Only Insurance Companies Win
Given recent events, I feel compelled to say I do not condone violence.
As an optometrist, I believe that insurance companies (which are for-profit businesses) are driving up the cost of healthcare at the expense of providers and patients. I spoke with a chiropractor and a medical doctor who also agree with this sentiment. This issue appears to be pervasive throughout the healthcare industry.
Below I am going to use optometry as an example because it's the industry I know.
We will start with discussing the cost of lenses. I own an edger which cuts lenses for me, meaning I can make a pair of single vision polycarbonate lenses for a mere fraction of what I have to charge if we are billing insurances.
However, insurance companies simultaneously refuse to pay optometrists our retail price while also forcing us to use their labs (instead of using my edger), and the labs charge me 11x for lenses comparable to the ones I can make in the office. Then, with insurance companies refusing to pay our retail price, I have to mark up that pair of lenses an additional 3x (for a total markup of about 33x) just to make a small profit. Providers are forced to come up with creative ways to try to pass on expenses to patients just to make ends meet. Which is unfair to the patients, and makes them feel like we are “upselling” them… and neither one of us likes any of it.
Patients understandably like to buy glasses which are covered by their insurance. But, I think what the insurance “covers” is not an accurate description of what’s happening. An example is when insurance says something like “30% off __.” Who is paying for that 30%? Not the patient. Not the insurance. It's the doctor taking a loss. Which is another reason why we have to jack up prices to be able to afford to give these discounts to our insurance patients, and it further prices out cash-pay patients.
It is illegal for optometrists to set different pricing for patients who have insurance, vs those who don't. Meaning, patients without insurance are forced to get creative as well (to be able to afford to see), and buy glasses online - where about 80% of the time the glasses are made with the wrong prescription. Now the patient is suffering with the wrong prescription, the doctor loses a sale, and we actually need the sale to cover our expenses. Who do you think this law was invented to protect? Because the only ones who are benefitting are the insurance companies.
The work-around is optometrists who have been able to find the money to buy a low end edger, like mine, for the cool price of $35,000, can offer discounts to patients who pay out of pocket. But, heads start turning when a business promotes an aggressive discount year round, and patients also start wondering what is wrong with the quality of the product. But that's how much discount optometrists who can afford to own an edger can give because of how much the labs mark up the lenses. And of course, to the consumer it looks like we are being greedy with our pricing if we are capable of sustaining such a severe discount. When in reality I can offer significantly lower prices for the same products to patients who are paying out of pocket because we are cutting out the insurance companies as a middleman.
Another indirect way that insurance companies hurt patients is the insurance companies are the ones who decide how much doctors are paid. When I bill insurance companies for a service, they are the ones who decide how much they will pay me. Insurance companies have not increased our reimbursements for about 20 years. Imagine making the same as you did 20 years ago in today's economy. Then imagine, as a business owner in private practice, needing to pay employees more than twice as much as 20 years ago due to the increasing cost of minimum wage. Do not get me wrong, the employees NEEDED a raise, but the doctors deserved to at least keep up with the cost of inflation.
The way this hurts patients is optometrists have to see twice as many patients in a day as they used to 20 years ago in order to be able to barely pay their employees as well as themselves. This means the patients are spending less time with the doctor and may experience long wait times if anything goes wrong with the schedule.
Optometrists do sign contracts with the insurance companies agreeing to their reimbursements. We can hire a lawyer to individually argue higher reimbursements for us (and hiring a lawyer is the ONLY way we stand a chance of winning). But, the cost of hiring a lawyer for every insurance to argue reimbursements is fruitless because the doctors almost never actually win.
I can see how I may sound like I am coming from a place of entitlement. But I want to make sure this is clear: by essentially controlling directly and indirectly the cost of every aspect of healthcare, insurance companies are degrading the patient experience. The insurance companies are also responsible for making healthcare unaffordable for patients who don't have insurance, which can be the difference between life, bankruptcy, and death.
Part of why it is so hard for Optometrists to win legislation that could help this situation is the perception in our society that doctors are rich. A bigger barrier is that insurance companies are so rich, doctor associations (such as the AOA - which is like our union) can't come up with the funds to compete.
Remember, much of what I have said here can be applied to multiple healthcare industries, not just optometry.
What the public CAN do about this is share this post, write to your legislatures, and file complaints with your insurance companies. We need to raise awareness and also create a movement to affect change.
What I can do about this is invite you to join the SSO Club.
What Do Cataracts Look Like?
I have found that the media has perpetuated a misconception about the appearance of cataracts, and so I wanted to share with you the scoop.
The first question is, what is a cataract?
The natural lens inside the eye is supposed to be clear, but with time it becomes clouded, and that is a cataract. As you can see in the picture below, the natural lens is located behind the pupil/iris which is the colored part of your eye (pictured in blue).
Given that the lens is located behind the iris, a cataract is virtually imperceptible. 95% of the time when I identify a cataract, I need to use my slit lamp, which is a specialized microscope.
Now, let me show you how cataracts are commonly portrayed in the media:
This is a picture from Smallville. Notice how the eyes look white? The reality is if an eye looked white like this, there would in fact be a problem with the cornea. As you can see in the diagram above, the cornea is the front surface of the eye which vaults over the location of the iris and lens. Despite what the media tells you, this is NOT what a cataract looks like. As I said before, a cataract is almost always imperceptable without a slit lamp aka a specialized microscope.
So, how would you know if you have a cataract?
The main symptoms are difficulty with glare at night, particularly from oncoming headlights. There can also be the appearance of halos around street lamps. Cataracts also cause progressive blurry vision which cannot be improved with glasses. The only treatment is to have them surgically removed; a very common, simple, and safe procedure. Cataracts are like looking through a dirty windshield; until the cataracts are removed (aka the windshield is cleaned), there is only so much that can be done to correct the vision with glasses.
Envision
Silver Strand Optometry offers innovative technology by Envision which allows us to perform two types of therapy: Radio Frequency (RF) and Intense Pulsed Light (IPL). IPL and RF have been used for 25-35 years respectively, and (like cell phones) has evolved significantly during that time to provide unprecedented therapy to the delicate tissues around your eyes.
One of the many diagnoses RF and IPL can treat is dry eye. Dr. Castillo sees so many patients with dry eye that she felt like she would be doing a disservice to you to not invest in this technology. The goal with RF and IPL is to get you creating your own good quality tear film and off of using dry eye drops and/or hot compress/lid scrubs all together. RF and IPL is more effective than even some of the prescription drops on the market for dry eye. For example. Restasis only has an efficacy of 15%, so low that it is not even approved for use in many countries. Whereas RF and IPL have an efficacy of 85%! Here are more details about each individual therapy:
RF is exclusive to Envision technology and can be used to treat:
Meibomian Gland Dysfunction (MGD) is a type of dry eye. You know you have MGD if I have recommended that you use hot compress and lid cleansers at home, and possibly also recommended you come to the office for gland expressions. MGD causes the glands that secrete your tear film to die off. The treatments available until this point help to slow down this process. RF can actually help regrow the lost glands. After just four treatments it negates the need to use hot compresses, lid cleansers, and to come in to the office for gland expressions.
Wrinkles around the eyes. RF stimulates the growth of collagen and tightens the skin!
RF can also be used to treat droopy eyelids. Here is a before and after:
Chalazions are bumps that can develop after a person has a stye. Until now the only treatment options for Chalazions have been surgical excision if hot compresses were ineffective. RF is a non-surgical alternative to breaking up the Chalazion. Here is a before and after:
IPL has been around for a few years and is not Envision specific. It can be used to treat:
Inflammatory Dry Eye. You know if your dry eye has an inflammatory component if you are using Pure&Clean, Restasis, Tyrvaya, or Xiidra. IPL can be more effective than any of the treatments listed above.
Demodex are parasites which can live in the base of your eyelash follicles. You will know if you have an infestation of Demodex if I have told you that you have parasites living at the base of your eyelashes. Until now the only treatments have been hot compress and lid cleansers to control the population of the parasites, as well as a medication that was FDA approved at the end of July. RF is now another treatment option.
Rosacea and spots on the skin can also be treated with IPL. Here is a before and after:
If you are interested in either of these treatments, please feel free to call our office at 805-486-3585 to schedule a free consultation. Dr. Castillo would be happy to review if you're a candidate and how Envision can benefit you.
The Myth of Visine/ClearEyes
Visine and ClearEyes are common eye drops that many people use to treat a variety of problems ranging from ocular redness and allergies to Dry Eye. As it turns out,Visine and ClearEyes are NOT good for the eyes. Visine and ClearEyes are both vasoconstrictors. Meaning, they make eyes look less red because they constrict the ocular blood vessels. However, after long term use of Visine/ClearEyes the eyes will essentially get “addicted” to the drops and cause the ocular blood vessels to become constantly engorged.
There are other over-the-counter eye drops that I recommend instead of Visine/ClearEyes. The drops I recommend vary based on what the patient is trying to treat with the drops.
For those who are using Visine/ClearEyes to relieve redness, I recommend using Lumify drops instead.
For those who are using Visine/ClearEyes to treat ocular allergies/itching I recommend using Pataday, Alaway, or Zaditor instead.
For those who are using Visine/ClearEyes to treat Dry Eye, please bear in mind there is a large variety of treatments for Dry Eye. The most accessible over-the-counter treatment option is artificial tears, and these are the brands of artificial tears that I recommend: Optase, Refresh, Systane, Blink, Retaine, GenTeal, and Thera Tears. With regards to Dry Eye, artificial tears are really treating the symptoms instead of the cause of the dryness. If you do have Dry Eye and would like to explore further treatment options please do not hesitate to make an appointment at our office 805-486-3585.
How to Elongate Your Eyelashes
People who want to elongate their eyelashes tend to go with eyelash extensions. Eyelash extensions come in a few forms, and usually individuals go with either do-it-yourself extensions or visit an eyelash technician for customized extensions. Neither one of these are terribly good for eyeballs for a couple of reasons.
First, over time many people develop an allergic reaction to the adhesive/glue used to attach the extensions, which can be very uncomfortable and lead to temporary loss of eyelashes (usually as the person tears out the lashes due to intense itching).
The second reason why eyelash extensions are not good for the eyes is they tend to matt the base of the eyelashes. There are tear glands at the base of eyelashes which secrete a tear film that covers the front surface of the eyes and allows the eyelids to glide over the eye instead of cause chaffing. If the base of the eyelashes are matted from the eyelash extensions, then this can prevent the tear glands from secreting a proper tear film, which can lead to Dry Eye. In addition to being uncomfortable, Dry Eye can cause blurry vision and difficulty with glare.
This being said, I do not recommend that my patients elongate their eyelashes with extensions.
An alternative that I do recommend is an eye solution called Latisse. This solution comes with an applicator and is applied at night before bed to the base of the upper eyelashes, much like eyeliner. Latisse will cause the eyelashes to grow longer and thicker. It is prescription only, but I would be happy to prescribe it for anyone who is interested. Please either ask me about it during your next eye exam or schedule an appointment to discuss further. The office number is 805-486-3585.
Eye Drops to Improve Vision
I am sure that many of you have seen the advertisements regarding new Vuity eye drops on the market that can improve vision. So, I wanted to take a moment to explain what’s the story with these eye drops.
I think a more accurate, simple description of the Vuity drops is they could replace reading glasses.
Patients who are a good candidate for these drops are those who need reading glasses. The best candidate is someone who has “perfect” distance vision and only needs help with reading. Patients who need distance as well as reading glasses could also be candidates, but they would still need to wear distance glasses as well as use the drops. Another case when these drops could be helpful would be for patients who want to wear contact lenses for distance and then put in the eye drops to see at near.
The way the drops work is they constrict your pupils, working in the same way as a pinhole camera. In other words, the constricted pupil allows only parallel light to enter the eye, reducing scattered light from causing blur. The constricted pupil also increases the focal length of the eye, allowing for a greater range of clear vision. If you want to learn more about how a pinhole camera works, this is a pretty good video: https://youtu.be/jhBC39xZVnw
The way you would use the drops is you would put them in your eyes in the morning, and after they constrict your pupils, you should be able to see at near. The drops wear off after about 6-8 hours, in which case they need to be reapplied. However, I do discourage re-application too late in the day because otherwise your eyes would be constricted at night, and then it would be very hard to see without enough light. 2:00 pm is about the latest I’d recommend re-applying the drops. As with a new glasses prescription, it can take time to get used to seeing with the Vuity drops.
If you are interested in learning more about the Vuity drops please do not hesitate to call our office at 805-486-3585 to schedule an appointment.