Practical Pearls

A Handy Guide to the Best Take-Home Tips in the April 2009 Issue of Ophthalmology MANAGEMENT

Staff members who avail themselves of continuing education opportunities are more motivated, better educated and more valuable to the practice. Remember to reward those who do show initiative or else the drive will be lost …Find it!

President Obama has pledged $1.1 billion to the Agency for Healthcare Research and Quality, HHS and NIH for comparative clinical effectiveness studies. This will lead to an explosion in the kind of head-to-head drug trials seldom seen in modern medicine …… Find it!

In the Tube vs. Trabeculectomy study, the cumulative probability of failure was 15.1% in tube patients vs. 30.7% in trabeculectomy patients. The complication rate was 34% tube, 57% trab. These and other results have convinced many glaucoma specialists to use shunts earlier and in a broader range of patients …… Find it!

Time-domain OCT samples the range of depth one point at a time by moving the reference mirror. This serial sampling is inefficient and limits the speed and sensitivity of imaging. The faster and more efficient Fourier-domain OCT detects reflections from the entire depth range simultaneously …… Find it!

There is a strong public policy initiative in Washington toward compensating primary care MDs for a perceived undervaluation of their services. Policy makers hope increasing payments to primary care will persuade greater numbers of young people to enter the field …… Find it!

Today's 18-year-olds are nearly as old as LASIK itself. Having grown up in the refractive surgery era, these patients require no convincing to sign up for the procedure. Patients aged 18 to 24 already perceive LASIK as a viable alternative to wearing glasses or contact lenses …… Find it!

Health care reform initiatives will include efforts to curtail growth of in-office testing, both in terms of volume and reimbursement rate. No other expenditure in health care is growing faster than in-office testing, and ophthalmologists receive a great deal of their revenue from inoffice tests …… Find it!

A study of ophthalmologists' interactions with glaucoma patients found that those who had been trained in better communication skills (e.g., asking open-ended questions) improved their ability to identify noncompliant patients from 25% to 78% …… Find it!

Of every 5,000 compounds discovered in the pre-clinical stage, only five result in an approved drug. That makes the odds for pre-clinical compounds one in 1,000 …… Find it!

The Physician Quality Reporting Initiative, which awards incentives to doctors who report data on quality measures, offers a foretaste of valuebased performance compensation. Though voluntary for now, something similar will likely be mandatory in the near future …… Find it!

Fibrin glue helps to facilitate hemostasis, so there tends to be less postoperative migration of blood and less sub-conjunctival scarring when using it for surgical closure. …… Find it!

BAK is cytotoxic at exaggerated concentrations and can facilitate increased penetration of the drug and epithelial cell death. However, dilution by the normal tear film and nasolacrimal drainage minimizes any ocular surface effects of typical BAK concentrations.…… Find it!

The keys to staff evaluations are honesty, consistency, timing and goal setting …… Find it!

Pharmaceutical industry experts agree that obtaining approval for any prescription dry eye treatment is difficult due to the subjective nature of some of the data. …… Find it!

The leading aqueous shunts are usually able to provide excellent IOP control for at least a decade following the surgery …… Find it!

OCT is theoretically capable of resolution close to 0.8 micron but in retinal imaging the dispersion (variation in the speed of light depending on wavelength) in the eye limits the practical resolution to 2-3 microns. …… Find it!

Myopes with high astigmatism are ideal LASIK candidates, but may harbor misconceptions that it cannot help them. "It's almost the more astigmatism the better, because while it makes glasses and contact lenses harder to wear, modern surgery can correct astigmatism extremely well," says Daniel Durrie, MD.…… Find it!

In 2009, there are two new CPT codes for DSEK: 65756 and +65757. For the surgeon, the first is always used. The second, an add-on code, only applies if the surgeon also performs the lamellar dissection of the donor tissue. …… Find it!

Frame-averaging improves OCT image quality by suppressing speckle noise, which varies in successive image frames taken at approximately (but not exactly) same location. Averaging several frames makes it easier to distinguish retinal layers that are very thin or have relatively low contrast.…… Find it!

In evaluating an NDA, FDA advisory committee members tend to look for an excellent study design, the dosing regimen, the use of controls, unbiased evaluation and whether the drug can fill an unmet medical need. …… Find it!

Though all ophthalmology residents should have the opportunity to conduct original scientific research, we should recognize that many residents have chosen to become physicians for other, no less important, reasons …… Find it!

If you routinely perform specular microscopy preoperatively, at no charge and as part of your comprehensive cataract workup, you will quickly find patients who are at risk of developing acute corneal edema after routine and expedient cataract surgery. …… Find it!

An immediate postop IOP spike following DSEK is not billable, because it is a known complication. Management of complications during the postop period that do not require a return to the OR are included in the global surgical fee …… Find it!

When prescribing BAK-containing medications, be sure to explain to the patient the necessity of dose compliance in order to avoid the potential downsides of BAK …… Find it!

The aqueous shunts available today are effective in an estimated 90% of the cases in which they are used. This compares to the 30% to 40% effectiveness of the original shunts used in the 1970s and 1980s. …… Find it!