Paul, I completely agree that accepting an angiogram using only 1CC of 25% dye
is less than optimal
Hving said that, the more sensitive SLO’s do a bang up job for most patients,
with clearish media, just fine
If you have extravasated the dye, the patient is less inclined to “please sir,
may I have another”….
In this case, we are willing to accept the perfectly clinically usable, not
fine art images we can get, than ask the patient to step up for another
injection.
My two cents…
Denice Barsness, CRA, COMT, ROUB, CDOS, FOPS
Ophthalmic Diagnostic Center
CPMC Department of Ophthalmology
2100 Webster Street Suite 212
San Francisco CA 94115
(415) 600-3937 FAX (415) 600-6563
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On ;
Behalf Of Paul Paquette
Sent: Thursday, March 10, 2016 4:55 PM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: FA dye dosage
What? Wait, 5% dye? I've only used & heard of 5cc of 10% or 2cc or 25% which
is exactly the same concentration (5x10=50, 2x25=50) & probably the same price.
If you cut back on the dose your early bolus won't be as crisp, your mids will
probably be adequate for most clinical diagnosis on a normal media patient &
lates will fade quicker & have less contrast. That being said, you can always
increase gain or enhance images post FA.
I wouldn't recommend either on less than ideal patients (which seems to be most
of my pts) & definitely wouldn't divide the 2cc/25% concentrations. If you
infiltrate any of that 1cc then you are reducing your concentration & image
contrast that much more.
Paul Paquette
-----Original Message-----
From: Ana Mills <ana@xxxxxxxxxxxx>
To: optimal <optimal@xxxxxxxxxxxxx>
Sent: Thu, Mar 10, 2016 2:40 pm
Subject: [optimal] Re: FA dye dosage
Hi Krista,
Ana here, how does your office manager feel about using the 10% fluorescein? I
use the 10% and I always only use 2.5cc for every patient, to cut costs, and to
cut down on the likelihood of an allergic reaction for the patient. With that
combo, I've noticed that it is very rare that I have patients with
nausea/vomiting or itching, etc., which is nice for everyone. My images very
typically still end up being of very high quality, and we don't blow through
our fluorescein supply too quickly. I'm not sure what the price difference is
between the 5% and 10%, but I think you should try to get your office to start
just buying the 10% and always only using 2.5cc per patient. I've been in the
field for five years now, and so far this is definitely my preferred way of
administering the fluorescein injections. I'm curious to see if they let you
switch!
Ana A. Mills
Ophthalmic Photographer/Technician
DC Retina, Dr. Neal Adams, M.D.
2101 Medical Park Drive, Suite 303
Silver Spring, MD 20902
Business phone: (301) 754-1200
On Mar 10, 2016, at 5:27 PM, Krista Peters
<krista_81@xxxxxxxxxxx<mailto:krista_81@xxxxxxxxxxx>> wrote:
My office manager is wanting to cut costs by lowering the dosage of FA dye from
5cc to 2.5cc. We are using a 5% dye and currently cut the dosage for people
with renal issues and those images are rarely as good as when using the full
5cc. My manager is claiming that lots of clinics are doing this. Do any of you
only use 2.5cc with 5%?? I'd be curious to know your thoughts so I can try to
convince the doctors otherwise.
Krista
