Category Archives: Doctors Information

Cardboard Is God’s Prophet For Optometry

If you knew the future of your business was in jeopardy and how far away in time that change is, would you do something differently?

garbage-402295_640Last night I dreamed I had a temporary job working for a large optical store chain in NY City (I did when I graduated Optometry School).  When I got there all the equipment was so old it was useless.  The batteries in the instrument handles were rotting. The corporate staff who ran the labs was upstairs watching TV as they no longer made lenses in the USA. The lenses came from Alibaba Wholesale of China or were send as complete pairs to customers on line. No one really wasted time shopping in stores that were expensive, old fashioned, and filled with depressed employees.  I tried to get some equipment to do my exams with from some of the staff watching TV but they just laughed at me and said, just give them more plus, their old and that will work. Young people get eye exams on line, they never come here anymore.

This is not imagination. Nearly half the people in America are on some sort of government subsidy (welfare) because they no longer have jobs. Manufacturing Cities, IMG_8992.jpglike Detroit, Memphis, Milwaukee, etc., look like the dystopian nightmare scenes sci-fi paints on your TV screens!  Since it is not really Sci-fi, it has in truth become the neon light of the sounds of silence, that no one hears.  Is it the end of America?  I doubt it, but it is the beginning of a huge new revolution. A revolution where many things die and new ones are born, many win and many lose. Will you be a winner or loser? What have you planned and worked to become?  If the answer is, “I have no plan yet”  then you are planning on losing.

Where do you choose to be tomorrow?  Will you be one of the people that government is planning on giving a “standard basic salary to so that they may find some work to raise them up from that poverty level?  Or are you a disrupter who will use technology to make change, progress, money with pride?

You have a choice before you but not for long.  The choice is not too painful now but will be later. What takes out the pain now is that it is still time to have a fusion of technology and tradition. Later you will have to lose all you own as it will be worthless and then you must start from scratch.  Have you seen this? If you have not noticed it, is is all around you!

Notice the Malls that are closing, and department stores that are going out of business Debeverywhere!  Everything is moving online. You can now shop directly from China via Alibaba.  Cardboard recycling is the new prophet. It prophesies the death of traditional business. There is a torrent of cardboard needing recycling as packages become cheaper to deliver than driving to the store. Amazon is the new supply company that is taking over the world, just as a few companies did in the movie Rollerball.

Change is inevitable as stone and steel comes to life and human form turns to….. We shall see.  The robots are not coming they are here.  You still have time, though.

If you are an eye doctor you can be part of the transition not the destruction and recreation; it is lots less painful.  This requires the Fusion of online home technology and 


in office service technology.  If you combine your in office service with the online homebound service need and product delivery you can transition rather than die and find  job in rebirth, if you are lucky.

Right now there is one chance, work with Vinny Calderon, Aspire Health Solutions and deliver service no one else has been willing to do. If not you have one clear future, it is written on the subway walls and tenement halls……… and it echoes in the sounds of silence.


Note.... Vinny Calderon does not know I wrote this! ...

Janr Ssor, Author,  Founder MeetUps For Intellectual Discussion And Dreams (in progress)



The IPA Is Making Money For You!


Dr Avi Zlatin has spearheaded a new empowerment for all IPA members through a NYOIPA – HOYA collaboration! Dr Ranani and Dr Rubinstein have been key players in making this possible. You will soon be hearing about the Collaboration which will:

  • Get you the best quality lenses anywhere at unbeatable prices
  • Pay for your dues, when you commit to using the services
  • Fund the IPA so that we can sell contracts for you and add value to your shares!
  • You WILL be hearing about this money making deal for you soon!


man-875702_640A Vision Care Contract is in the offing!

Dr Steve Rubinstein has spearheaded what looks like our first contract with a major vision care third party administrator.

Ami, Steve, Avi, myself and Reid Nelson have been working on this for nearly two months now.  A meeting to finalize a deal should be near.  We are anticipating news in the next 3-4 weeks!

………… more to come!


Why Not To Join VS Until Next Year!



MONEY GOES A LONG WAY:  As the New York IPA rose in visibility and significance over a year ago,  Vision Source sought to claim our network as its own. To do this they offered Vinny Calderon and myself Financial reimbursement in terms of lower dues and growing benefits for each of the  new members we signed up. Both Vinny and I refused despite the excellent personal Financial opportunity.  We chose to discuss VS with the board  instead.  The board decided that we would keep the door open for the future but not give up all you have worked for and paid for to VS). VS wants to  see itself as the next OD network in NY.  If we fail they may be. If we fail,  That should however be your last resort because if they are your only network (ipa) then you have NO CONTROL just like being a VSP or EYEMED  service provider!

HOW VISION SOURCE CREATES “ENTHUSIASM”  Vision Source grows by giving HIDDEN (Secret) benefits to those who will enthusiastically promote them. When I joined VS,  five years ago, it was because of the Overwhelming excitement shared by Dr Farkas’ office team. It was also NOT a franchise at that time. Had I known they were being paid (with a discounted fee and bonuses for signups) to be excited, I would not likely have joined even for the great camaraderie of Barry Farkas, Susan Resnick and their team.  I did not ever lose money  in VS and VS does have some good proprietary products to offer.  However, When a single doc is paying out the usual franchise fees they should not expect any big profits!  If you pay 3% of your gross and your gross is near $800,000   $24,000  is what you pay VS!  (A first year discount helps but you have likely traded $$ for lost empowerment).

DIVIDE AND CONQUER: The  VS new new strategy  (Sine your board chooses not to sell our network to them)  is to “encourage” your membership by giving you a first year discount (money). The downside is to your future. They get you into their network, when your board voted NOT to join VS at this time, because it potentially diminishes the NYIOPA’s power to work for you!

Why not come along for the ride this year and be a winner with us!  There is power in unity!



Put The HealthCare Puzzle Together -See The Picture!

  • Optometric visits capture at risk patients between ages 15 –> 45 that PCPS do not see!  We see them for blurred vision. We are the Entry point to health care that is critical before it gets costly.
  • Optometric geographical distribution and office hours, makes us the ideal easy place for patients to come to, not a big central medical office that MD’s are forming for efficiency.
  • Optometric contact with leadership provides access to contacting ACO leadership for entry points.
  • Optometric technology – makes it easy to diagnose systemic disease via retina photography, cheaply, quickly and efficiently.
  • Primary Care Optometry — providing referrals to OMDs is the most efficient use of OMD surgical skills
  • Forming a Cooperative team and Branding ourselves in NY State would likely make us a sought out entry point  for MD / OD healthcare partnerships. Requiring a paradigm shift:
    • Retina Imaging Being Routine
    • Standardized reporting to pcps
    • Referring at risk patients to PCPS for consultation.
    • Taking the initiative by dispensing educational materials
    • Educating patients in our offices (as Dr Hom Suggested)
    • Connecting patients with online dietary advice such as health letters written by leading physicians who promote diet and lifestyle changes
The resultant picture:

How Optometry Might Cut The Cost Of Health Care

I am the president of the NYOIPA,  a NY IPA dedicated to providing quality medical eyecare.  We are building an OD / OMD network to reduce the cost of healthcare in NY.  We plan to do this by creating a primary care optometry that directs surgical care to OMDS to keep them busy at what they do best, tertiary care. At the same time we are using the scope and availability of our network to screen patients who are at high risk but rarely see their PCP, until disaster strikes. These are people between the ages of 18 and 40 who see us for blurred vision but rarely see a PCP because they believe they are “invulnerable.” Certainly diabetes is  a common finding; however,  I believe there are even bigger issues that need the coordinated attention of PCPs and OD’s to help protect our countrymen’s lives and  the future economics our health care insurance industry.

nickikng_blood_vessels_driOne enormous coming personal healthcare disaster and financial behemoth, waiting in the wings is the expense of  hospitalization and disability caused by vision loss, strokes, heart attacks.  Most of these are caused by venous occlusions and hemorrhages.  The great opportunity is that Optometry can diagnose the early signs and help protect our neighbors while keeping down the disastrous expense these events cause our insurance system.

What makes me think this is possible?  I have been in practice over 40 years.  In that time, just like you,  I have seen patients with arterial nicking (from arteriolar sclerosis and hypertensive retinopathy) who,  within a few years or diagnosis, end up with a venous occlusion (elsewhere in their body or in their eyes)  causing blindness,  a stroke, a heart attack or even sudden death.  Fundus photography,  when used as a screening tool, will frequently disclose this pathology (as well as diabetes).  

If we believe in the value of our arsenal of cholesterol lowering drugs, BP meds and dietary modification should these patients not be offered preventive treatment?  Can we afford to not see the preventive option?  Should we wait till the picture is painted with more red blood? The cost of eyecare is small the cost in disability is huge! It would seem common sense to intervene now!  Every OD worth their salt has the tools to do this in their office, now.

In my office retinal photography has been offered as a screening for over 10 years. It is now more common across America.  Progressively thinking companies like VSP, are even offering it in some of their routine vision care plans!

What should this coordinated OD / PCP approach look like?  Every OD

Nurse and doctor team happy thumbs up

should strive to screen their incoming patients at regular intervals for micro-vascular pathology.  The finding of nicking, should be well documented and the PCP should be alerted to this finding.  Patients with this finding should likely  be monitored at regular intervals for progression of this systemic pathology. Though there are no clear clinical standards yet in place, it would seem logical that an annual or biannual imaging and comparison should take place. Obese patients, hypertensive patients and diabetics should likely be seen yearly and reports of progression sent to their PCPs.  

I would recommend that all ODs,  noting these changes,  give their patients a written dietary and lifestyle questionnaire to complete in an effort to look for a common profile that can help the PCP understand the pathology and us help manage the patient’s care.  Though we have yet to formulate such a questionnaire, past verbal assessment frequently points to diets high in carbohydrates, fast food, regular soda drinkers and alcohol consumption.  Stress appears to be a common factor too……however these are all speculative until better studies are available.  Nevertheless, many popular healthcare newsletters clearly espouse this connection.

What should you do now?  I recommend screening as many patients as possible with high resolution retinal photography.  I believe that the research documents below clearly indicate a need for the early diagnosis of not just diabetes but equally as important (if not more) nicking of the veins (hypertensive / arteriolar sclerotic vascular changes).  A small investment now in the minimal cost of retina imaging can prevent a huge expense later in disability and hospitalization. What should an optometrist expect from a referral to a PCP?   At a minimum we might expect testing  to look at treating high blood pressure, cholesterol issues, C reactive protein and high triglycerides.  What is the outcome or value of this process? If the patient is diagnosed, and there is a treatment option progression may be halted.  Even if the patient just modifies their diet and lifestyle to lose weight and be more healthy, morbidity is likely reduced.  Until there is a very detailed process for monitoring vascular changes (which appears to be soon forthcoming) I suggest that reasonable clinical judgment is indicated in monitoring as discussed above.

What is the research evidence for this coordinated OD / PCP approach?   

  • An article in American Diabetes Care:  Retinal Vascular Changes in Pre-Diabetes and Prehypertension New findings and their research and clinical implications.  This review suggests that retinal image analysis offers a novel noninvasive measurement of early changes in the vasculature—not detectable on routine clinical examination—that may allow the identification of individuals at risk of diabetes and hypertension and their subsequent complications…….. read more.
  • Retinal Microvascular Abnormalities Predict Progression of Brain Microvascular Disease: These data are consistent with previous reports that retinal microvascular signs predict white matter disease and lacunar infarcts. In treating WMP as a continuous measure and combining it with lacunar infarcts, we see associations between brain microvascular disease and retinal signs that, though expected based on common pathophysiology, were not seen before. The cumulative brain microvascular disease score that we developed could be a useful research tool in further studies seeking to elaborate on risk factors and outcomes associated with lacunar infarcts and white matter disease.………read more.
  • BRAIN a journal of neurology.  Retinal microvascular abnormalities and subclinical magnetic resonance imaging brain infarct: In this population-based cohort of middle-aged persons without clinical stroke, retinal microvascular abnormalities measured at baseline were prospectively associated with long-term risk of subclinical cerebrovascular disease on MRI, independent of conventional risk factors. The presence of retinopathy signs was associated with more than 2-fold higher odds of cerebral infarct and 3-fold higher odds of lacunar infarct. The presence of retinal arteriovenous nicking was associated with more than 2-fold higher odds of not only brain infarcts but also with incidence and progression of WMLs. Associations were similar in people with and without diabetes and hypertension. read more.
  • Retinal and cerebral microvascular signs and diabetes: the age, gene/environment susceptibility-Reykjavik study.   Retinal microvascular abnormalities and brain microbleeds may occur together in older adults. People with both diabetes and signs of retinal microvascular lesions (AV nicking and microaneurysms/hemorrhages) are more likely to have multiple microbleeds in the brain. Microvascular disease in diabetes extends to the brain….. read more.
  • Retinal microvascularisation abnormalities and cardiovascular risk  Retinal vascular abnormalities appear to be predictive of an increased coronary, and more widely, cardiovascular morbidity and mortality predominantly in individuals under the age of 75….  read more.
  • Retinal Vascular Signs: A Window to the Heart?   How should current information and retinal imaging be translated into clinical usage? A recent review has recommended an updated classification system of these retinal signs, which, because of their close association with hypertension, are often referred to as hypertensive retinopathy. This new classification system divides hypertensive retinopathy into 4 levels: none; mild, which refers to the presence of generalized and focal arteriolar narrowing, and arteriovenous nipping; moderate, which refers to the presence of lesions such as microaneurysms and hemorrhages, hard and soft exudates (cotton wool spots) and severe, referring to optic disc edema. The authors recommend physicians undertake more vigilant monitoring of cardiovascular risk profiles in patients with mild retinopathy and adopt a more aggressive approach to risk reduction in patients with moderate retinopathy, while optic disc swelling requires urgent intervention to lower BP. The presence of these signs could be elicited either through ophthalmoscopy or photography after pupil dilatation. Patients of ophthalmologists and optometrists often have such photographs taken digitally, which are better records than ophthalmoscopic examination and enable monitoring of longitudinal changes in these retinal signs as well as in vascular health.  ….. read more.
  • Retinal signs and stroke: revisiting the link between the eye and brain.  New data, from population-based studies, suggests that many retinal signs, in particular hypertensive retinopathy signs (eg, focal retinal arteriolar narrowing, arterio-venous nicking), may be markers of stroke risk and mortality, independent of other stroke risk factors. Diabetic retinopathy signs (eg, microaneurysms, hard exudates) are similarly associated with incident stroke and stroke mortality. … read more.

The Potential Dangers Of Obama Care – Health Care Reform As Currently Evolving:   Managed Care has its new EMR /  Data Exchange mechanism for evaluating clinical care and choosing the least costly path via “Service Review Committees”.  This may help with misuse obamacareand overuse but it will not lead us down the path to the huge savings that America needs and good health care demands.

“Health Care Reform”  is designed by businessmen for businessmen to make them money. It is designed to make profits for the companies that manage the doctors and hospitals  by restricting access to services.

We need an additional structure to introduce long term change that results in huge savings and huge health benefits long term.  Not short term profits that the current “reform” is designed for.  The current designs for “managed care”  will like make money for its corporate structures for short periods and destroy health care long term. Just as Wall Street takes investors to profits by quarterly evaluations but lead corporations to stagnation and failure through too much cost cutting and lack of  R&D as they dance to the drum beat of quarterly profit reports.  Corporations addicted to Wall Street financing cut corners, minimize services and fail to plan for the long future.  This is a part of why America is sliding backwards economically.  Do this to health care and people will pay with their lives as well as their dollars long term!




Are IPAs The Answer To Managed Care? — A Podcast From The PowerHour!




Listen To The Podcasts Below!

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Feel free to share this/email it/put it on web sites . . . however you see fit.  Great show and thanks again!

powerhourBest regards,


Dr. Gary Gerber

Chief Dream Officer

Women In Optometry!

business womanODS WITH FAMILIES IN MIND:  With a majority of optometric graduates now being women, many are seeking
better quality of lives than that offered by commercial optometry.  Commercial optometry demands long hours, Sunday hours and late nights. For many women this disrupts the family life they hoped to enjoy by being employed and not having to work the long hours they imagined  their own business might require.

ASK NYOIPA DOCTORS VICKI CHENARIDES OR DEBBIE ROODNER: To meet this challenge,  smart women in optometry are starting to buy existing practices and do it in twos!  Two doctors purchasing a single doctor private practice can easily afford it and still get the lifestyle of their dreams that supports a family. As a team, two doctors can set their own hours,  which means less late nights and no Sundays. They can even work just a few days a week each and still have a full time practice; Vicki and her partner Debbie chose this.   In addition they can each cover some holidays and as a result have many of them off with family.  Vicki and Debbie even chose the more challenging route and started cold!

MANAGING A PRACTICE: Managing a practice is much easier too as the responsibilities are shared.  Vacations with family do not have to meet corporate needs,  as a private practice owner you make your own decisions.  When starting cold,  there is a small challenge however,  as you have to learn to lead an manage your staff, until you can hire an office manager; however, this can be avoided when purchasing an existing practice.  Even when starting cold, sharing the opportunity with a partner makes it a fun team building experience.  If you buy an existing practice,  the retiring doctor could teach you how to run it in just a few months time; so it can be more fun and exciting!  Best of all, its yours!

THE FUTURE:  Is this the future for Women in Optometry?   For many the answer is yes as more and more commercial practices demand more and more hours and volume of patients. The profit potential per hour worked in private practice is growing again as medical care comes front and center and IPAs accross America team up for amazing buying power!  Is this your opportunity?   If it sounds like it,  find a partner and start shopping. With baby boomer doctors retiring, opportunities have never been better and it is unlikely they will be again; or,  just start cold as Vicki and Debbie did!  In any case, let the NYIPA help you!

SOON TO GRADUATE?  NEW GRADUATE?   Become an associate member of the NYOIPA and learn how you can benefit from our experience! Talk to our doctors!  You can even talk to Vicki and Debbie!

HOW HAS THE NYOIPA HELPED ITS DOCTORS?   In just the first quarter of our fully legal existence,  the NYOIPA  has added thousands of dollars to our member’s profits!  VCD labs now provides us with the finest lenses in the world and unbeatable prices.  In addition our IPA is receiving  nice fat checks from our national IECP organization for helping to grow our own lab.  This is the amazing part of owning your own business and via the NYOIPA owning part of our national team creation.  Optometry’s future has never looked brighter!  Join the team!



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