Archive : Editorial

Ahhhh, the fresh smell of spring is now upon us.  Spring is one of my favorite times of the year.  I extend a very happy spring season for my readers. SOFT CONTACT LENSES:  GP Specialists launched a new lens which is called YamaKone™ IC at the Global Specialty Meeting in Las Vegas during the last week of January.  The YamaKone™ lens is a family of specialty lenses with the keratoconic patients in mind.  My long time readers will know that fitting specialty contact lenses is one of my passions in life.  I find them stimulating and challenging.  Yes, they do take some chair time but the end results often bring about very happy patients who become very loyal and great for referrals. Every GP lab around the country has focused their attention to the development of their own brand of scleral lenses.  Some say that the growth of GP lenses can be directly linked to the rebirth of scleral lenses. By now, I’m sure that I’ve whetted the appetite of most of my readers about soft cone lenses.  What? Why? For what reason?   I have a very large Keratoconus practice which grew over a period of 49 years.  I have run into patients that eventually became so advanced that they no longer...

2013 is starting out of the gate on a solid note for our practice and we hope that all of our members are doing likewise. KERATOCONUS:  In my last editorial, I promised to report more on our clinical studies with soft contact lenses.   My passion for contact lenses began in 1959 and continues to this day.  Working with PMMA lenses taught me a great deal on edge designs.  I quickly learned that the comfort of the lenses depended on how nicely I made the edge’s. Keratoconus found me soon after I was discharged from the military service in 1964.  An OMD whom I had befriended while at Ft. Ord began to send me young cone patients to evaluate.  They were in their early teens and some as young as 9 years of age.  Thus my entrance into pediatric contact lenses began with fitting young cone patients.  I found that the young patients adapted quickly to the PMMA lenses and before I had gotten my feet wet, my calendar became filled with similar cases from around the country.  Word of mouth began to spread amongst practitioners that I was very good at fitting their cone patients. Those were the days when we were dependent on keratometry to weed out these cone patients.  The mires were...

Many of my readers have known my personal quest to uncover the hidden secrets of scleral lenses.  I can break it further down to 3 different classifications.  First, there is the corneal-scleral lens.  These lenses are anywhere from 13.0 to 15mm.  I began fitting these lenses about 3 years ago.  I soon ran into problems with these lenses clinging to the sclera creating a suction like effect. Fitting sclerals is very similar to fitting gas perm lenses.  Sclerals are like gas perm on steroids.  These lenses presented a steep learning curve for me.  Patients are able to adapt much quicker to these larger diameter gas perm lenses than they are to corneal lenses.  These lenses come to a rest over the sclera which makes them much less aware for the patient. I progressed from fitting the corneal-scleral diameter to the full scleral lenses that equal 18.0mm in size.  Although these lenses were quite comfortable to wear, we found that our patients had difficulty in learning how to insert these larger diameter sclerals. We then migrated to what we call:  mini-sclerals which equal 16.4mm.   Finally, we found the size that our patients could learn to handle. We found these to be very...

At the beginning of 2012, I told my staff and friends that this was going to be a special year for us.  Last year, I had let it slip that my 50th year since I graduated had slip by unnoticed thus I promised myself that I would do something special during 2012 as some sort of private celebration. I had thought that it was time to do a “makeover” of my practice. I began by retiling the front entrance to our waiting room.  That is when an article by Dr. Gerber appeared:  “You cannot afford Not to do it.”  His first two points rang loudly in my ear.  Point #1: He stated that we should move our location.  Since we own our own building that made point #1 moot.  Point #2 stated that we should remodel.   Now that made a lot of sense.   My retired dentist noticed the change of the new tiling in our office and he remarked, “While attending CE lectures, they are told to do something to their practice every 5 years. “  He remarked on how nice the new tiles had made our practice look.   That was very inspiring and I wanted to do a bit more. I began to discuss my thoughts about remodeling.  One suggestion that I considered was wood flooring in the exam rooms.  My first...

I’m a bit late on writing about my reflections of the previous year. 2011 was a very special year for me. For one thing, the year went too quickly. Working on 3 exciting seminars at the same time does take a lot of my personal time but whenever I see the finished product it makes me feel somewhat accomplished. We will be having 3 more fabulous seminars in Southern California hosted at the Doubletree hotel in Orange. In fact we will be having one this month on the 20th. Hopefully many of my readers can make this one. Our staff has listened to our attending colleagues and we are doing our best to provide at least 6 hours a year on glaucoma. I believe that 2012 will have closer to 12 hrs on glaucoma. Unlike most other states, California received permission to begin allowing optometrists to become glaucoma certified via the new rules. Attendance at both Berkeley and SCCO has been at an all time high in attendance. I was fortunate to have completed all my requirements at SCCO with my final class completed in September. Many of my close colleagues have decided to forgo the certification process.  I can’t say that I really blame them for their decision. For those, like me who have gone...

One of the first things that I do is to look for my long time friend’s editorial in the Optometric Physician.  Art is a world traveler and lecturer and I tend to glean words of wisdom from the words that flow from his pen. In one of his editorials during October of last year, Art titled his editorial:  “Do it until it hurts…” Among the many things that have interested me during my career, meibomian gland dysfunction has fascinated me more than most.  I first learned about MGD from Eric Donnenfeld, then a young ophthalmologist fresh out of a cornea fellowship at Wills Eye. Knee deep in problem contact lens patients back then, this early understanding of MGD was a revelation.  I later learned that it was Donald Korb, a well-known optometrist in Boston and who has since become a mentor and a friend, who discovered MGD and first reported it in the literature. I became almost evangelical about meibomian gland disease. Some of my earliest dry eye lectures, old enough to pre-date PowerPoint, explored MGD.  Warm Compresses and lid massage were routinely prescribed in my office and if patients didn’t improve they were admonished to apply compresses longer, make them warmer or...

The entire staff at C&E extends the best of the Holidays to you, your family and to your staff. I have been saving this article which I would love to share with my readers as the first editorial of 2012.  The story was written by John M. Glionna from Tokyo.  As I read the story from the beginning to the end, the words touched my heart and I hope that you will enjoy and benefit from this story. “They Felt It In Their Core”:  They were two old friends catching up over coffee. Retiree’s swapping stories and gasping at the unfolding nuclear nightmare at the Fukushima Daiichi power plant.  But instead of merely throwing their hands up over the disaster that shook the plant in the wake of the March 11 earthquake and tsunami, Nobuhiro Shiotani and Yasuteru Yamada, both 72 year old scientists, decided they could do something to help.  They devised a plan that some have called heroic, others misguided and suicidal.  They would enlist a small army of researchers and other skilled workers to come out of retirement to venture inside the radioactive plant and use their expertise to help stabilize its stricken reactors. In early April, Yamada got on the phone to former colleagues...

Just a few days ago, my wife and I was listening to the radio on the way to work when we heard a very interesting story.  Some professor began to collect data on 1,500 of the smartest kids who graduated from a college in California in 1921.  He followed their careers until he passed away in 1956 then some one else took over.  Then in 1999, that person died and then the person being interviewed on the radio took over for the last 11 years.  The interviewer asked one question that caught my attention:  “Did you discover the secret to long life?”  The gentleman said, “Yes”.   We turned up the volume at this point and continued to listen.  He said, “Those who worked very hard non-stop lived the longest.”  Those who retired early died shortly after retirement.  Men died shortly after losing their spouse while women went on living without their spouse for many years.  Mental dementia occurred in people who stopped working.  My wife looked at me and said, “No worries. You are never going to retire.”  End of story. Just the other day, I received a fax from one of our healthcare vendors with this note on the “Importance of Diabetes Tests”.  The message stated...

Every now and then I will receive tips on something that I need to check out.  My good friend, Brian Banks referred me to a new vendor.  I placed a call to Bruder Healthcare Company located in Alpharetta, Georgia.  They explained to me that their company sold Eye Hydrating Compress for many causes of Dry Eye. The first thought that crossed my mind was, “Why do I need another savior to our dry eye patients.  We have enough drops, systems, etc, etc?”  The president suggested that he send me a few samples of their product for us to test. A few days later, my daughter was telling me about one of her daughters who was having a series of styes.  She was having some difficulty in heating up a small hand towel and applying it to her daughter’s lids.  The darn cloth would cool down so quickly that it became a labor of love.  I listened to her explanation and I told her that perhaps the answer was in the Eye Hydrating Compress that was coming in the mail. Sure enough, we received several compresses to test. My daughter was the first recipient to receive one.  That was back in May of this year.  I then gave one to my son whose son was having some eye issues with styes.  Next my...

Since I became an eyecare practitioner some 40+ years ago my goal was to somehow be in a position to aide patients stricken with Diabetes and Macular Degeneration.  I began to attend as many conferences as I could on the topic until I began to slowly digest the cause and effect.  In those days, no cure was on the horizon.  Only doom and gloom. I recall attending a seminar given in a hospital in Santa Monica.  I had driven 60 miles to attend a lecture on diabetes given by a world renowned physician.  At the conclusion of the 6 hours, the main theme of his lecture was diet, diet, diet, diet, and more dieting.  At first, I thought it was some kind of joke but over the years of being in practice I have come to the realization that the physician was spot on in his conclusion.  He told the small gathering of eyecare practitioners that he had failed in his lifelong pursuit of attempting to get his diabetic patients to overcome their disease.  I listened intently as he concluded that many of his patients had ended up with kidney failure, loss of limb, & blindness. I drove back to my humble home and became somewhat depressed.  I purchased many books on the subject matter and began...

VSP began rolling out its in-house edging program last year and the program is now in full swing.  More and more of my colleagues are beginning to give purchasing an in-house edger another look.  In house edging can provide your practice with a quicker turn around time.  Some colleagues have told me that the financial rewards being offered were not worth the consideration. Saving money? The reason I begin the paragraph with a question mark is, an eyecare practitioner who has never done any prior in-house finish work is looking at the expenditure of a costly patternless edging system plus the hiring of an optician to do the work.  In my case, I have the best of both worlds.  You see, my wife is the optician and I’ve trained her on the art of edging some 30 years ago.  As our edgers went from pattern to patternless she just grew with the change.  The change has been positive and time saving.  Today’s patternless edgers are not only accurate but they are simple to operate.  So simple that any novice who understands lensometry can soon be on their way to turning out really nice work. So why do so many enthusiastic practitioners fail?  The reason here is a two headed snake. ...

It was 4 years ago that while attending an OAA convention in Houston that I began to hear about scleral lenses.  Several lecturers began to incorporate scleral lenses into their notes.  Apparently with the advent of higher DK materials – a rebirth of scleral lenses became dug out of the grave.  In the early pioneering days, a few contact lens fitter began to fit scleral lenses molded out of glass.  I take my hat off to those pioneers for the introduction of sclerals. Why, I ask?  Why on earth would anyone wish to wear sclerals when we have soft lenses, hybrids and gas perm contact lenses?  It is no secret that not everyone can wear contact lenses.  Many patients have terminated the wearing of contact lenses due to dryness. The lecturers began to come out of the woods proclaiming a new savior was born… sclerals , semi-sclerals , mini-sclerals & corneo-scleral.  I began to look into the matter.  Four years ago, I found no literature about the fitting parameters on sclerals.  I only heard through the grapevine that they were 18.2mm in diameter. One day while having my teeth cleaned, the new dental hygienists asked me, “Sir, what do you do for a living?”  Gagging...

HAPPY NEW YEAR to everyone!  The entire staff at C&E joins with me in wishing each of you, your staff and your family a fruitful and abundant year. WHAT’S NEW FOR 2011? For 6 months, my practice has been serving as a beta testing site for a new program which C&E Vision asked us to look into.  I don’t wish to bore my readers with a long explanation as we all have better things to do with our time.  This new and innovative company calls itself, Lifestyle Eyecare Centers.  So, what is so different about Lifestyle Eyecare Centers?  Like so many of my readers, we have limited or no capitol to invest into new practice management ideas.   Having said that I knew, in my heart that if our practice was to improve upon itself for now and for the future, we could not do it ourselves.  After all, we had tried everything from soup to nuts.  Two years ago, we got involved with Medical Coding/Billing only to discover that our reimbursements were being pared down by over 20% by our government. When I signed up for Lifestyle Eyecare Centers they told me that they could improve our sales and add to our bottom line.  How you ask? (The same question which I asked.) They sent us beautiful...

During this special time of the year, the entire staff at C&E would like to say: HAPPY THANKSGIVING! We have seen so many of our patients during this past year lose their jobs, cars & homes.  Of Course these events will eventually trickle down to affect everyone sooner or later.  It is our hope that your patient base remains strong for the remainder of this year and well into 2011. Reflecting back on the year, I have some thoughts that I would like to share with my readers.  Our practice located just east of Los Angeles had a very good year for the most part.  June was practically a dead month but from that point on – it was business as usual.  Having things humming everyday is one of my challenges which I have faced for the past 45 years.  It doesn’t seem to get any easier as the cost of staying in practice just keeps getting more costly.  Why?  We love gadgets and hi-tech equipment and thus our world revolves around machinery and equipment.  That is what keeps us going day in and day out, year after year after year.  The main target of our efforts is our patients.  Our patient base has remained loyal for decades and they are pleased to send us their colleagues...

OLDIE BUT GOODIE: Recently I had a most interesting patient that I couldn’t wait to share this experience with my readers.  A 53 year old Caucasian male patient came in for his eye exam for new glasses.  He was a first time patient in our practice.  After completing the exam, he turned to me and pulled out an old pair of frames which he had purchased on eBay.  He preceded to hand me this delicate pair of gold filled super thin wired metal frames.  I stared in silence while my fingers gently turned the frame from all angles.  The eyesize measured 36mm with a B box measurement of 26.  The temples were comfort cable design with no plastic covering.  The bridge was one piece with no nose pads.  It was the thinnest metal frame that I had ever seen.  He looked like Ghandi with the frames on his face.  I measured a seg height of 14mm. Here was his request, “Can you make me a pair of progressive lenses using my frame?”  His PD was 65.  The frame PD measured 54.  I responded, “I will be happy to give you the Rx to take elsewhere to have it filled.”  He responded that he had been to a local LC’s and he was turned down.  He loved the frames and would assume all responsibility...