Article Date: 12/1/2005

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Bring CVS Treatment Into Your Practice
Treating Computer Vision Syndrome benefits your patients as well as your bottom line.
KAREN HIGASHI-REYNOLDS, O.D., Colorado Springs

Any patient who spends time in front of the computer is a candidate for CVS evaluation.

Why should you incorporate treating Computer Vision Syndrome into your practice? For one thing, it's a specialty that your patients will love. For another, it will improve your practice's bottom line. Just ask your patients if they use the computer. Nearly every one of them will say they do. Now, ask how long they spend on the computer. If they say more than two hours a day, you have the potential to add a "specialty" and extra income to your practice.

I decided that I needed to purchase the computer vision tester after attending a lecture by Cary Herzberg, O.D. He made me feel guilty that I wasn't offering a solution for my patients who complained of tired eyes at the end of the workday, or headaches while working on the computer. So I purchased the adult PRIO Vision Tester and the child PRIO Vision Tester. These were two of the best investments I've made for my practice.

I've had my CVS tester for about three years now and the equipment paid for itself within a month. The fees we charge for the computer evaluation, plus the sale of computer-specific glasses generate extra revenue.

How to set fees

There are several ways you can incorporate computer evaluation into your exam fees, so you will need to decide which one will work best in your practice. Here are a few to consider:

► Charge a small fee for your specialty "computer evaluation" in addition to your regular examination fee. I've tried this and it works well. My patients don't complain about the additional fee, because they see the benefit of this procedure.

► Raise your regular examination fee. Keep in mind, though, that with managed care plans, if you incorporate the computer evaluation fee into your regular exam fees, then you cannot charge the patient extra. The benefit of incorporating the computer evaluation into all of your regular examinations, though, is that you can evaluate every patient for CVS.

If your patient's chief complaints are headaches or eyestrain after working on the computer all day, along with dry eyes, you can bill their medical insurance. Code 367.53 for spasm of accommodation, and 375.15 for dry eyes. The patient now knows that this is not just a "vision" problem, but also a "medical" problem.

Computer Vision Syndrome: Treatment in Action
by Richard S. Kattouf, O.D., D.O.S.
Who exhibits the much-talked-about Computer Vision Syndrome (CVS)? Potentially any person on a computer more than two hours per day. The symptoms could include any or all of the following:

Headache: due to focusing problem created by accommodation issue.
Ergonomics: shoulder and neck discomfort, due to patient manipulating his/her working distance and posture due to focusing problems.
Dry eyes: due to decreased blink rate.
Tired eyes: due to focusing problems.
Ghost images: due to tear distribution and accommodative fatigue.
Short attention span: due to overall visual discomfort. The patients want to stop the activity.
Blurred vision: due to tear layer alteration, focusing issues and environmental myopia.

The reason for all of the above symptoms is lag of accommodation (LOA). In simple terms, the patient's eyes are fixed at a working distance of twenty inches, but the brain is focusing well beyond the computer screen. The eye and brain are in a "battle" to get the object in focus. This causes significant visual stress. The lag of accommodation is greater when viewing pixels (computer characters) as compared with solid lines found in normal print.

You can elicit CVS subjectively by asking the patient if he or she is experiencing some or all of the above symptoms. These types of questions can be part of a medical case history. An objective method of diagnosing CVS is to measure with the use of a computer simulator, like the one by PRIO. I personally have compared LOA with solid print versus computer characters; there's no doubt that pixels create a greater LOA.

CVS testing requires more time, skill and knowledge. This requires an additional professional fee for service. Optometry has a history of giving its services away. Do not give your services away. The fee should be between $25.00 and $39.00. The results of the CVS evaluation will lead to a multiple prescription for the patient. A specific prescription used for the computer eliminates LOA and most of the symptoms listed here.

The computer simulator is placed at the distance of the patient's CRT (computer) on the reading rod of the phoropter. Perform retinoscopy through the aperture of the simulator with both of the patient's eyes wells opened. The patient reads computer characters as you perform the testing.

There are many different lenses that can be used for CVS spectacles. Single vision, readables and access lenses are just a few of the possibilities. The addition of CVS as an optometric specialty can reap large patient and financial rewards.

Case In Point

Following is a good example of how specialty optometry significantly increases unit sale per patient:

51-year-old female
•   Subjective and objective CVS
•   Dress glasses and computer glasses prescribed at a total fee of $900.00
•   Exam charge $98.00
•   CVS evaluation $39.00
•   Computer glasses relieved all symptoms except dry eye syndrome.
•   Dry eye work-up indicated need for punctal occlusion. Reimbursement from medical carrier $390.00.
•   Total collection for professional services and materials: $1,427.00.

Great services to your patient population and increased income are what all practices must strive for.

The benefits don't stop there

What other benefits can treating CVS bring your practice? My patients like the additional time I spend with them trying to find just the right prescription for their "computer glasses." They always thank me for being so thorough. So, not only are you making more money by bringing this specialty into your practice, but your patients think you're great, too! 

Making converts

Let's discuss how your patient benefits from your Computer Vision specialty. Computer glasses help relieve their eyestrain. So many times I've heard my patients say that their eyes feel so much better after using their new computer glasses.

It's amazing how long it takes some of my patients to realize that they should get computer glasses. Several had never worn any correction in their lives. In fact, you'll find that their distance vision is often in the 20/20 to 20/25 range, so they don't think they have a problem. Even after I evaluate their eyes with the CVS tester, they still don't think they have a problem. So, back they go to sitting at their computer monitors all day long with the same symptoms.

After another year goes by, they come in with the same complaints of headaches, eyestrain and blurred vision after working on the computer all day. Eventually, they give in and purchase a pair of computer glasses. And when our office makes that follow-up call, they are always so happy with their new glasses.

Going back for seconds

I've found that the initial prescription I find with the PRIO tester is not always the prescription I'm going to give my patient. Sometimes I over-plus the prescription through the CVS tester, so I'll back the prescription out about 0.25D. It's never more than that. This is why I always trial frame the prescription and have the patient sit at my computer for a while. It's so funny to see patients flip the trial frame up and then down, up and then down, comparing their vision with the lenses and without. They can't believe the difference the lenses make.

If you have a difficult time selling a second pair of glasses to a patient, keep in mind that many companies will help subsidize the cost of computer glasses. Often, your patients will let you know that their company pays for computer glasses. Just write a letter to their Human Resources department or ergonomics department. Our CVS system manufacturer provides a wonderful kit containing letters, forms and coding assistance.

Meet the candidates

Computer glasses make video games more comfortable.

As you can imagine, the best types of patients for computer glasses are those who stare at a computer screen all day long, such as computer programmers, editors, help center personnel, etc. But adults aren't the only ones who benefit from computer glasses. Think about how many children play video or computer games. Their eyes are red and tired after playing for hours on end; I've seen it first hand.

A couple of years ago, my 5-year-old son was playing on the computer at my office while I was seeing patients. After a few hours he said, "Mommy, my eyes hurt." I looked at his eyes and they were bloodshot. I put him behind the Kids Tester and found he needed +1.00D OU. This doesn't sound like much correction, but it's amazing that every time Matthew is on the computer, he's wearing his computer glasses — I don't have to nag him. He knows that his eyes feel better with his glasses on. He also wears them while playing with his Game Boy.

Parents are always concerned about their kids hurting their eyes playing on the computer or with video games. Evaluate their child for CVS. Often you'll find at least +1.00D. When I see this, in addition to an imbalance of the child's NRA and PRA, I have a talk with the parent about the child's focusing system. While the child is on the computer or playing a video game, his or her eyes should feel comfortable, so we discuss computer glasses.

Prescription pearls

I use near variable focus and single vision lenses for computer glasses. There are several near variable focus lenses on the market; with experience you'll learn which lens works best for your patients.

Many patients try to use their everyday progressive lenses for the computer. If you find that they raise their head to see their computer monitor, show them the difference between their progressive and the specialty near variable focus lenses.

I prescribe a single vision lens, using the patient's computer prescription, for a person whose near and intermediate prescriptions are identical. Whichever design you choose, remember to educate your patient not to walk around the office with either of these lenses on. Also warn them that anything further away than their computer will be blurry. As much as my patients love their computer glasses, they say that if they walk around the office wearing them, they feel sick.

The near variable focus lens designs claim that they have a small portion on the top of the lens allocated for distance viewing, but most patients will not dip their heads to use this portion. So my patients keep their computer glasses at their desks.

The most important option to prescribe for these lenses is a premium anti-reflective coating. Remember that our goal with computer glasses is to make the patient's eyes feel comfortable. Reducing glare really does help.

Get ready for success

Once you start prescribing these lenses you'll find that your patients will talk about their computer glasses much more than their normal, everyday glasses. Many of my patients were referred by a co-worker or friend who raved about their computer glasses. What I like about this specialty is that you really don't need to do external marketing. I just ask every patient about his or her computer usage. If I notice on their patient history form that they use a computer, I ask more questions. That's all.

I know I'm glad I brought computer vision treatment into my practice, and I know that my patients are happy too! OM

Dr. Reynolds is in private practice. You can reach her at msvcvision@ yahoo.com.



Optometric Management, Issue: December 2005