(96582-PM, 0.5 hr CE)

Dr. Chris Lopez discusses the complexities of billing and coding for glaucoma and retina conditions in optometry. He highlights that only 28% of optometrists bill for visual fields, 28% for OCT of the nerve, 27% for OCT of the retina, 33% for fundus photos, 6% for pachymetry, and less than 5% for gonioscopy. Ophthalmologists bill for these tests at higher rates.

Dr. Lopez emphasizes the importance of medical necessity and provides detailed reimbursement rates for various tests. He also notes the growing demand for medical eye care due to an aging population and the need for optometrists to expand their roles.

(96581-PH, 0.5 hr CE)

Hosted by Dr. Chris Lopez and Dr. Sam Valley, this episode discusses hydroxychloroquine, its uses, side effects, and role in eye care.

Introduced in 1955, hydroxychloroquine is used for malaria treatment, prophylaxis, and autoimmune diseases like lupus and rheumatoid arthritis. Key dosing guidelines are 400 mg weekly for malaria prophylaxis, 800 mg initially followed by 400 mg at intervals for malaria treatment, and 200-400 mg daily for autoimmune diseases.

Monitoring for toxicity involves visual field testing, OCT retina, and other assessments. Risk factors include dose, duration, age, renal function, and genetics. Effective communication with rheumatologists is crucial for patient care.

(96580-PM, 0.5 hr)

Dr. Miki Lynn Zilnicki, co-owner of Twin Forks Optometry, shares insights on cold starting a vision therapy practice. Key decisions include whether to focus solely on vision therapy or offer full-scope services, accepting insurance, and whether to include an optical.

Miki emphasizes the importance of aligning practice goals with personal values and cautioned against over-investing in advanced technology initially. She details the costs of starting a practice, which was around $250,000 for her, and highlights the benefits of virtual vision therapy during COVID-19. She also discusses the importance of precise documentation for workers' compensation and no-fault cases.

(COPE ID 96562-PH, 0.5 hr)

Dr. Sam Valley, who holds both an OD and PharmD degree, discusses the interplay between hypertension, cholesterol, and cardiology, emphasizing their implications for ocular health.

Key points include the ASCVD risk calculator, which evaluates factors like blood pressure and cholesterol levels. Hypertension treatments are detailed, highlighting thiazide diuretics (e.g., hydrochlorothiazide) and their side effects like dry eye. ACE inhibitors (e.g., Lisinopril) and ARBs (e.g., Losartan) are also discussed, noting their effects on blood pressure and potential side effects like dry cough. Calcium channel blockers and beta blockers are mentioned for their roles in hypertension and arrhythmia management. The conversation also covers statins for hyperlipidemia, their benefits and rare side effects like myopathies. Finally, the discussion touches on medications for congestive heart failure, including loop diuretics and potassium-sparing diuretics, and their potential ocular side effects.

(COPE ID 96221-PH, 0.5 hr)

Dr. Sam Valley, who holds both an OD and PharmD degree, discusses the role of eye care providers in diabetes management, emphasizing inter-professional communication and continuity of care. Key points include the common use of metformin for type 2 diabetes, its adverse effects like nausea, and strategies to improve patient adherence. Sulfonylureas, such as glipizide, glyburide, and glimepiride, were highlighted for their risk of hypoglycemia. GLP-1 agonists, like ozempic, were discussed for their effectiveness in controlling blood glucose and reducing cardiovascular risks, despite potential ocular side effects. The importance of monitoring patients on these medications was stressed, especially for those using them for weight loss.

(COPE ID 96218-PO, 0.5 hr)

Dr. Josh Davidson, dry eye guru and practice owner, discusses norms and expectations in preoperative prep for cataract surgery.

He highlights that 60-80% of cataract patients have ocular surface disease (OSD), which affects post-surgery satisfaction. He also goes over the following: 1) emphasize the importance of treating OSD before surgery to prevent vision and safety issues, 2) routine preoperative lab tests are unnecessary, citing studies that found no benefit 3) recommend tear osmolarity, MMP-9 tests, and staining for preoperative workups. 4) stress the need for optometrists to educate patients about surgical options and preoperative hygiene.

(COPE ID: 96220-NO, 0.5 hr)

Dr. Miki Zilnicki, BV/VT specialist and co-owner of Twin Forks Optometry, discusses handling complaints of double vision (diplopia). Key steps include determining onset, frequency, and direction of double vision, which can indicate serious conditions like space-occupying lesions. Best practice regarding testing and management are discussed in detail.

(COPE ID: 95851-TD, 0.5 hr)

In this episode, Dr. Chris Lopez discusses the advancements in posterior segment technology, focusing on four key areas: ERG (Electroretinography), extended color vision, virtual visual field testing, and lasers in optometry. ERG, now a handheld device, assesses retinal function objectively, with protocols like DRA for diabetic retinopathy.

Extended color vision tests, quick and subjective, aid in retinal and optic nerve function assessment. Virtual visual fields, performed via headsets, offer convenience and are comparable to traditional tests. Lasers, including YAG capsulotomy, LPI, and SLT, are increasingly used by optometrists, especially in rural areas, despite low ROI, emphasizing comprehensive patient care

(COPE ID: 95851-TD, 0.5 hr)

Dr. Chris Lopez discusses the integration of anterior segment technology in optometry to enhance patient care. Key technologies include low-level light therapy (LLLT), which has anti-inflammatory properties and improves dry eye symptoms, and intense pulse light (IPL), which reduces inflammatory mediators and improves meibomian gland function. Zest, a product by Zocular, uses okra polysaccharide technology to remove Demodex mites, providing immediate clinical improvement. Anterior segment cameras aid in disease management by improving patient compliance and buy-in for advanced treatments. These technologies offer significant ROI and are often used as cash-pay services. 

This episode qualifies for 0.5 hr COPE-accredited CE.

Dr. Josh Davidson, an entrepreneur, educator and optometrist at Williamson Eye Center, discusses norms and expectations in preoperative prep for cataract surgery. He highlighted that 60-80% of cataract patients have ocular surface disease (OSD), which affects post-surgery satisfaction. Davidson emphasized the importance of treating OSD before surgery to prevent vision and safety issues. He noted that routine preoperative lab tests are unnecessary, citing studies that found no benefit. Davidson recommended tear osmolarity, MMP-9 tests, and staining for preoperative workups. He also stressed the need for optometrists to educate patients about surgical options and preoperative hygiene.