Optometric Resources

After discussion with parent regarding myopia control options & the risks/benefits of each treatment option, parent decided to begin use of Atropine eye drops. Parent is not interested in CLs or other myopia control options at this time. Edu parent that atropine is not FDA approved at this time (edu parent that this is an off-label use of the medication) and edu pt & parent on possible side effects associated with atropine use - both systemic and ocular. Pt understood all instructions and risks involved with initiation of medication. Pt would like to proceed with atropine use. Sent atropine ____% prescription to Crossroads pharmacy. Edu pt to call the clinic asap (sooner than the scheduled follow up appointment) for an urgent evaluation & to discontinue the medication if unexpected symptoms arise. Edu pt on what symptoms to be aware of that would require an immediate evaluation. Edu pt on how to use medication (qhs in both eyes) and purpose of using the medication. Pt under

Edu pt on condition & exam findings. Edu pt on urgency of evaluation with Retina Center of Texas to determine if hole requires treatment. Edu pt on consequences of delaying evaluation with retina including but not limited to permanent reduction/loss of vision. Edu pt on risk of retinal detachments and associated symptoms such as but not limited to flashes of light/floaters in vision and reduction/curtaining of vision. Pt understood all instructions and risks involved. Sent pt records to Retina Center of Texas. Provided pt with contact information for Retina Center of Texas. Appointment has been scheduled for pt. 

Released new spec rx today. Edu pt on risk of retinal detachments, holes, breaks, and tears. Edu pt on signs/symptoms of retinal detachment including but not limited to sudden onset and/or increase in frequency of floaters and flashes & curtaining/reduction in vision. Edu pt to RTC asap if such symptoms arise for an immediate fundus evaluation. Edu pt and parent on importance of dilating the pupils to obtain better view of fundus. Edu pt & parent that without dilation, only limited view of retina is possible. Edu pt and parent on risks associated with not dilating (including possible permanent vision loss due to a limited view of fundus) and pt & parent understood all instructions & risks involved. Despite discussion & explanation of risks involved, pt & parent decided to decline dilation. No reported pt systemic or ocular hx, no surgeries reported. No reported family systemic or ocular hx. AOV: 90 deg R, 90 deg L

Create emergency kit: Morgan thing for irrigation useful for medication prescribing:  https://eyemedsnow.com/?fbclid=IwAR2NncfKPKFwuy-4nhM4ldBNZrRnNjCWj4Cq4C8gSJfTBLz2sQgAefk8L8Y  useful for treatment: https://www.epocrates.com

https://eyesoneyecare.com/resources/applications-tea-tree-oil-ocular-disease-video-interview/ https://eyesoneyecare.com/resources/the-ultimate-guide-to-demodex-blepharitis/  https://www.amazon.com/OCuSOFT-Hypochlorous-Associated-Blepharitis-Dysfunction/dp/B013M57VZG/ref=sr_1_3?crid=2VCR4WC93HW21&keywords=ocust+demodex&qid=1657714575&sprefix=ocust+demode%2Caps%2C215&sr=8-3 & IPL

 

Left side is AGE and right side is in DIOPTERS

In order to bill refraction to the vision insurance, you have to bundle it, meaning that you have to bill the 92004 or 92014 code in order to bill the refraction code. You can’t just bill the refraction code alone.  You also can’t bill

  Moxifloxacin 0.5% for bacterial ulcer is pretty cheap

  stat_3_2022 my own   https://1drv.ms/w/s!AmiA59ykvqqt3S5gOeMBx29Sgi-I?e=lWzfkp 

 

 

 

  https://us512.directrouter.com/~odskwgnj/wp-content/uploads/2019/10/Clinical-pocket-guide-2014-v2.pdf

 

Refer to ophthalmologist for YAG cap to improve BCVA. Pt counseled about the risk and benefits of the laser procedure. After discussion, pt elects to proceed with surgical referral. Referral of pt to ** insert ** was made for YAG cap. Pt was provided information in clinic today. RTC for post-operative care as directed. Pt was educated on condition and exam findings.

Edu pt on condition and exam findings. Edu pt regarding surgical treatment option of a vitrectomy including what to expect during the procedure, the risks/benefits/advantages, and the expected recovery process. Pt understands a general recovery of at least 3-4 weeks is expected s/p vitrectomy which includes (but not limited to) avoiding activities that may cause the head to move and keeping the head in a specific position for most of the day and night for 1-3 weeks s/p vitrectomy. Pt is aware that the surgeon will provide specific and more detailed instructions regarding the recovery time.

Pt was counseled on the importance of monitoring the condition as directed. Pt may use ATs PRN and was advised to avoid blood thinning medications to promote quicker resolution. Instructed pt to immediately report any change in condition outside of expected and discussed symptoms. RTC if not resolved in 2-3 weeks or if reoccurrence is noted.  Edu pt on condition and exam findings.

 Pt edu on condition and exam findings. Pt counseled that medically necessary contact lenses are required to improve functional vision level. RTC for contact lens fitting as directed. 

Patient was educated on the signs and symptoms associated with a retinal detachment - new onset flashes of light, floaters, loss of field of vision. If these symptoms are experienced, patient understands to RTC asap for dilated eye exam.

Recommended use of UV protection and ATs QID. Edu pt to RTC if symptoms worsen. Edu pt on condition and exam findings.

Pt was counseled on the importance of monitoring the condition as directed. Pt understands changes are normal for age. Instructed pt to immediately report any change in condition outside of expected and discussed symptoms. Stressed need to RTC ASAP if acute signs/symptoms of RD are experienced such as new onset flashes of light and/or floaters, increased frequency of F/F, or curtaining/reduction of vision. Pt acknowledged understanding of condition and all instructions provided in office. RTC for additional testing as indicated. 

Edu pt on condition and exam findings and explained reason for reduced vision is due to the macular hole. Due to the acute nature of the condition, recommended surgical referral for vitrectomy. Emphasized to pt that delay in surgical repair could result in reduced success in hole closure and visual benefit/recovery. Informed pt that vision does not typically return to "normal" even after hole closure. Edu pt that there is a remote chance of spontaneous macular hole closure if surgery is not performed. Expected visual outcome s/p surgical repair was also discussed and the pt understands that even with a successful surgery, residual visual blur and metamorphosis may persist. Edu pt on statistically a 10-15% chance of a macular hole developing in the fellow eye.

Emphasized to pt importance of lid hygiene as directed with tea tree oil based product - written instructions given to pt. Advised artificial tears may be used as needed for ocular surface lubrication. Edu pt on condition and exam findings. RTC for follow up as indicated.

Provided pt with updated spec rx but edu that optimal vision will not be obtained with specs only. Recommended pt proceed with specialty CLs fitting for optimal vision - after discussion with pt, follow up for RGP fitting was scheduled.  Edu pt regarding condition and exam findings. Pt edu about all treatment options and was informed that there are no current surgical procedures available to cure the condition but may be considered in the future if progression is noted on topography / MR testing. 

Based on the clinical findings today, recommended pt continue to PCP for systemic care and follow up with eye exams as directed. Emphasized to the pt the importance of systemic control of underlying conditions. Pt edu about today's exam findings and counseled about the nature of hypertensive changes to the eye. 

Prescribed oral medication to be used as directed and warm compress to be used 2-3x/day until resolution. Emphasized to pt the importance of lid hygiene. Advised ATs may be used as needed for ocular surface lubrication.  Edu pt on exam findings. RTC for follow up as indicated.

Glaucoma - Glaucoma Suspect POAG suspect based on ______.  IOP lowering treatment is not indicated at this time; continue to monitor condition as directed. RTC for special testing to rule out glaucoma progression.  Edu pt on exam findings. Advised pt on risk of vision loss associated with glaucoma & need for treatment & testing compliance. Glaucoma Continue Treatment Pt is meeting target IOP in office today - see chart notes for more details. Continue treatment with topical IOP lowering medication as directed. RTC for special glaucoma testing as directed.  Edu pt on exam findings. Advised pt on risk of vision loss associated with glaucoma & need for treatment compliance.  Glaucoma Initiate Treatment Pt's IOP measurements are above ideal target pressure - see chart notes for more details. Initiate treatment with topical IOP lowering medication as directed. RTC for special glaucoma testing as directed. Edu pt on exam findings. Advised pt on risk of vision loss associated

40 - 45   1.00 - 1.25 ------ 45 - 50 1.50 - 1.75 ------ 50 - 55 1.75 - 2.00 ------ 55 - 60  2.00 - 2.25 ------ > 60  2.25 - 2.50

  State Law Requirements (see below)   For New pt for whom you are prescribing glasses: - Case History - VA - Accom measurement (Push ups, NRA/PRA, Near VA) - IOP - BV (CT, verg) - angle of vision - AR/Ret - Manifest Refraction (doesn’t have to be in phoropter and doesn’t say how you need to do it)

 Crowded Disc at Risk for Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION):  BP measured in office WNL. Edu pt on importance of controlling BP and maintaining regular f/u with PCP for systemic control of any vasculopathy conditions. Edu pt on condition and exam findings. Monitor yearly with fundus evaluation, unless symptoms such as suddenly reduced VA or significant changes in vision arise, then RTC sooner.

For general retinal stuff for retinal eval: H35.463 - Secondary vitreoretinal degeneration, bilateral S05.01XA -  Injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter DRY EYE H16.223 - Keratoconjunctivitis sicca, not specified as Sjogren's, bilateral MGD (Meibomian Gland Dysfunction) H02.79 - Other degenerative disorders of eyelid and periocular area CHOROIDAL CRESCENT H31.22 - Choroidal dystrophy (central areolar) (generalized) (peripapillary) Q14.3 - Congenital malformation of choroid GLAUCOMA SUSPECT H40.013 - Open Angle with Borderline findings, low risk, bilateral HEADACHES: G43.C0 - Periodic headache syndromes in child or adult, not intractable OCULAR ALLERGIES  H10.45 - Other chronic allergic conjunctivitis POST-CATARACT PT - IOL Z96.1 - Presence of intraocular lens (IOL) SECONDARY CORNEAL EDEMA, right eye H18.231  DISK AT RISK for NAAION Q14.2 - Congenital malformation of optic disc POST-LASIK PATIENT H17.13 - Central corneal opacity