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Optometrical Practice Management Monthly Newsletter - Tips & Reviews. Volume 5. October 2005

Business Tip: Computerisation (the elusive paperless office)
This month we have a special guest Richard Rees, who will focus on advanced computerisation of your practice. This single investment will set up your platform for growth and efficiency.

Read on for more.


 
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Therapeutic Review: Herpetic Keratitis
Even though this is not a particularly common issue in everyday optometry practice, it always needs to be ruled out, when keratitis is present. It is a great masquerader.

More Detail.



Product Review: NightMove Orthokeratology System
Gelflex manufacturers and distributes these fantastic OrthoK lenses. This procedure is now a must to treat early onset myopia.
Read on and find out why.

 


Business Tip: Harnessing the Efficiencies of Computerisation (and the elusive paperless office) by Richard Rees IT Specialist.
In a time when virtually everything it takes to run our business keeps getting more expensive, it’s nice to be reminded that some prices are not going up, and in many instances are coming down.

Anyone that’s had much to do with Information Technology (I.T.), will tell you that what your dollar buys today, is miles ahead of what it bought even 3 years ago. That’s why it amazes me how many practices are still resisting the need to seriously invest in their I.T. infrastructure.

Think of this: for what it would have cost to buy basic hardware a few years ago, could now buy the same hi-tech functionality that was once only available to the massive corporations at the top end of town.

For example, we all know that you should be able to access any data from anywhere in your practice. Take an image of a patient (or better still, have one of your staff take it) and view that image in your consulting room. Obviously many of you do this, most still don’t.

Well how about viewing this image from home or from your hotel overseas? Easy!

You can quite simply review patients from anywhere, add notes to their file, make recommendations and re-appoint them… check appointments, and be available no matter where you are. Telecommuting is now more possible and affordable than ever!

Many of you are now using the new SMS feature in your practice management software to notify clients of their spectacles and contact lenses being ready, and emailing stock orders and prescriptions to save time and money. This is just the beginning!

We’ve all seen the explosion of the consumer digital camera market! What it used to cost me to capture digital images is now just a horrible memory! Thankfully now, our diagnostic camera’s can mostly interface via a simple Universal Serial Bus (USB) port, standard on all new computers.

This double-edged sword has brought both blessing and challenges… we can now get fabulous hi-res images from relatively low cost devices. The challenge of course, is how do we store them all, and how do we back them all up!

This is where we need to rely upon professional outside support! And while they’re making room for all these images, let’s finally get of all our old patient cards, referral letters and paper file notes on-line!

Hi-speed double-sided (duplex) scanning units are available for around $1,000 placing them well within reach of any small practice. Only 5 years ago, going ‘paperless’ was a fanciful dream unless you had upwards of $50,000 to spend.

So how much do we need to allocate for a ‘bleeding-edge’ automation of the average practice? Well, depending on the size of your business and your floor space the level of computerisation from Optometry practice to Optometry practice will vary.

The average practice with an optometrist, an optical dispenser and a reception person could be set up to have a workstation in each of your ‘work’ area’s (i.e. one in the consultation room, one at dispensing and one in the lab). You’ll need at least one workstation at reception, and ideally two depending on the traffic in this area. To run all of this you’ll need a dedicated server of some sort, with mass storage and backup capabilities.

For a practice such as this, don't expect any change from $20,000 but keep in mind a rolling 3-5 year life expectancy for this investment, and constant provision for improvements to prevent massive unexpected drains on cash flow. It can be done cheaper, but usually you’ll get what you pay for in terms of brand-name hardware and components.

Register for Business 2005. Our computer wizz Richie Rees will speak about what to do and what NOT to do when it comes to this very important topic. We will also concentrate on staff and take home business tips that are bound to increase your efficiency and your bottom line.

Contact Richard Rees for expert advice. Even if you are not in Sydney, Richard has a network of IT specialists around the country that can solve your current problems to even setting up fully paperless practices from scratch.

 

 

 

 

 

Sometimes I think we will need the following setup

 

 

 

 

Ideally today, the average Optometry practice should be looking at installing the folowing IT configuration.

It will pay for itself many times over with increased efficiency and productivity.

 

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Therapeutic Review: Herpetic Keratitis

Now that ocular therapeutics is a reality in Australia, it is very important to be familiar with this disease process.

Typically it presents as a unilateral red eye with variable irritation. Often the irritation is inconsistent with the presentation ie the eye is not as irritated as the appearance would suggest. This is due to the hypoaesthesia that occurs when the dormant herpes virus reactivates and replicates down the nerve pathways in the cornea. This in turn desensitises the cornea.

Herpetic keratitis normally presents as epithelial keratitis but the danger of recurrences means that the stroma can be affected and eventually permanent visual axis scarring can occur.  It is thus important to make the diagnosis quickly and implement appropriate ocular therapeutics so that minimal corneal damage occurs in case of reactivation of the disease process.

A dendritic ulcer is the classic sign of herpetic epithelial keratitis. They often can start as superficial punctate keratitis before punctate lesions coalesce and form the dendritric appearance with bulbs on the end of the dendrites. The herpetic dendritic ulcer typically stains with fluorescene, whist the "terminal end bulbs" stain with rose bengal or lissamine green.  Unfortunately it is not always easy to make the diagnosis. Oopposite there are a number of different presentations of herpetic keratitis.  The reality though is that most cases are easily treatable by the therapeutically qualified optometrist.

Treatment of epithelial keratitis is quite simple. Acyclovir ointment (Zovirax) applied in the lower culdesac 5 times a day until the epithelium has healed is all that is required. Toxicity or side effects from this medication are minimal.

When the epithelium is not intact it is very important not to introduce topical steroids, as it can often make the condition much worse.  Once the epithelium is finally intact if there is residual stromal inflammation it is then appropriate to treat with topical steroids but always with the antiviral cover of an oral antiviral like Famvir. Stromal involvement is more serious and at this stage of the evolution of ocular therapeutics in Australia it is best to involve a corneal specialist.

 

Herpetic keratitis deserves a whole days seminar. Register your interest for Ocular Therapeutics 2006 , which will devote a session to the diagnosis and management of this ocular disease. Efficient implentation of ocular therapeutics is another great way to differentiate your practice and thus make you more profitable.


 

Other presentations of herpetic keratitis

 

 

Stromal disciform keratitis

 

 

 

Herpetic epithelial defect

over stromal involvement

 

 

 

Geographic herpetic

epithelial keratitis

 

 

 

The worst possible form of herpetic eye disease - necrotising stromal keratitis


Product Review: NightMove Orthokeratology System by Gelflex Laboratories

"Orthokeratology is the most profitable procedure in Optometry today!":

Gary Gerber (Optometrist)GOS 2000. This quote definitely still applies today and will in the foreseeable future.

Apart from being profitable orthokeratology is fun and a specialty service that possibly slows downs or even stops the progression of myopia. A couple of months ago I was in Chicago for the Global Orthokeratology Symposium. For years we have suspected that myopia does not progress when orthokeratology is performed. Obviously this is anecdotal but theories are eventually proven or disproven by a hypothesis. At this years symposium Earl Smith (3rd) and Pauline Cho presented some amazing data to move us another step closer to proving this hypothesis.

These studies were so profound in my eyes that maybe I can see the day when if a child presents to your office and is a -1.00D myope and you do not recommend orthokeratology you might be liable with professional negligence. Explaining the studies in detail in this newsletter are well beyond its scope and space, but I guarantee you, it deserves your attention. Especially in an era where we are seeing an epidemic of myopia due to the environmental influence of computer screens and indoor activity.

Orthokeratology has been part of my practice since 1995, when John Mountford introduced the concept to 30 practitioners from around Australia (myself included). We have come forward in leaps and bounds since then.

Currently there are a number of great orthokeratology lenses such as John Mountford's BE lenses, the CRT system by Paragon, The Emerald lenses and the Contex lenses just to mention a few.

I am using the NightMove series designed by the famous orthokeratologist Roger Tabb OD. and manufactured by Gelflex laboratories in Perth. I have chosen this design because it is available in a 100 lens diagnostic and inventory set.  The first trial lens is straight off the flattest K and the refractive power we need to achieve. You then teach the patient insertion and removal and schedule an appointment the next morning. Usually at least 70% of the refractive error has been achieved on the first morning. Within a week we have a stable plano refraction all day.

Recently we conducted an all day workshop to introduce orthoK into the average optometrist's practice. We will be conducting another in the new year. Register your interest here for next years OrthoK Workshop 2006. Type OrthoK 2006 in the subject.

For those that cannot make the workshop on a Sunday I also have a downloadable version, which includes complimentary questions via email and mentoring through your first orthokeratology case. If you are interested in this remote learning option register your interest here. Type OrthoK Downloadable in the subject.

 

 

You will notice the base curve is flatter than the cornea but in fact does not touch the cornea. There is always at least a 5 micron gap between the apex of the cornea and the back surface of the Orthokeratology lens if the reverse curve is designed properly to join the base curve to the alignment curve.

 

 

 

 

 

Corneal topography before treatment

 

 

 

 

 

Corneal topography three days later successfully correcting -3D of myopia.

From some of the current research it seems that the post orthoK shape causes the myopic progression stimulus to turn off.


 

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