCC was half the price.
  • GDxVCC was more compact and could be fitted onto our preliminary testing rotor table.  This was more efficient in testing the patient, as IOP, field screening, automatic refraction and optic nerve head analysis could all be performed without moving them.
  • The staff preferred to use the StratusOCT.  I suspect this was only because they had significantly more experience with it.
  • Dilatation of pupils is required occasionally with both instruments.
  • Patients were equally impressed with both instruments.

So what is the bottom line?  If both instruments were available in Australia late last year, when we were deciding on purchase, I still would have chosen the StratusOCT.  This is even though the cost was double.  Our practice sees many patients with reduced visual acuity.  It is imperative that we rule out retinal and macula pathology, as well as diagnose and monitor glaucoma.  The multi functionality of the StratusOCT serves us brilliantly.  The price was not an issue as we are a two optometrist practice so our patient volume is more than capable of supporting the lease.

For those that space and or patient volume is an issue, I would recommend the GDxVCC in a flash.  Purchasing this type of technology will not only impress your patients and be profitable for you, but will help you keep excited about our great profession.  Your patients will notice your enthusiasm and look forward to visiting you and your new gadgets.

Download your registration form for:

Glaucoma 2005

This workshop will demonstrate many of the new technologies including the GDxVVC, StratusOCT, Matrix, Stereoscopic Digital Imaging and Pachymetry with a focus on introducing them and of course profiting from their implementation.  This technology is important for our future and just as importantly the well-being of our patients.

 

 

Advertising

CIBA Vision's unique O 2 OPTIX material, lotrafilcon B, contains 33 per cent water, with a permanent surface treatment to assure wettability for comfort and a surface that is resistant to deposits.

Visit the website or

Read our recent review

 

 

Great News!

Next month we will discuss in detail the new ruling by Medicare.  It is no longer a grey area to charge separately and privately for imaging.  Finally you can be confident in purchasing new technology and know that you can afford to provide excellent care to your patients.  They deserve it!

 

"Structure vs Function" was discussed in detail this month around Australia by Murray Fingeret (Glaucoma specialist).

Download his publication, which discusses this important concept in detail.

 

 

Advertising

Our optical dispensing is important to us.  We introduced the Etnia Barcelona range from General Optical recently and its success was instant. Next month we will discuss why. In the mean time go to: www.etniabarcelona.com for more information.

Get one of the reps to show you the range.  Request more information from: enquiries@genop.com.au


 

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