Optometrist Perspective by Harvey Yamamoto, OD

Harvey Yamamoto, ODVSP 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.  The first part is increased overhead with the hiring of additional personal because the doctor is too lazy or busy to do his own edging.  The new employee can and will suck the profits out of doing one’s own in-house edging. When the trained employee leaves the practice then the doctor is sort of caught between a rock and a hard place.  The second part of the two headed snake is equipment maintenance.  I was told by a sales rep that every piece of equipment that we purchase will sooner or later break down.

Repairs: The repairs can become a back breaker over time.  Once a machine needs to be repaired and you are not willing to do the repair then somebody has to pay the repairman.  A typical repairman must be compensated for travel, hotel, meals, & parts required for the repair.  I’ve seen repairs on many such repairs averaging close to $3,000 to $5,000 and higher.

My personal thoughts: I have been edging since day 1 in my practice. That means that I have been doing finishing work in my practice for nearly half a century.  Mind boggling if one is inclined to count the years.  1973 was a big year for me as I added the first auto refractor available and also added both surfacing equipment and contact lens grinding equipment.  It was a sink or swim year for me.  I must have spent an extra 6 hours a day teaching myself the ins and outs of making glasses and contact lenses until I finally got it right.  In my spare time, (I really did not have any) I would take the machines apart to see what made them work.  This gave me a tremendous insight on repairs which saved me literally thousands upon thousands of dollars. To this day, I pride myself on being able to do 95% of the repairs in our practice.

New machinery: Most of our recent acquisitions have been good used machinery.  I make it a point to read the manuals and learn how to make adjustments by myself.  On our dry edging system, I change the carbide blade once a month. With each blade change come adjustments that have to be made in the software.  I want my edger to cut right on the money every single time and this does require maintenance.  So before one considers making the leap into the wonderful world of edging ask yourself if you are willing to do the maintenance.  If the answer is a resounding – “No!” My advice is to send out your work to your local lab.  That will prove much cheaper with fewer headaches in the long run.

My most difficult repair: I’ve been asked this question many times so here is my answer.  In 1986, I purchased a back side coating machine from Coburn Optical.  They are now called Coburn Technologies, Inc. When one manufactures polycarbonate hi-index lenses in one’s practice then back side coating becomes a necessity.  In 2007, our coating unit stopped functioning.  Since I had purchased the machinery new from Coburn Optical, I was able to call and speak to their Techs for support.  We began our first such call on March 1 and by April 15, 2007, the repairs were successfully completed.  The total cost for the materials alone came to $2,300.  The repairs could easily have come to over $7,000 if I had them do the repairs.  I even tried to coax the sales rep, whom I had purchased the unit from in 1986, to come to our office to help with the repairs. His answer was, “I wouldn’t try to do the repairs on that unit for all the tea in China.”  In other words, it was going to be a very difficult piece of machinery to work on.  Those words gave me the incentive to give it my best effort which fortunately turned out very successful.

In October 2010, the same coating machine stopped functioning again.  I called the Tech and we were able to isolate the problem to a simple pressure electrical component that resolved the problem for just $150.00.  Because of my willingness to tackle a job that no one wanted to undertake, I understand the machine as well as any of their techs.   I am kept very busy performing many repairs on all of our machinery.  Some are simple software adjustments where others can become very complex and time-consuming.  So before you decide to purchase any type of machinery I would ask, “Are you willing to do the repairs and maintenance?”  Is your answer is: “Yes, I am.” Then you are ready.”  Good Luck!

Is Glaucoma a Central Nervous System Disease: Re-evaluation

Glaucoma is a typical optic neuropathy mainly caused by elevated intraocular pressure (IOP). In recent years, with the advances in understanding of glaucoma and visual sciences, and the development of a neurological cross-discipline and neuroimaging technology, the question about the nature of glaucoma has been raised. Is glaucoma merely an ocular disease? Is it a disease that begins from the eye, and then involves the whole visual pathway? Or is it a particular central nervous disease, which manifests itself in the eye?

The answers to these questions are controversial. Growing evidences have showed that glaucoma is a disease with multi-level, multi-factor damage to the entire visual pathway, which involved from optic nerve to the lateral geniculate body, optic radiation and visual cortex. Its mechanisms are complex. The authors believe that glaucoma is a central nervous system neurodegenerative disease. Recent study showed that the primary damage of glaucoma occurred in central nervous system rather than in the eye.

The new generation of concept steps forward in the knowledge of the pathogenesis of glaucoma, and may illuminate the potential of neuroprotection in glaucoma management.” (SOURCE: Liu XY, Chen XM, Wang NL. Is Glaucoma A Central Nervous System Disease: Re-Evaluation; Chinese Journal of Ophthalmology (Chung-Hua Yen K’o Tsa Chih), Dec 2010)

CONCLUSION: I don’t know if there is any conclusion as of this writing when it comes to Glaucoma.  I believe like many of my colleagues that perhaps the Pandora’s Box is just beginning to open.  The authors in the above paragraph has come up with a new concept: “Does Glaucoma begin in the central nervous system rather than in the eye?” This question is deserving of our consideration?  If the authors are correct then this new viewpoint can certainly begin a new chapter in Glaucoma.  Once we get closer to understanding this subject matter then perhaps, a real cure/treatment can begin.

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