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    New world order of glaucoma presenting strong challenges


    Ophthalmology goes online

    Meanwhile, physicians must grapple with new technologies for delivering care, Dr. Iwach said. Younger people are willing to visit their doctor by video, and many are seeking eye care from primary care physicians in this way. The company, Doctor on Demand, offers medical consultations, including for some eye symptoms by video within minutes.

    “In the Bay Area, there are companies putting serious money into this and we need to know how to respond,” Dr. Iwach said.

    Ophthalmologists may need to answer questions about data on their practices that is online as well, he said. He cited the example of ProPublica, a public interest news site offering a data base that links individual practitioners with amounts of money purportedly received by industry. In Dr. Iwach’s case, information on the site was incorrect.

    Information collected on practitioners through the Physician Quality Reporting System (PQRS) is also public. “I started scanning it and it just didn’t make sense,” Dr. Iwach said. “So that’s the upside or downside of participating in all these programs.”


    One product cures all?

    Ophthalmologists also have to answer questions about products advertised on the internet, Dr. Iwach said. A website advertising one product claims they can help with glaucoma, cataract, corneal disorders, eyestrain, dry eye, retinal diseases, and other disorders, but disclaimers make it look suspicious. “I don’t think it’s ready for prime time, but this is what’s out there,” he said.

    Internet misinformation got Dr. Iwach thinking about bizarre aspects of ICD 10 codes. One code covers being bitten by a parrot, he noted. Another covers being sucked into a jet engine – for a second time.

    “These are not made up,” Dr. Iwach said. “It’s extraordinarily frustrating for the clinicians. We’re here to help patients. We understand the issues of cost, but we are not the main cost factor in this whole picture. If you feel frustrated, you’re not alone.”

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