We don’t have to dilate you…..

Aside

…well, maybe.

A dilated fundus examination (DFE) remains the standard of care for the detection, management and treatment of retinal disease.  Although this can often times be inconvenient, uncomfortable and laborious it still remains as one of the most traditional methods for the examination of the back of the eye.  Things have changed but it took a number of years to get there.  I remember my first encounter with an instrument that claimed to be able to negate the need for a dilation, I was an intern in my final year of optometry school.  I don’t want to date or age myself but that was in 2001 and that instrumentation has improved (17 years later) but it still produces an image like the one below:

This image has always bothered me because it is not how the back of the eye appears.  There is no green whatsoever in the physical examination of the retina.  Even the diagrams/cartoons we study in textbooks and are easily searched on the internet to show no green and those lashes at the bottom could sometimes hide a valuable finding:

Screen Shot 2018-10-07 at 6.57.50 PM

So, the question has always lingered, what is that prior image representing?  Is it a true representation of the retina or simply a shortcut to see more patients by not having to wait to dilate the patients?  While charging patients for an image that may not be truly representative of how the eye appears for the sake of convienence?

I am not here to judge what others do.  I am here to justify why Gee Eye Care has finally now decided to employ the use of ultra wide-field (UWF) imaging and what I have decided to do.  First off, an undilated view of the retina with traditional methods (ie. direct ophthalmoscopy, slit lamp with an auxiliary lens like a superfield or digital wide field lens) usually only yields, at maximum, a field of view of 30-60 degrees.  A dilated view or a traditional image with dilation may yield a view at 100 degrees or more (depending on skill level).  An image very similar to the one below:

Screen Shot 2018-10-07 at 7.00.45 PM

The time has come where we can now produce an image to at least 200 degrees in true color!  I have been waiting on this day since 2001.  Some have questioned why I still dilated eyes at Gee Eye Care.  Truth be told, I was not comfortable with any other technology that would properly be able to replace a dilated view with my own eyes and I was not going to compromise your eye health for a shortcut.  Now I finally can show you why because we didn’t have the technology to show you before and you just had to take my word for it!  I now feel confident in the image I am able to obtain in order to reliably depict the actual retina. It took some time and yes, further investment but I am so excited to present to you the following images taken by me on an undilated patient:

Screen Shot 2018-10-07 at 7.10.27 PM

Starting on October 8th we will be presenting patients with the opportunity to defer dilation and choose this imaging.  However, some patients will be required to be dilated:

  • all new patients
  • children (in order to best determine refractive error changes)
  • certain patients with known or suspected disease that may affect the retina (to name a few):
    • diabetes
    • hypertension
    • acute peripheral retinal degeneration
  • certain patients at Dr. Gee’s discretion

This imaging is available to all, even if dilated, for documentation purposes.  When appropriate, it may be billed to your insurance but the cost will be $30 out of pocket for both eyes.  This option will be presented to you before the examination and you will be given the choice to choose prior to beginning your examination (note, Dr. Gee may need to still dilate your pupils if something is noticed upon obtaining the image).  These images will be reviewed by Dr. Gee and shared with you during the examination.  If you would like them digitally sent to you, please ask and they will be emailed immediately.

Welcome to the new age of eye care.  Dr. Gee and Gee Eye Care has always been proud of being on the forefront of eye care technology and this is no different!

Click here to set up your appointment for the “no puff,” “non-dilated,” “no 1’s or 2’s” eye and health examination!

#SiennaEyeDoc

https://www.mayoclinic.org/tests-procedures/eye-exam/expert-answers/eye-dilation/faq-20057882

https://www.reviewofoptometry.com/article/pointcounterpoint-ultrawidefield-imaging-vs-dilated-funduscopy

Notes:

  • Image #1: reference and link to OptoMap Daytona, taken directly from their website
  • Image #2: diagram taken from Cirrus OCT poster
  • Image #3: photo captured by Dr. Gee
  • Images #4 & #5: photo captured by Dr. Gee on an undilated patient

“Where’s Warby?”

I have encountered a few patients lately that have purchased from Warby Parker. For those of you that are not familiar with Warby Parker, the company began years back as a convenient, cheap pair of mail order glasses. It was really one of the first online marketplaces for eyewear. Soon we would start to see others follow, Zenni Optical, Coastal, Glasses.com to name a few. Specifically, Warby Parker has continued to impress me.
{here’s a place marker for me to pause and explain that most any optical owner out there is gasping by that last statement. Fact is fact and I plan to outline that here. I am speaking specifically only to Warby Parker right now, as an optical owner}

 

I remember my first experience of stepping into a brick and mortar Warby Parker storefront four years ago. I felt like a traitor, a fish out of water, I left with some type of distaste for the brand. “How dare they? First online, now real salespeople to help you out—oh, the demise of the independent optical!” That was then, reflecting back, most of that sentiment was a result of the newness of these other outlets sprouting up everywhere and the “sky is falling” cry of the traditional optical world.

 

Hey, Warby, I can’t beat you on price, I don’t know how you do it. Your lenses are quite good as well. The styles you have are current, likable, I can’t dislike you for any of this. However, I believe there still exists a faction of society that still respects small businesses and exceptional customer service, keeping it local—so to say. I’ll take that. We’ll continue to welcome everyone but cater to those loyal to the small business. It’s really only being fair to those that have decided to spend a little bit more for that level of service. So the saying goes, “you get what you pay for,” we will continue to always provide you a copy of your prescription and if you need a measurement of your interpupillary distance (IPD) we will do that as well.
Beyond that, “Where’s Warby” when someone needs an adjustment, a nosepad replaced, or even a sanitation in our OpticWash? While we’ve been providing theses services complimentary as a form of customer service, now, all our services, these above as well as our no questions asked assurances on breakage and scratches will be reserved for those clients that purchase from our optical gallery.
Menu of Services for Spectacles NOT from Gee Eye Care*:
Plastic/Zyl Adjustment $10
Metal Adjustment $20
Rimless/Drill Mount Adjustment $40
Screw Replacement $15
Reattach a temple (arm) $15
Nylon suspension lens placement $30
Nylon suspension repair $50
Rimless/Drill Mount repair $80
OpticWash Sanitation $10
*these options are all a la carte
-For example: if a plastic frame has a detached temple and there is no screw, the cost will be $30 (for the screw and the labor to attach the temple). If additional adjustment is required a $10 service fee be assessed as well.
-We reserve the right to refuse repair of any pair of glasses not initially dispensed by Gee Eye Care.
-A waiver (dissolving responsibility from our optical staff for any permanent damage) for ALL repairs on glasses not initially dispensed by Gee Eye Care will also be required before any service is initiated.
#SiennaEyeDoc

“Freedom Week”

IMG_1109Last week, my team and I entered into what we called “Freedom Week.”  Yes, it was a week before July 4th but I did not want to tarnish or make light of what the actual meaning of Independence Day was for our Nation.  We simply decided it was a good time to do what we did and here are the results of it.

If you go back to my prior blog post about insurance this may make a lot more sense. Basically, I decided to let my team know there is freedom without insurance and that our patients are more free when there is no insurance.  What did we do?  If you didn’t visit with us last week, here’s how it went:

  • we verified no insurance at all the entire week
  • I conducted myself as I usually would by providing the best care and judgements for my patients
  • at the end of the examination, patients were presented with the table of “allowables”
  • patients were informed of what the insurance would normally reimburse for the services that were provided
  • patients were given the opportunity to pay whatever they thought the services were worth–any or no amount, no pressure, no questions asked

So much effort (sometimes unnecessary effort) is given toward insurance.  The patient is told one thing by the insurance or their HR director, our office staff spends time verifying and getting authorizations that (again, may be accurate or terribly inaccurate) and we ultimately have to file these claims.  Mind you, I stated “effort” not money, it’s resources, efforts that could be reallocated toward taking better care of you as a patient.  Less confusion, less angst, less conflict and more concentration on your problem, devoted time to your care and personalized service.

We are not going to abandon insurance.  But think about the world without it.  Would it be possible?

 

#SiennaEyeDoc

in·sur·ance (why?)

You have to admit, whenever you visit a healthcare facility the word “insurance” is always in the back of your mind.  I mean really, it’s on the mind of the staff, the patient and usually the doctor.  It is the definition of “the elephant in the room” until someone breaks the silence.  But why?  Why do we continue to be dictated by such?  Why does a doctor’s decision to do the right thing for a patient have to be determined by whether “insurance covers it?”  Why does a patient have to decide whether to proceed with what has been determined by the doctor to be the best treatment (either procedural or medicinal) because of “insurance coverage?”  Is it fair for a patient to be cynical and have to think, “my doctor is choosing this route of treatment because a.) he/she will profit more because the insurance reimbursement is more than the other route? or b.) “does my insurance even cover that?”  There was a simplier time you know.

It begs the question, why is health insurance like this?  Automobile insurance does not cover maintenance, oil changes, tires purchases, etc.  They cover accidents, they help fix stuff, yes they have deductibles as well.  Home insurance is the same, it does not cover maintenance like landscaping, heaven-forbid water, electricity and gas bills.  It covers catatrophe, theft, but what else?  Oh, yes, they have deductibles also.  Why is health insurance perceived to cover everything needed for maintenance?

 
This thought took me to the good ‘ol Webster’s Dictionary of “insurance” which states:

Definition of insurance

1  a the business of insuring persons or property
    b coverage by contract whereby one party undertakes to indemnify or guarantee
         another against loss by a specified contingency or peril
    c the sum for which something is insured

2a means of guaranteeing protection or safety 

  • The contract is your insurance against price changes.
  • Frequent hand washing is good insurance against the common cold.

Well, call us crazy but we are going to be doing a few things differently this week….I’ll be back next week with a summary of how things went.

#SiennaEyeDoc

“Insurance.” Merriam-Webster.com, Merriam-Webster, http://www.merriam-webster.com/dictionary/insurance. Accessed 25 June 2018.

The office is Closed! Why???

In life there are experiences that can’t be replaced, replicated or overlooked. That being said, the office has been closed a few days the past two weeks as a result of the World Series. I wanted to write an open letter explaining why and apologize for any inconvenience I may have caused.

Imagine a young boy growing up playing baseball, fond memories with his dad playing catch & trying to improve his game. Some memories that many would tell about him throwing a ball before he even remembered and shortly after learning to walk at a young age. Life, career choices took him a different direction but the love of the “game” has always been there. Now grown and making a living that same boy, a young professional, vowed he would purchase season tickets at the first chance he had to afford them, starting with only one in the outfield on a mini-season and then two behind the dugout a few years later—so that that father of his could experience the “game” with him. At one time attending every home game played, all 81.

Privileged to go to Spring Training with his father and mother, this tradition continues to this day, every year in March for 1 week. Privileged to visit every ballpark in all of Major League Baseball—31 (+1 new Yankee Stadium also). Privileged to see a miracle World Series run in 2005 only to be swept by the other team. Privileged to attend two Hall of Fame Induction ceremonies again all with his mother and father. Privileged to be associated with and serve the team he grew up cheering for as a member of the Astros’ Buddies.

That’s me. Your doctor by day but son, and now father, by night. I don’t get too personal about stuff in the public but I felt compelled to make a statement because I’m not just closing the doors for a few days of leisure (frankly it’s a lot of work) but I’m closing for the experience to do this with my mother and father, wife and son. I want my son to have these memories recited to him when he grows up.

This World Series run is emotional and much like the “game” it has its ups and downs. I wish I could have predicted that we would be where we are now (actually not really because it wouldn’t be the same) as to not have to reschedule and inconvenience patients but an opportunity like this doesn’t come around very often. Thank you for understanding and Go Astros!

We will be closed Tuesday, October 31st through Thursday, November 2nd as we travel to Los Angeles and reopen on Friday to regular business hours. You can reach Dr. Gee anytime via email or text.  DrGee@GeeEyeCare.com or 281.778.9912 (feel free to text)

I was wrong, I’m sorry…

…I don’t ‘sponsor,’ I ‘support’

If I was ever wrong, then I stand corrected especially now. If I ever said that I ‘sponsored’ an event—I was wrong, evidently. My efforts in the community are to ‘support,’ events, organizations, individuals, in anything I put pen to check.

I want to make it very clear that the efforts that I contribute to are because I believe in them and what they stand for, NOT for marketing/advertising. As a matter of fact we have a hashtag (#CommunityMatters) in the office and that’s what it is all about.

As a business person it’s a fine line on how this is viewed, both by myself and by the public. Those that are out there working hard to get sponsorship money from other establishments may take heed of this, for me it is not about ROI (return on investment) but merely just giving back. You know it’s not always about business. I have to make the right decisions based on financials but I budget for the major schools in our community and it’s usually flexible but the thought, “what am I going to get out of this?” rarely ever crosses my mind.  Rather, whether it fits in the budget, who is asking (whether a patient or just a cold call) and of course value (how is the money going to be used) all are considered more heavily.

I opened the office in 2007 and also dropped a stake in the ground in Waters Lake of Sienna Plantation to build a home. I wanted a place to call home, not just a house. I wanted to be a part of the community. As a result, I’ve been around to see two elementary schools develop, a high school and soon to be another middle school. I’ve supported all of them and intend to do the same for the up and coming. I remember when Ridge Point, in its infancy came to ask for assistance with their band and athletics programs. I’m honored that I was asked and even more honored to be able to participate. I am honored that many have remembered that and continue to give me the opportunity. Fast forward to 2017, 10 years later, we were fortunate enough to be able to move the office to an updated and larger location. One thing for sure, #CommunityMatters is even more important and I will not back down from supporting community efforts.

So, while I’ve probably been using the incorrect word all these years, I stand corrected, the intent has ALWAYS been to support the community that I live and am a part of.

 

#SiennaEyeDoc