Optometric Physician



Vol. 25, #9 •   Monday, March 4, 2024


Off the Cuff: When Clearinghouse Convenience Comes Home to Roost

Insurance claim clearinghouses are essentially hubs where medical providers submit claims electronically. All our medical claims from multiple insurance companies transmit in a single electronic “claim file” that securely goes to the clearinghouse, which then sends these claims out to all the individual insurance plans for us. This claim file contains info about our office, the doctor who provided care, the patient’s insurance IDs, procedures we’re billing and the associated diagnosis codes for these procedures. It’s very convenient. Not only do we submit claims via these services, if our billers made an error that got by our systems, the clearinghouse can catch problems before it gets sent to the plan. Some insurance carriers can process the claim and send a file back to our systems to post the insurance payments to each appropriate patient's ledger. It’s automated billing, processing, posting and payments. Again, it’s all very convenient… until last week.


In our office, we use the web-based Compulink Advantage electronic medical records system. When we signed up, the only clearinghouse option was Emdeon which later became Change Healthcare and in 2022 was bought by United Healthcare/Optum. Anyway, it takes about 2-3 weeks to get the clearinghouse all set up with the different medical plans we accept. Last week I went to send a claim file and got an error message. No worries. It’s pretty rare. It has happened before when they’re running maintenance, or sometimes the file that generated is bad and it just has to be deleted and recreated. The alert said to try again later. The next day I got the same error. Very odd. I had my staff call Compunlink, and they said there’s an outage at Change Healthcare and to try again on Monday. Later I found an email sent Feb 22 that talked about the server outage. The following day another email came stating that Compulink was meeting with Change about the outage. Excellent. The next email that day was not so excellent. Change Healthcare/Optum’s servers weren’t just down, they were successfully cyber attacked “by foreign state” actors. The FBI and Homeland security are involved. On Monday more details came out that the ransomware group BlackCat was responsible, and Change/Optum doesn’t know if or what protected health information was compromised. This attack isn’t affecting only optometry. Thousands of healthcare companies and pharmacies are affected.

Compulink has been very transparent. They’ve been working on processes to allow us to submit claims directly to plans (hopefully up and running by Monday, March 4), essentially going around the clearinghouse, and even suggesting jumping ship to new clearinghouses. Signing up with a clearinghouse usually takes weeks to accomplish even when there isn’t a mass exodus of providers. I’m sure this would be a considerably longer process now.

At the time I write this, there’s been no new updates on the status of the Change Healthcare/Optum servers. Without medical claim submissions, there’s no revenue from medical services. Because of this, Optum Pay has set up a relief program with a payment relief website to get money to providers to continue running their practices based on averages that were being paid prior to the outage. As for me, I’m waiting to see how this plays out. I have enough in reserves to keep everything running for a while. Fortunately, as optometrists, we still have revenue coming in from vision plans. While I don’t want to be reactionary and potentially create bigger problems for my office, I think it’s prudent to stay informed, monitor the situation, and make smart decisions when decisions need to be made.

Shannon L. Steinhäuser, OD, MS, FAAO
Chief Medical Editor


Want to share your perspective?
Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.



A Comparative Analysis of IOP Measurement Accuracy With Reused iCare Probes

This prospective comparative analysis assessed the accuracy of reused iCare probes after disinfection with 70% isopropyl alcohol and ethylene glycol compared to new iCare probes and Goldmann Applanation Tonometry (GAT). A total of 118 eyes from 59 patients recruited from the Aravind Eye Hospital glaucoma clinic in Tirupati, South India were included. Intraocular pressure (IOP) was measured on each eye using a new iCare tonometer probe, an iCare probe previously used and disinfected one time prior (once used probe) and five times prior (multiply used probe), as well as with GAT. Probes were disinfected after each use with 70% isopropyl alcohol swabs and ethylene oxide sterilization. Agreement was evaluated with intraclass correlation coefficients (ICC), mean difference in IOP values with limits of agreement, and Bland-Altman plots among IOP measurement approaches.

Compared to new iCare probes, both once used probes (ICC=0.989; 95% CI, 0.985-0.993) and probes used multiple times (ICC=0.989; 95% CI, 0.984-0.992) showed excellent agreement, and the mean difference in IOP was minimal for both once used probes (0.70 mmHg, 95%CI 0.29-1.11) and multiple used probes (0.75 mmHg; 95% CI, 0.66-0.82) compared to new probes. Bland-Altman plots demonstrated minimal differences between new and reused probes across the spectrum of IOP. When comparing multiple used probes to once used probes, there was a high level of agreement (0.993 [95% CI, 0.990-0.995]) and negligible mean IOP difference 0.04 mmHg (95% CI, -0.32-0.40). Additionally, ICC values for new probes (0.966; 95% CI, 0.951-0.976), once used probes (0.958; 95% CI 0.940-0.971), and multiply used probes (0.957; 95% CI, 0.938-0.970) compared to GAT were similar and all showed excellent agreement. Both new and reused iCare probes underestimated IOP by 2-3 mmHg compared to GAT.

In this prospective comparative analysis, researchers found that reusing iCare probes up to five times did not compromise the accuracy of IOP measurements when disinfected with 70% isopropyl alcohol swabs and ethylene oxide. Reusing iCare probes has the potential to transform care by reducing cost, decreasing environmental waste, and allowing for glaucoma screening camps and increased glaucoma monitoring in low resource settings leading to earlier identification and treatment of glaucoma.

SOURCE: Vedesh M Kulkarni, Elizabeth C Ciociola, Ashok S Vardhan, et al. A comparative analysis of IOP measurement accuracy with reused iCare probes. Ophthalmol Glaucoma. 2024 Feb 22:S2589-4196(24)00032-2. Online ahead of print.



Could Children's Myopization Have Been Avoided During the Pandemic Confinement?

The objective of this study was to evaluate the association of the presence of conjunctival ultraviolet autofluorescence (CUVAF) with the level and progression of myopia and the impact of reduced sunlight exposure during the COVID-19 pandemic confinement (PC). A retrospective observational study was carried out using three cohorts, children (9-17 years old), young adults (18-25 years old), and adults (>40 years old) with myopia (≤0.75D) and at least three annual eye examinations (before and after PC). All participants underwent an automatic objective refraction and CUVAF area analysis. All the participants filled out a questionnaire regarding lifestyle and myopia history.

The 298 recruited participants showed that during the PC, children's and young adults' myopia progression rate increased on average by -0.50 and -0.30 D/year, respectively, compared with the pre-pandemic level (p<0.0001 and p<0.01). A significantly greater progression was observed in those with low baseline myopia compared to those with moderate or high myopia (p<0.01). CUVAF showed its protective effect associated with outdoor activity (OA) with regard to the age of onset of myopia and mean diopters (p<0.01). In fact, although there were no differences in the increase in diopters between children with and without CUVAF during the PC, those who had CUVAF started with lower gains (-0.3 D/year) compared to those who did not (-0.5 D/year; p<0.05). The myopia treatments (atropine drops, Ortho-K, and MiSight® contact lenses) showed a reduction effect in myopic progression rate post-PC in comparison with non-treated children (p<0.0001, p<0.0001 and p<0.01, respectively).

The strict restriction of OA during PC led to the rate of myopia progression doubling among children and young adults. This progression occurred mainly in children with previously low myopia, and with CUVAF, as a biomarker of OA, reflects its potential to provide benefits in the form of recommended behavioral changes to protect against the development of myopia.

Miriam de la Puente, Cristina Irigoyen-Bañegil, Aura Ortega Claici, et al. Could Children's Myopization Have Been Avoided during the Pandemic Confinement? The Conjunctival Ultraviolet Autofluorescence (CUVAF) Biomarker as an Answer. Biomedicines. 2024 Feb 1;12(2):347.

Long-Term Intraocular Pressure Fluctuation and Epiretinal Membrane in Patients with Glaucoma or Glaucoma Suspect

A relationship between glaucoma and epiretinal membrane (ERM) has been suggested previously. Researchers investigated the association between intraocular pressure (IOP) fluctuation and idiopathic ERM in patients with glaucoma or glaucoma suspects. Among patients with glaucoma or glaucoma suspects, data from 43 patients with ERM and 41 patients without ERM were reviewed and analyzed in this retrospective study. The long-term fluctuation of IOP was defined based on the standard deviation of IOP across all visits.

Patients with ERM were older and had a higher SD of IOP and a higher proportion of having a history of cataract surgery and greater macular thickness (p=0.018, 0.049, 0.013, and <0.001, respectively). In multiple logistic regression analysis, the high-IOP-fluctuation group was associated with the presence of ERM (p=0.047). Among patients with ERM, eyes with stage-3 or -4 ERM had worse visual field defects based on mean deviation than those with stage-1 or -2 ERM (p=0.025).

Long-term IOP fluctuation was associated with idiopathic ERM in patients with glaucoma or glaucoma suspects. Idiopathic ERM could serve as a biomarker for long-term IOP fluctuation in glaucoma patients, particularly in clinics where measuring long-term IOP fluctuation during the first visit is not feasible due to its time-consuming nature.

SOURCE: Kyoung In Jung, Jiyun Lee, Da Young Shin, Chan Kee Park. Long-Term Intraocular Pressure Fluctuation and Epiretinal Membrane in Patients with Glaucoma or Glaucoma Suspect. J Clin Med. 2024 Feb 17;13(4):1138.




Industry News


• Optos announced a milestone of more than 25,000 devices installed worldwide and the collection of 2,500 clinical and peer-reviewed studies spanning 235 disease states. For more than 30 years, Optos has aimed to positively impact the standard of retinal imaging technology.
• The National Rosacea Society (NRS) launched a Seal of Acceptance program to identify skin care and cosmetic products that may be suitable for people who suffer from rosacea. Learn more.
• CoFi, a provider of a multi-provider payment software platform for eyecare practices, announced that patient payments with the CareCredit credit card, a Synchrony solution, can now be processed through CoFi’s multi-party payments platform. Read more.
• Prevent Blindness declared March Workplace Eye Wellness Month. Read more.








Journal Reviews Editor:
Shannon L. Steinhäuser, OD, MS, FAAO

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