They [show they care] with their check books.

on December 14th, 2017 | Filed under Optoblog

The drug companies report to CMS regarding how much they spend on each doctor for marketing, research, etc at the website, so feel free to search your own name. You can also search by the company making payments: (Alcon, J&J, Coopervision, Allergan, etc.
You can see my numbers here.

2015 Me: 59.27 Mean OD: 735.78 Median OD: 135.78
Mean physician: 3271.25 Median physician: 160.38
2014 Me: 36.81 Mean OD: 637.37 Median OD: 127.46
Mean physician: 3382.39 Median physician: 168.37
2013 Me: 86.06 Mean OD: 429.08 Median OD: 94.72
Mean physician: 1583.47 Median physician: 111.25

What I notice immediately is that the mean and median numbers are WAY different, so there must be a few doctors out there making TONS of cash from the pharmas and medical manufacturers.

Also…why are MY numbers so low??? What’s up with that!? I guess I don’t get invited to as many free lunches as the mean and median optometrist.

From what I can tell by searching eye doctors that I know, Alcon had a huge marketing push in 2015. And also Alcon beats J&J and Coopervision in the free lunch dept.

Also note how the median optometrist is just a big ball-o’-nothin’ compared to the mean other doctors.

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@ the Optotrician: actual eye doctor

on December 12th, 2017 | Filed under @ the Optotrician, Optoblog

Back when I worked at Walmart, I overheard the following conversation:

A guy wants to buy contacts but doesn’t have his Rx on him and his doctor is in another state. Walmart optician explains the Rx can be faxed to us since we need the written Rx and not just the contact boxes.
Optician: Was the exam done at a Walmart?
Guy: No, it was at an actual eye doctor.

Read more @ the Optotrician posts.

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Optoblog Poetry #006

on December 12th, 2017 | Filed under Optoblog, Poetry

Opt School or a house?
Electricians make more cash.
Too late to drive truck?

As a mid-career optometrist still 20 years from any kind of retirement, I often wonder if I made the right decision. I’ve had to do some electrical work on my 1960 house (because that’s the kind of house an optometrist can afford) and really enjoyed it. Also I really like driving, so I probably should have been a trucking electrician or an electrical trucker.

If you liked this one, read more Optoblog poetry.

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Presentation by Dr. Lester Caplan about Indian Health Service

on July 23rd, 2015 | Filed under Optoblog

I was an Indian Health Service optometrist for two years, but my dad was one for 34, beginning in 1971. I believe he was the first PHS-IHS optometrist to join and then serve a full 30 years. (There may have been others that actually retired before him, but they had previous military time-in-grade.)

One of his contemporaries was Dr. Les Caplan, OD, MEd, FAAO. Dr. Caplan is an award-winning optometrist of historical significance. He was the first optometrist assigned as the Clinical Consultant for Optometry to the director of the Indian Health Service. Back in the early 70s, optometrists were barely being integrated into the IHS healthcare system as real eyecare physicians, so Dr. Caplan traveled around the country to help make this monumental transition, paving the way for increased scope of practice for optometrists in all modes of practice.

In June 2015 at the AOA meeting in Seattle, there was a presentation sponsored by the Optometric Historical Society that Dr. Caplan gave, and I got a hold of his presentation. The powerpoint file was 128 MB, so I condensed it to an 18 MB PDF, which you can view here with Dr. Caplan’s permission.

On page 39 there is a picture of some wetlands viewed through an airplane window. That is actually a 5 minute silent video filmed in 8mm that shows highlights from Dr. Kaplan’s trip to Alaska in 1971.

Anyone interested in Indian Health Service optometry should go through the entire presentation. It is also of significance to anyone interested in optometry’s advancement in scope of practice.

Click here to read PDF

Click here to read PDF

To learn more about the AOA’s optometric history initiative, read this.

There is an award given to PHS optometrists named after Dr. Caplan.

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optoblog movie short #001: The Air Puff

on March 24th, 2015 | Filed under Optoblog, Scripts

Title: The Air Puff

Author: David J. Langford


Fade in.


DR. LANGFORD, an optometrist that smiles like a clown, tosses his clipboard on the adjustable table behind three items of ophthalmic instruments. He lowers the table as JANAE, pretty and wholesome, sits down on the stool on the other side of all the machines.


So...Jay-Nay? What brings you in for an eye exam today?


Juh-Nae. Oh, just a check up.


Okay, then. Let’s start with this machine.


Oh, no. Is this that puff of air thing?


Yeah. This one is not too bad.




It’s the most gentle non-contact tonometer on the market.



Janae puts her forehead on the rest. The doctor clicks the button. The machine whirs, and we hear a PUFF of air.


(high, almost squeal)


She sits back and rubs her eye.


Ready for the next one?


I guess...

The machine whirs again then PUFFS. Janae recoils the same way.


(rubbing second eye)

I’m glad that’s over with. What does that machine do, anyway?

Dr. Langford tries to repress his wierd smile.


It checks eye pressure, which is important to know because if it’s outside the normal range, you could have a serious eye condition.

Janae blinks a lot.


My eyes feel dry now.


Okay, let’s move on to this machine. It gives me a close idea of any glasses prescription you might need. Chin on the chin wrest.

She puts her head up to the autorefractor. It beeps and then-PUFF!!


Ah! Hey! I thought we had already finished the puff of air thing!


Did that puff at you?




Huh, let’s try the other eye then.

She puts her head back to the machine, but the monitors shows that she’s squinting in anticipation.


Okay, for the machine to take the measurement, you’re going to need to open your eye wider.


But I don’t want it to puff at me.


Just a little wider...

Janae’s eye opens just barely more and...PUFF!


Ow! It did it again.


(holding up the print-out) printed out these glasses prescription numbers, so it can’t be broken.


But it blew air at my eye!


I’ll have a look at it later. Let’s move on to the last machine in this room.

He holds out a clicker for her to take.


It’s going to test your peripheral vision. Every time you see a flicker in your side vision, just click on the button. It takes about a minute per eye.


Okay, that doesn’t sound so bad...

She takes the clicker from Dr. Langford and puts her forehead up to the machine. She SEES THE FLICKERING SQUARES on the screen.


So when I see those dealies I just click?


Yup, but don’t move your eyes around just look straight ahead. Okay...begin.

She presses the clicker and- PUFF! She sits back.


What the...


Keep clicking!

She gets in the the machine again. She clicks, and...


PUFF! Janae clicks, puffs, and yelps over and over. Dr. Langford looks on with a sly grin.



Doctor, every time I clicked on the button, it gave me a puff of air in the eyes!

Dr. Langford looks at his display.


Oh, you know what? I had it set to the serial tonometry setting. Sometimes it’s helpful to take multiple readings to see what your eye pressure is over time. Oh well, no harm done. Let’s go into the exam room.


Janae enters rubbing her eyes and sets her things down. As the doctor enters, she looks in the mirror on the wall to see that her eyes are bright red.


My eyes are really red!


Don’t worry, that will go away in a minute. Have a seat on that dentist-looking chair.


I hope you’re right.


Of course I’m right.

He scoots a big Phoropher up to her head.


Now, which is better? One or two?

We see an eye chart, and switching between one or two, WE DON’T NOTICE ANY DIFFERENCE.



Black Screen




And now which is better, one or two? One or two?


I don’t...uh..

Dr. Langford pulls the machine away.


Okay, it looks like you don’t need glasses still.


All that just to find out-


Okay, one last thing, I’m going to look inside your eyes with my microscope.

He swivels a slit lamp over. It looks kinda’ like those other machines in the pretest room.


Doctor, look...I’d rather not do this one.


Well, I need to look inside your eyes to complete the exam.


But couldn’t you do it with something...else?

He pulls out an ophthalmoscope, an innocent-looking flashlight.


I guess I could use this.


Let me see that.

He hands it over. She twists it apart, looks, and reassembles it.


Yah, I guess that’s okay.

He takes it back and gets...uncomfortably close to her face.


(pushing back)

Whoa, whoa!


With the ophthalmoscope, I have to get in close. You chose this one. Don’t worry. Nothing touches you.

Janae still has a defiant look of doubt.


Just a quick thing, and then we’re done.


(a look that says don’t cross me)

Real quick.




It won’t hurt.




Fine. Get it over with.

He brings the “flashlight” in again, still uncomfortably close.


And then... PUFF! She recoils.


That’s it! I’ve had it!

She stands up from the exam chair.


I’m not paying for this!

She starts to walk out.

A BLACK SPOT BLINDS her central vision and full view of the doorway.

Janae hits the wall. She holds her forhead.


You are sick!

As she exits she has fire in her red, red eyes.


Dr. Langford strolls to his car. As he gets out his keys.. WHACK! A force of nature- a flash, which vaguely looks like Janae, body checks him onto the car. His limp body then slides to the ground.

Janae brings around the car a big air compressor on wheels. She holds open his eyes while pressing the trigger. Air whooshes his hair and then her aim corrects to his eyes.


(as she alternates the aim between his eyes)

Which is better now, doctor? One! or Two!

Dr. Langford whimpers, eyes red. Now Janae has the weird smile.



Dr. Langford gets really close to Janae with an ophthalmoscope...and steals a kiss.


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Fun Fact #001

on January 8th, 2015 | Filed under Asides, Optoblog

The phrase “apple of thine eye” is really a mistranslation. We should be saying “Little Man of the Eye” or “Little Doll of the eye.”
If you are the little man in God’s eye that means He is watching over you so closely that whoever looks at His eyes will see you in His cornea’s reflection.

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The Mysteries Surrounding Imagine Dragons, Matt Meese, and On Top of the World Music Video

on June 21st, 2014 | Filed under Asides, Optoblog

The “On Top of the World” music video by Imagine Dragons is my most favorite music video of all time.  The video portrays a faked moon landing while referencing Stanley Kubrick and late 1960s pop culture.  It was written and directed by Matt Eastin and Corey Fox.  In addition to Imagine Dragons, it features the lead actor from Napoleon Dynamite, Jon Heder, and many from the cast of StudioC, BYUtv’s sketch comedy show.   Guest appearances also include Whit Hertferd, Marvin Payne, the monkey from Friends, members of New Electric Sound, and Robert Connolly from Fictionist.  Also appearing is Alex Sermon, wife of lead guitarist Wayne Sermon, and Aja Volkman, wife of lead singer Dan Reynolds and from the band Nico Vega.

Making Of

Some great coverage regarding the making of the video includes:

Studio C and Matt Meese

Interestingly, many of the StudioC cast members are in the video, but not all of them!  Here is a list of Studio C cast members and their roles along with a link to their twitter accounts:

Curiously missing are Matt Meese, Stacey Harkey, and Stephen Meek.  It’s possible that with a tight shooting schedule that the three of them were out-of-town or otherwise disposed, but is that likely?  Sure, neither Stacey nor Stephen are  the creator of Studio C, so they may not have been asked to be in the music video.  (However, why not??!!!???   What is wrong with you guys?  Will Stacey and Stephen ever speak out about this injustice?)  Now, Matt Meese on the other hand created Studio C.  Why wouldn’t he be in the Imagine Dragons music video with almost all the other Studio C cast?

UPDATE: Read this comment by an anonymous poster who seems to know what he or she is talking about.

Well, it turns out Matt may be in it after all.  Take a careful look at this image.

TV viwers watch the Moon Landing via a shop window.  Is Matt Meese there?

I propose that the guy in the brown fedora wearing sunglasses is none other than Matt Meese! (UPDATE: The aforementioned anonymous poster says the Fedora Guy is Monson Hayes.)

Notice the face in question is baby smooth with faint lips just like these photos of Matt Meese trying not to laugh:

Matt Meese almost laughing.

Matt Meese almost laughing. h/t @Studio_C-Fan

[UPDATED: IMDB now says, :(13 Nov 2013) Music video released for Imagine Dragons “On Top of the World” – Window Watcher”  I had previously been informed that IMDB said he was a Russian cosmonaut, which he clearly wasn’t.  Sorry about the much-ado-about-nothing.]

So I apologize to Matt Meese for accusing him of not being in the video when he actually was.  It’s possible that Stacey and Stephen were in the video but their scene was cut.  I would really like an explanation.  It’s curious that more people involved in the making of the music video haven’t blogged every detail about their involvement.  The only one to do so that I’ve seen is the costume designer (see link above).  Did they have to sign non disclosure agreements  or something?

Hot Topic

Imagine Dragons currently have four official videos. This narrative could be considered controversial because, well, just ask anyone, “Do you think we put men on the moon?”

You are likely to get strong responses for Yes and No, Read the rest of this entry »

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The Problem with Godzilla (2014)

on May 17th, 2014 | Filed under Asides, Reviews

I took my son to see Godzilla in 3D on opening night. It was great that we shared the experience, but the Godzilla movie left me emotionally unsatisfied for 3 reasons:

(Spoilers ahead)


  1. I thought the movie was about the father, but then they take a turn, and I guess we follow the son the rest of the movie even though the father had all the emotion in the first act.
  2. Everyone knows you don’t kill the mentor until the end of the second act.  If the father isn’t going to play the hero, then I guess he is the mentor.  They kill the father in the early second act.
  3. Fine, you kill the father early on, but you’re not going to let us see any catharsis with the father and son? Seriously, the closing image should have been the son at the father’s grave or something. Emotionally I want to see the son reconcile with his father.

Anyway, other than not being emotionally satisfying, Godzilla 2014 was…fine.


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Allergy Eyes Handout

on May 15th, 2014 | Filed under Optoblog

I posted on my practice website the information that I wrote for a patient handout on allergy eyes. There’s some new stuff in there reflecting the current research on intestinal flora and allergy symptoms.
See also:

It appears that most of America’s health problems could be solved by ceasing the Standard American Diet and implementing the Paleo/Atkins/LowCarb diet. I’m betting research will someday show it helps with glaucoma, AMD, dry eyes, MGD, and many other eye conditions related to inflammation and blood vessel pathology.

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I am Dropping Participation with BlueCross

on March 28th, 2014 | Filed under Optoblog

This is the e-mail I just sent to BlueCross:

Dear BlueCross,

It is with regret that I inform you that I wish to terminate my contract with BlueCross and no longer be in your network. I understand that I have to continue seeing BlueCross patients for 90 more days.

If you are interested in why I am leaving you, my accounts receivable with BlueCross patients is unacceptably high.

Since I am an optometrist, I need fast, easy access to whether a member has a routine eye exam benefit (S0620, S0621) and whether a contact lens evaluation is covered (92310).

For non-Regence plans, I have to make lengthy phone calls and navigate through terrible phone trees before finally talking with a representative. This process takes longer than performing the actual exam.

While Regence has a nice website for explaining benefits and is good about paying what I expect, every other BlueCross association is unpredictable about paying what I’m expecting. I often have to send out statements or refunds. Usually statements. Hence the high accounts receivable.

I know this will hit you in the wallet as well since I am the lowest-fee eye doctor in Cache Valley. If in the future BlueCross comes out with a website that allows an optometrist to see vision benefit details for any BlueCross member from any state/association, then feel free to let me know, and I’ll reconsider. I would also reconsider if a new rule allowed one to participate only with Regence and exclude all other BlueCross associations.

David J. Langford, O.D.

I find it unacceptable in this day and age that I can’t look up vision benefits for an entire insurance company in one place. This probably has something to do with BCBS being independent associations instead of one giant insurance company. It is still ridiculous and a big pain in my side that won’t be there in 90 days.

I feel sorry for my BCBS patients. If it’s any consolation, the Utah State University BlueCross beneficiaries can send in their receipt and get 70% reimbursed for a routine eye exam done out-of-network. Not bad.

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