[optimal] Re: optimal Digest V5 #132 (Away Message)

From: "Mindy Cole" <ColeM@xxxxxxxxxxx>
To: <optimal@xxxxxxxxxxxxx>
Date: Tue, 26 Aug 2014 01:09:38 -0400
I will be out of the office until Wednesday August 26, 2014.  I will reply to 
your email when I return.  If you need immediate assistance please call the 
Department of Ophthalmology at 315-464-5253.

>>> FreeLists Mailing List Manager <ecartis@xxxxxxxxxxxxx> 08/26/14 01:09 >>>

optimal Digest  Mon, 25 Aug 2014        Volume: 05  Issue: 132

In This Issue:
                [optimal] Pupil Photos Set-up?
                [optimal] AUTO: Keith Effert (returning 09/02/2014)
                [optimal] Re: Pupil Photos Set-up?
                [optimal] Re: Pupil Photos Set-up?
                [optimal] Re: Pupil Photos Set-up?
                [optimal] Re: Pupil Photos Set-up?
                [optimal] Re: Pupil Photos Set-up?
                [optimal] Re: Pupil Photos Set-up?
                [optimal] Re: ptosis/dermatochalasis fields & external photo

----------------------------------------------------------------------

From: Adeline Stone <astone@xxxxxxxxxxxxxx>
Subject: [optimal] Pupil Photos Set-up?
Date: Mon, 25 Aug 2014 16:55:19 +0000

Hello-
We have a new neuro-ophthalmologist and I am wondering the set-up for external 
pupil photos? We are following the (adies) moran eye center protocol room light 
at far, near, with reaction, room lights off 5 secs, pilo for 30 then room 
lights off  5secs. I am taking these with an IPad which is what we do our upper 
lid photos with. You can imagine these were not very good or easy to get....

Any suggestions on equipment would be great so we can get better quality?

Thanks,
Adeline Stone, COT  CRA
Diagnostic Services Supervisor



------------------------------

Subject: [optimal] AUTO: Keith Effert (returning 09/02/2014)
From: keith_effert@xxxxxxxxx
Date: Mon, 25 Aug 2014 10:01:31 -0700


I am out of the office until 09/02/2014.

I am out of the office until 09/02/14

I am out of the country traveling on business and will respond as soon as I
am able.

For immediate assistance please call the following;

For Sales Related Matters - 800-223-9044 X 281
For Service Realted Matters - 800-223-9044 X 282

Thank you for your understanding
Keith Effert


Note: This is an automated response to your message  "[optimal] Pupil
Photos Set-up?" sent on 8/25/2014 9:55:19 AM.

This is the only notification you will receive while this person is away.


------------------------------

Date: Mon, 25 Aug 2014 13:13:02 -0400
Subject: [optimal] Re: Pupil Photos Set-up?
From: Marshall Tyler <marshalletyler@xxxxxxxxx>

Adeline,
Position patient with head against wall and where you can get to the light
switch while holding the camera in shooting position. Consider a foot
switch!
Frame up, shoot room light photos - far & near,
Frame up, lights off 5 seconds, don't move, voice command to patient: "Open
eyes wide by # ONE,  3,2,1",  shoot, verify focus and framing,
repeat using 30 seconds.
Re-shoot as necessary.
May the force be with you,
*Marshall*
Marshall E Tyler, FOPS
www.TwinChimney.com
Books for the Ophthalmic Photographer
  sv *Silk*

On Mon, Aug 25, 2014 at 12:55 PM, Adeline Stone <astone@xxxxxxxxxxxxxx>
wrote:

>  Hello-
>
>
>
> We have a new neuro-ophthalmologist and I am wondering the set-up for
> external pupil photos? We are following the (adies) moran eye center
> protocol room light at far, near, with reaction, room lights off 5 secs,
> pilo for 30 then room lights off  5secs. I am taking these with an IPad
> which is what we do our upper lid photos with. You can imagine these were
> not very good or easy to getâ€|.
>
>
>
> Any suggestions on equipment would be great so we can get better quality?
>
>
> Thanks,
>
> Adeline Stone, COT  CRA
>
> Diagnostic Services Supervisor
>
>
>


------------------------------

From: Paula Morris <paula.morris@xxxxxxxxxxxx>
Subject: [optimal] Re: Pupil Photos Set-up?
Date: Mon, 25 Aug 2014 17:31:12 +0000

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------------------------------

From: "Verdick, Randall E" <randall-verdick@xxxxxxxxx>
Subject: [optimal] Re: Pupil Photos Set-up?
Date: Mon, 25 Aug 2014 18:13:06 +0000

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------------------------------

From: Adeline Stone <astone@xxxxxxxxxxxxxx>
Subject: [optimal] Re: Pupil Photos Set-up?
Date: Mon, 25 Aug 2014 18:01:33 +0000

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------------------------------

Date: Mon, 25 Aug 2014 15:35:18 -0400
Subject: [optimal] Re: Pupil Photos Set-up?
From: Marshall Tyler <marshalletyler@xxxxxxxxx>

Randy,
 Are you still taking the nose out with the double prisms, or in software?
Marshall

On Mon, Aug 25, 2014 at 2:13 PM, Verdick, Randall E <
randall-verdick@xxxxxxxxx> wrote:

>
>
> Here at Iowa, we use an infrared and visible light black and white video
> camera at 1280x1024 res. Software allows us to record video and/or still
> images from a computer screen. We use an IR light to see the image in
> darkness. After the images are grabbed, we upload to OIS via one of Paul
> Montagueâ€™s old image upload programs. We used to do this with Polaroid
> film! I included a couple examples.
>
>
>
>
>
> Randall Verdick, FOPS
>
> Educational Media Coordinator
>
> Department of Ophthalmology & Visual Sciences
>
> 319-356-2918
>
>
>
>
>
>
>
> *From:* optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx]
> *On Behalf Of *Paula Morris
> *Sent:* Monday, August 25, 2014 12:31 PM
> *To:* optimal@xxxxxxxxxxxxx
> *Subject:* [optimal] Re: Pupil Photos Set-up?
>
>
>
> HI from Moran, Adeline,
>
>
>
> When the Moran imagers shoot the pupil series, we use a Nikon D100 with a
> 28-70 mm zoom.  Download into our image data base with a card reader, but
> crop to just eyes first.
>
>
>
> When the PA in neuro shoots the pupil series, she uses the Canon PowerShot
> SX10 IS with a 5 -100 zoom.  Download with a cable.  Framing in so you have
> bilateral canthus to canthus and still can see lid position is what we aim
> for.  We use a tripod so you neednâ€™t worry about the camera drifting with
> the lights off.  I personally have the pt hold their head still against the
> chair or the wall using Mr. Bill Nybergâ€™s fabulous tool, a light weight box
> that the pt holds between the hard surface and their head.  It is a great
> tool â€“ the pt can hear their head move against the box, and they hold
> really still â€“ if they are capable of that.  Pts can even tell you when
> they have moved so you can re-align.
>
>
>
> Good luck â€“ the investment in the camera will be worth it.
>
>
>
> Glad the Moran protocol translates well â€“ Dr. Digre sat at the foot of the
> master, Dr. Stan Thompson at Iowa, and we have been using that protocol
> with excellent success for 25 years.
>
>
>
> As ever,
>
> p
>
>
>
> *From:* optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx
> <optimal-bounce@xxxxxxxxxxxxx>] *On Behalf Of *Marshall Tyler
> *Sent:* Monday, August 25, 2014 11:13 AM
> *To:* optimal@xxxxxxxxxxxxx
> *Subject:* [optimal] Re: Pupil Photos Set-up?
>
>
>
> Adeline,
>
> Position patient with head against wall and where you can get to the light
> switch while holding the camera in shooting position. Consider a foot
> switch!
>
> Frame up, shoot room light photos - far & near,
>
> Frame up, lights off 5 seconds, don't move, voice command to patient:
> "Open eyes wide by # ONE,  3,2,1",  shoot, verify focus and framing,
>
> repeat using 30 seconds.
>
> Re-shoot as necessary.
>
> May the force be with you,
>
> *Marshall*
>
> Marshall E Tyler, FOPS
>
> www.TwinChimney.com
>
> Books for the Ophthalmic Photographer
>
>
>
> On Mon, Aug 25, 2014 at 12:55 PM, Adeline Stone <astone@xxxxxxxxxxxxxx>
> wrote:
>
> Hello-
>
>
>
> We have a new neuro-ophthalmologist and I am wondering the set-up for
> external pupil photos? We are following the (adies) moran eye center
> protocol room light at far, near, with reaction, room lights off 5 secs,
> pilo for 30 then room lights off  5secs. I am taking these with an IPad
> which is what we do our upper lid photos with. You can imagine these were
> not very good or easy to getâ€|.
>
>
>
> Any suggestions on equipment would be great so we can get better quality?
>
>
> Thanks,
>
> Adeline Stone, COT  CRA
>
> Diagnostic Services Supervisor
>
>
>
>
>
>
> ------------------------------
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------------------------------

From: "Verdick, Randall E" <randall-verdick@xxxxxxxxx>
Subject: [optimal] Re: Pupil Photos Set-up?
Date: Mon, 25 Aug 2014 19:40:04 +0000

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-æ-²Œq©àzÖ*¶×«ªæ¥ŠÜÿN§’ÏÀuéb*ä-¢wÿäÂDh¶'*8b±By©m„&«yïæj)ÿŠw%¹Ø§*«miÈfz{l*+¢÷«yÖò¶„*ç-®‰âp*&šéâq«b¢{®+Ús
 
**|Sôÿ*¹×OöçmÿŠÇ(*ø*z{bjV§vf²mé^*©eÊšâ¾)^*çÿ!ü¨¹ª**‹m…è§µé*yÚ*r*bz{ÿÊ‹š-è^-æò*‹b~'*¶-j|«z×§¶*'*Ø¬±é¢*«b¢*ŠËk‰»-Š‰ÿ¢*(§(§‚‡í†+¢i®*'¶*'ŠË-®'-—*k¢›Š×*üù^jÇ«z™r¶‹azÇ§uêí…«r¢èZ½ê*qè¯yÛazg¬±¨Šw«®Šÿ¶§ué^µè-*8Z*L¨»ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ

------------------------------

From: CPMC Ophthalmic Diagnostic Center <cpmceyelab@xxxxxxxxxxxxxxxx>
Date: Mon, 25 Aug 2014 15:59:40 -0700
Subject: [optimal] Re: ptosis/dermatochalasis fields & external photos

PTOSIS
What I know: It was my understanding (pre-SOCAL) that the fields & photos 
minimum requirements are dictated/governed by the insurance company's 
guidelines/minimum requirements. Insurances vary a bit, but the basic formula 
works for all.  Furthermore, that if we (photographer) does not follow the 
minimum requirements, the claim would be denied as "medically necessary" then 
becoming an out of pocket cost to the patient as a "cosmetic" surgery. More 
based on the functionality ( the perimetry) than the photo ( cosmetic ) Is the 
lid impeding the vision and to what degree?

In my experience, this meant specifics about what was plotted and stimulus 
size, as well as this meant taking very specific instructions for the external 
photographs.  Yes, although more and more an iPhone or smart phone photo is 
done and is sufficient for insurance needs.

What goes on in our department: For the fields there is no standardized 
stimulus size, I've seen folks plot out entire/complete isopters (why you would 
need to know what's going in the inferior hemisphere for a 
ptosis/dermatochalasis patient is beyond me). I've been doing Goldmann ptosis 
fields since, sorry, before you were born.  I'm old.   It's pretty simply.   
Basically a 4V target and a minimal target ( depending on patient's VA ) of 4-1 
suffices.  Taped and untapped.  You are simply documenting the difference 
between the two.  This is not a threshold test.  Multiple isopters are 
redundant here.

As for the photos I've seen too many variations in terms of what a doctor 
captures if they take the photos or if someone other than a member of my 
diagnostics team takes the photos. Beyond that we take the photos in any room 
that we can, we don't have standardized location/background or any of that. 
When I first started (2011) here at USC, I shared my concerns with our 
Oculoplastics physicians and billing team. No one knew what I was talking 
about. I was shocked but thought heck, if this is what the prestigious Doheny 
Eye Institute was doing all these years well then, there must not be a problem 
right!? Insurance companies are not as discrimentating as we ophthalmic imagers 
are.   A very well known, high volume plastic surgery ophthalmologist here, a 
professor at UCSF, does iPhone photos all of the time without issue.  I haven't 
had a request for external photography for lid ptosis since Carter was 
president...

Where I am now: All of our oculoplastics doctors left to join the Dohney UCLA 
endeavor. I have a new oculoplastics doctor who came from a place that had 
standards in place. She has concerns stemming from a recent RAC audit which 
shows a 69% denial rate secondary to missing or incomplete documentation as it 
pertains to oculuplastics fields and photos. My guess is that the chart 
documentation andor/ the perimetry is what is lacking

In the past I had a team of folks whom I could count on as a resource to answer 
such questions. Unfortunately where I am now, we lack that sort of 
organization. I'm gonna have to figure this out on my own.

What I need:  I need to get my hands on the aforementioned guidelines & minimum 
requirements. What do you all do?   I can provide you with the guidelines.
Denice


Thanks,
_______________________________________________________________________________
Cullen Barnett, COT CRA OCT-C CDOS
Clinic Supervisor, Diagnostic Services
Department of Ophthalmology

Keck Medical Center of USC
University of Southern California
1450 San Pablo Street
Los Angeles, California 90033
Office 323-865-6814  Fax 323-865-9248
cullen.barnett@xxxxxxxxxxx<mailto:cullen.barnett@xxxxxxxxxxx>

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------------------------------

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[optimal] Re: optimal Digest V5 #132 (Away Message)

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