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Optometrical Practice Management Monthly Newsletter - Tips & Reviews. Volume 7. December 2005

Business Tip: Some changes to make for the New Year

Xmas is upon us and with the New Year coming it is time to reflect on our activities of 2005. What worked well? What could we have done better? Will we do anything different in 2006?

Read on for more.


Visit Porsche Design


Rodenstock Australia

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.


Product Review: The Impression Product family by Rodenstock.

Rodenstock has now expanded it's customised lenses from the ILT Impression multifocal to single vision and extended range readers. You owe it to your patients and yourself to recommend these high tech products to everyone.

Read on and find out why.


Therapeutic Review: Blepharitis and it's treatment.
Introducing Dr Anthony Maloof (Anterior Segment & Oculoplastic surgeon). This is one of the most common eye conditions we will encounter in practice.

More Detail.

Business Tip: Let's implement some change
Before we implement change, it is important to have an outcome in mind. Otherwise the change that we might create will not have any relevance or importance to us. At an even higher level, all of us will have a "PURPOSE". This is something that "inspires us or pushes our buttons". This should be expressed not only through your business but also everything you do in your life and personal relationships. Make sure that any change you make to your business is consistent with your "PURPOSE", otherwise the change could in fact be detrimental to your direction.

Let's stop the airy, fairy stuff and now get into some meat. For those that have not read my E-Book "Seven Critical Mistakes that most Optometrists make..." this is often a good template for change. An important thing to remember is that it is a good idea not to take on too much at once. At any given time do not try and change or focus on more than three things.

Using my practice as an example let me share with you what we are currently trying to implement:

1. More bums on seats - over the course of the last 8 years we have gradually gone through our database and incentivised only patients that are interested in their eye health to continue using our services. This means that many unprofitable patients no longer use our service. In the first instance it is great, as it has opened up nearly 50% of my appointment book and we are actually more profitable now.

We have all heard of the 80/20 rule:

In most businesses, because we are not selective with who we provide service to, 80% of the profit is generated by 20% of the patients. The other sad fact is that the unprofitable patients often take up most of our time, so we are not in a position to service those that appreciate us.

Our practice (by consultation fee structure) has moved about 25% of our database to other service providers, yet our profitability has increased and our overall turnover has not gone down. The next project now is to fill up the appointment book with profitable patients.

We are now partnering with one of our suppliers Essilor, to help us achieve this. Essilor have helped us design a Corporate Vision program that we will roll out to the many Corporate Entities in Sydney CBD over the course of next year.

2. More frame sales - we have been flat with our frame sales in the last 12 months. This is because we have changed the focus of our practice to consultation and eye health care. It is quite common for a patient to happily pay over $200 for their consultation fee, which leaves less money in the kitty for frame purchase. This overall has been a good move as our consultation fees do not have any cost of goods, so we are now more profitable, but seeing our spectacle sales drop a little now needs some reaction.

Again we have partnered with one of suppliers Ciba, to help us increase our frame sales. You might ask, "How will a contact lens supplier help increase my frame sales?". Surely they are competing against each other. The answer to this is you can choose what this means to your patients. With the help of Ciba we are focusing on increasing our daily disposable lenses by offering a small complimentary supply of Ciba daily disposables with every purchase of a complete set of spectacles.

3. Increase our daily disposable contact lenses - historically our practice has been very strong in contact lenses, but this has mainly been due to our expertise in keratoconus, post graft, orthokeratology etc. Our disposable business has been relatvely strong but not outstanding. Recently the "Microbial Keratitis Study" by Fiona Stapleton, Lisa Keay and Fiona Edwards of the CCLRU, seems to suggest that daily disposable contact lenses are the safest of all contact lenses. In hindsight I don't think this is surprising but it is nice to be supporting our advice to our patients with evidence based medicine where possible.

Good eye health is always going to be one of the pillars that I use to promote contact lenses to my patients, so promoting daily disposable contact lens wear is good for the patient, good for the practice and good for the contact lens industry. Everyone wins.

By pairing up the sale of the spectacles with contact lenses, our practice is promoting these optical modalities as complimentary, not competing against each other.

Stay tuned over the course of the next 6 months and I will reveal any success, failure or fine tuning that comes our way. Remember every change you attempt to implement will not necessarily be successful. The key is to come up with a hypothesis that makes sense, implement the change, measure the outcomes and then make appropriate adjustments.


Now that I have revealed the three things we are currently focusing on, what are you going to focus on? One piece of advice is that you will need strong IT to implement change. We will get back to out IT series by Richard Rees from in early 2006. In the mean time:

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 anything from your current problems to even setting up fully paperless practices from scratch.






The 7 Critical Mistakes that


Optometrists Make in Their Practices

… And how to avoid them

By Jim Kokkinakis














Visit Lookup for all your IT needs

Lookup has a great understanding of the two main practice management systems; Vision and Optimate. They also have experience in configuring diagnostic instrumentation such as Retinal digital imaging systems to your practice management software and to your network.


Product Review: The Impression Lens Product Family by Rodenstock

Over the course of the last year, I have been upgrading as many patients as possible to high end lenses. Apart from the fact they are more profitable, my patients use my services because they know that I will provide them with the best possible vision, the most comfortable product and do my utmost to gurantee their eye health.

All the major laboratories having been doing their best to convey to our profession that the newer high tech lenses actually do benefit our patients significantly. Our usage of antireflection coats is now greater than 95%. Lenses that we sometimes do not coat are some photochromatics and some polarized sunglass prescriptions. Virtually all our clear lenses are 1.6 index or greater with antireflection coats.

The Impression Lens Family by Rodenstock will change the perception of spectacle lenses from something that just magnify and are a commodity, to something that is customisable for the individual that values superior vision. All lenses come in 1.67 index with the superb Solitaire antireflection coating. The Impression Family is made of:

  • Impression Progressive and Impression Progressive XS

These designs cater for both a long and short corridor requirement.

See the previous review we did on this unique multifocal.

  • Impression Hyperop and Impression Hyperop XS

Often we get the hign plus patient that requires a multifocal. This customisable series caters for the +6D - +13D hyperope with up to 6D of cylinder. As we know the high plus lenses tend to restrict vision the most in a multifocal. The Impression maximises all zones for these difficult scripts.

  • Impression Mono

Aberrations are common with single vision wearers especially when larger prescription changes are required. There is no question that my patients perceive far less distortion when I prescribe this design.

  • Impression Sport

This design has been especially designed for the presbyopic sports person. A number of golfers come to mind that have praised the new spectacles on the golf course. Panaromic undistorted distance vision with a reasonable reading area. This design is also ideal for most sunglass prescriptions.

  • Impression 40 and Impression 80

These lens designs are ideal for the desk worker. The 40 is ideal for the person that has a small VDU workload, whilst the 80 is ideal for the person who is a heavy VDU user.

These lenses need to be fitted by experts. Our optical dispensers have been trained in fitting these lenses and the comments we get from our patients have proven to me that customised lenses are the way forward. Rodenstock supply a great CD that goes through the fitting procedure of these lenses.

Ask yourself this question: If you are prescribing spectacle lenses for yourself, what would you now prescribe?

I am 44 years old and am just starting to need a reading add of about +0.75. I purposely have prescribed myself both a traditional multifocal and and Impressions multifocal both with a +2.00D add to try and maximise the distortion of what a first time multifocal wearer might feel.

Let me tell you there is no comparison. I have no trouble walking around and driving in the Impression design, whereas with the traditional multifocal design, I had no hope of managing, even though I tried it for a week straight.

Contact Sharon Smith at Rodenstock and she will send you a CD to view. Even though the fitting process is pedantic, it also goes a long way to prove to the purchaser that this is indeed a unique product and that you are pedantic about their most precious sense - their vision.

Just like it is important to make a great impression in the consulting room, it is also improtant to make a great impression in the dispensing area.

For more technical details on this series of lenses follow the links opposite.

Comparison of traditional lens distortions to the Impression are graphically displayed.







Link to Technical data for the Impression Range


Impression Progressive and

Impression Progressive XS

Impression Progressive Hyperop and

Impression Progressive Hyperop XS

Impression Mono


Impression Sport


Impression 40 and Impression 80





Contact Rodenstock for your Impressions fitting CD


Therapeutic Review: Blepharitis (an overview by Dr Anthony Maloof)

Eyelid anatomy and function

The eyelid margin is a delicate and critically important element in protection of the eye. Protection is conferred by production of mucus and oils, as well as mechanical opening and closing around the surface of the eye. Defective secretions, involving either oils, mucus or tear film, can result from either a lack of production, or altered production. In the western world, blepharitis commonly occurs from altered oil production.


Microscopically, the eyelid has multiple layers, each of which may be affected primarily or secondarily, resulting in a clinical picture of blepharitis. Skin or systemic conditions may present with blepharitis as part of their clinical picture. These conditions include Rosacea, Dermatitis, psoriasis, lupus, discoid lupus and endocrine insufficiency.

The presenting clinical picture of blepharitis

Blepharitis is a general term used to describe inflammation of the eyelid margin. It includes the selective disorders of the Meibomian gland termed Meibomian gland disease (MGD). MGD includes both seborrhoeic dysfunction of the Meibomian gland, where a relatively thicker oil layer is produced, and inflammation of the Meibomian glands. The confusing thing about blepharitis is that it may present in many different ways; this arises as the disorder is both multifactorial, and multitissue related. Also of importance is that blepharitis may NOT be the culprit in the patients presenting symptoms, adding to the confusion. Therefore, I like to keep these facts central in my mind with the following concept:

  • “blepharitis (and dry eye) is the most overdiagnosed, underdiagnosed, and misdiagnosed condition of the external eye”


This statement is important to keep the disorder in perspective in whilst you are assessing the patients symptoms and signs.


Presenting symptoms in blepharitis

  • Ocular discomfort
  • Contact lens intolerance
  • Red / dry / itchy eyes
  • Patients may complain of lumps on the eyelids
  • Eyelid lumps / recurrent eyelid lumps (acute or chronic)
  • Epiphora / tearing
  • Crusty debris on eyelids
  • Dirty spectacle lenses
  • Recurrent styes


On examination the typical hallmarks of blepharitis are:

  • Seborrhoea of the lash cilia
  • Meibomian gland disease
  • Quiet; dome plugs in Meibomian glands
  • Meibomitis (active inflammation of the Meibomian glands)
  • Stye
  • Chalazion
  • Telangiectasis of the eyelid margins

Managing Blepharitis

Mainstays for treatment include

  • Oral antiinflammatories
    • Non steroidals
    • Steroids
    • Specific antiinflammatory agents eg cyclosporin
  • Oral antibiotics: tetracycline systemically if chronic
  • Topical steroids: short term only
  • Topical antibiotics: rozex gel
  • Topical lubricants: preferably preservative free
  • Topical hormone application: research, not commercially available
  • Lid hygiene – including lid cleansing (bicarbonate scrubs, Lid Care®, makeup remover) and Heat and massage regimes. This is very very important
  • Oral supplements: omega 3 oils, flax seed oils
  • Avoidance behaviour: minimize sun exposure, minimize mechanical rubbing


Specifically for Rosacea, control the skin inflammation is important and dermatological intervention may be required.

Other issues. Whilst loss of lashes may occur in blepharitis, they may be a hallmark of other diseases such as a morpheaform BCC of the eyelid. Treat all lash loss with suspicion and refer. There may be other underlying possibilities such as Trichomania (pulling of lashes) or atopy (chronic allergic skin inflammation), rather than blepharitis.

If blepharitis is unilateral, suspect a viral cause such as Molluscum Contagiousum, or even lice on the lash margins! IN recurrent cases, it may even be a cancerous lesion of the eyelid presenting as blepharitis.. a so-called pseudo blepharitis or Masquerade syndrome.

For those interested follow the link below to a few case reports with some multiple choice questions to enhnace the learning experience.

Next month Dr Anthony Maloof will expand further on blepharitis, it's complications and be more specific on treatment options.

Blepharitis deserves to be in 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 implementation of ocular therapeutics is another great way to differentiate your practice and thus make you more profitable.





Visit Porsche Design


Rodenstock Australia

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.



Hordeolum caused by blepharitis


Meibomiam gland dysfunction


Staphylococcal blepharitis, note the loss of lashes.


Note the telangietic vessels in the lid.

Not only is it common in blepharitis,

but is also a subtle sign of rosacea.

Also note the seborrhoea on the lashes.



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