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Special Opportunities for Members Website developed by
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Items of Interest The format of our meetings has changed, in order to increase attendance. We will have 10 hours of credit at the annual conference and 4 hours of credit at our fall brunch meeting in September and our spring brunch meeting in May. American Academy of Ophthalmology E-Learning for eye care professionals made quick and easy. Tips for
Taking Fundus Photos 1) Communicate with your patient! 2) If you see something of
interest - photograph it! Document everything! 3) Let your patients know that they can blink as needed, BUT to open eyes wide between blinks. If you don’t tell them they can blink, they will try not to. This will cause stress on the patient, strain, squinting, tearing, and poor image quality. Let your patients blink! 4) Use the fixation pointer if the patient has a difficult time seeing the fixation light. However, if the patient is cooperative, since the pointer may distract from the photograph, pull it out of the lens at the last moment before clicking the shutter. 5) For light sensitive patients, turn the viewing light down low. Try to line up the eye as best you can peeking through their squinted eyes. You should be able to line up their vessels, find their optic nerve, etc. Try to obtain the best focus possible like this. Once you have everything lined up, have the patient blink, and then lift their lid with a Q Tip and shoot. You may need to make a few adjustments, but you’ll definitely get a better photo than if you held their eye up through the entire process. 6) When taking stereo optic nerve photographs, focus the first image on the rim of the optic nerve head and the second image on the cup. This will give the pair a much more appreciative three dimensional view. 7) When shooting images for a montage, photograph the fields in a clockwise or counter-clockwise direction beginning always with the posterior pole. This will help you to make sure you have obtained all necessary fields and the order helps the computer software match up the images more accurately. 8) If you’re having a difficult time getting a clear view of the eye, pull the camera back a bit and set the focus lens on A. This will give you a view of the opacity and how to get around it to obtain a clearer fundus image. And while you’re at it, take a photograph of the opacity. Document everything! Get Certified! OIG Study: Ophthalmology Has Prevalence of Unqualified Staff The Department of Health and Human Services Office of the Inspector General (OIG) recently released a study of services billed as “incident to” a physician (services that are billed by physicians but are performed by non-physicians). The study finds 37 percent of ophthalmic services, including eye exams, diagnostic imaging, photos and ophthalmoscopy, are performed by “unqualified” non-physician staff. The OIG defines qualified staff as personnel that have the training, certifications and licenses required by state law/regulation and/or Medicare. However, Medicare rules do not require licensure or certification to bill for “incident to” services, and no states have licensure or certification requirements for ophthalmic technicians. While Medicare rules do not require certification in an ophthalmology office at this time, there is precedent for them to require certification in order to be paid by Medicare. Independent Diagnostic Testing Centers must use certified personnel to qualify for Medicare reimbursement. Vascular laboratories are required to use certified technicians. JCAHPO certification provides validation of your qualifications to perform ophthalmic services. Be proactive. Get certified now. In addition to three levels of general certification, there are also specialty certifications in Ultrasound, Ascan, and Surgical Assisting. Go to www.JCAHPO.org for information about getting certified. Tips
for Optimizing Scans with the Stratus OCT Tip #1: Be sure to properly center the scans Off center scans create false data results, and may miss important pathology. If you see that the scan is not centered properly, you should not save the scan. Just begin again with a properly centered scan. To make centering on the macula easier, I recommend that you left click with your mouse on the image of the scan in the left side of the screen. This will create a line down the center of the scans, which will help you to align your scans properly. Then use the arrows or the mouse to adjust the scans so they are centered on the fovea. When performing the RNFL scans, use the "Move Scan and Landmark" tab when centering the circle around the nerve for the RNFL scans. Make note of where the landmark is so that if there is eye movement you can quickly and easily adjust the scan using the mouse or the arrows. Tip #2: Print out the results while the patient is in the room Make sure there are no “fishtails” on the macular thickness map. The algorithm incorrectly identifying the RNFL or RPE can cause these artifacts. Repeat the scan while the patient is still in the room. Tip #3: Look for signal strength of 6 or higher Use the polarization optimization to increase the signal strength. Use the focus knob to fine-tune the signal strength of the scan. Focus the scan on the RNFL, not the RPE. Check the position of the measurement lines using the Retinal Thickness or RNFL Thickness analysis. Tip #4: Place the scan in the lower 2/3 of the screen Look for the “scan too high” or “scan too low” messages and adjust the position of the scans. The macular thickness map algorithm adjusts the entire scan to the height of the highest part of the scan. If there is edema on the scan, it may be “chopped off." Tip #5: Check the central standard deviation on the Macular Thickness Map Using the Macular Thickness Single Eye, or the Volume Analysis, the central thickness should be within 10% standard deviation. E.g. 180+/_ 18 Tip #6: Look for an even signal distribution throughout the scan You may need to adjust the joystick to increase the signal strength on the edges of the scan. It should appear even from left to right across the screen. Tip #7: Perform the fast RNFL scan more than once Use the RNFL serial analysis to compare all the scans performed on that visit for consistency. The Eyes Have
It
The Glaucoma Service Foundation to Prevent Blindness at Wills Eye Hospital offers a glaucoma patient support group, which meets monthly from September through May on Sunday afternoons in the Wills Eye Hospital auditorium. The foundation's newsletter, Searchlight on Glaucoma, is published three times a year, and mailed to approximately 20,000 glaucoma patients and their families. All issues are archived on its website (Glaucoma Service Foundation at Wills Eye Hospital). Subscriptions to the Searchlight on Glaucoma newsletter is free. Every Wednesday night, from 8:30 pm to 9:30 pm a Wills Eye Hospital glaucoma specialist hosts an online Question & Answer session on scheduled topics. Edited transcripts of these sessions are available on the website. For
information on glaucoma and macular degeneration, Links Online Portal for Ophthalmic Technicians Wills Eye Hospital® 61st Annual Alumni Conference Technicians' Program American Academy of Ophthalmology Glaucoma Service Foundation at Wills Eye Hospital HIPAA Privacy Rules Guidelines American Society of Cataract & Refractive Surgery and American Society of Ophthalmic Administrators Macular Degeneration Foundation American Printing House for the Blind Centers
for Medicare & Medicaid Services (CMS) American Society of Ophthalmic Administrators Associated Services for the Blind Our thanks to Diane Brash of the Associated Services for the Blind, our speaker at the September meeting. Diane has provided us with resources to assist our visually impaired patients: Associated
Services for the Blind Library
for the Blind, GED programs: PA
Bureau of Blindness and Visual Services: PA
Association for the Blind: The
PA Association for Blind Athletes
needs volunteers to assist visually impaired participants. Visit their
website for more information:
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