I don't know if you fly much these days, but anyone who does surely has noticed the airlines new strategy: they charge a fee—often outrageous and absurd, for just about everything they can. Rather than just being a blatant rip off, these fees are actually the stuff of genius. Let me explain.

Take fees for checked bags. Until recently, checking your luggage was pretty much free. Today, if you check even one bag, you pay for the privilege. Surprisingly, this didn't seem to upset as many folks as you would expect. I observed nary a whimper from the hundreds of passengers who were forced to hand over their hard-earned cash.

This past week, Spirit Air began an entirely new chapter in the book of airline business strategy. Spirit now charges for carry on luggage. CEO Ben Baldanza calls the fee “a consumer benefit”. When it comes to charging a la carte, Spirit is way ahead of the curve. They charge $3 for water, between $8 and $20 to select an assigned seat, and I would not be surprised to see pay toilets in the airline's future. Heaven help us.

Personally, I would never set foot on Spirit (I hate being nickel and dimed), but there are lots of uncomplaining, happy-to-go folks who line up for the promise of less expensive fares and free choice options. I know, I have the same bridge to sell them.

Still, Spirit gave me an idea. Maybe we have it all wrong. I think we doctors need to get in the Spirit spirit. Forget bundled fees for tests or routine services that you don't charge for. Break it out. Break everything out. The airlines already figured that out. Today's consumer (and that is what our patients have become) wants to pay only for what they use. I can get jiggy wid that. So can you.

Hey consumer? Want a refraction? It will be $30 for a standard one. Want to see 20/20? That's an extra $20. How about a slit lamp exam? Why sure, that's $35. A slit lamp exam with me really paying attention? That'll be $55 please. BIO? $25. A BIO that lasts more than 20 seconds per eye, that'll be $50.

You get the idea. Let patients pay for the tests they want and the level of professional involvement they feel comfortable with. And for heaven's sake, don't forget to charge a fee for explaining your fees.

Disclaimer: The preceding editorial was written with humorous intent. The fees described are not actual fees. Providers should insure that all patients receive adequate care. The medical model proposed above may not fulfill requirements for the medical home or qualify for PQRI.

Arthur B. Epstein, OD, FAAO Chief Medical Editor [email protected]

 

 

In traffic accidents, eye injuries occur as isolated or with polytrauma. They may involve just one eye, but simultaneous injuries to both eyes do happen occasionally. The aim of this paper was to reveal the risk factors, in an effort to reduce the number of such accidents and to prevent bilateral ocular damage. All patients hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, due to traffic accidents with bilateral eye injuries in a period of 9 years from the beginning of 2000 to the end of 2008 were analyzed.

In this 9-year period, a total of 36 patients were hospitalized and treated for bilateral ocular injury (72 eyes). There were 23 males among them, the male-female ratio being 1.8:1. Mean age was 33.9 years. The occupations of injured persons were the following: the most common were workers (15), followed by clerks (7), while less common were pupils, students, pensioners and housewives (3 of each of them), and farmers (2). Front-seat passengers were the most common among the injured (20, 55.6%), then drivers (15, 41.7%), with only one passenger from the back seat on the right side (2.7%). As many as 33 (91.7%) of them failed to fasten their seat belts, while 18 (50.0%) were drunk. Penetrating bulbar injuries or eyeball ruptures were predominant (66.7%), while blunt injuries were found in only two (2.8%) eyes in one single person; but in 22 cases (30.5%) there was adnexal damage, too. Visual acuity at discharge and subsequent controls was as follows: amaurosis in 21 (29.2%), less than 0.3 in nine (5.6%), 0.4 and better in 42 (58.1%), and normal visual acuity of 1.0 in 28 patients (38.3%).

The major risk factors for getting bilateral eye injuries in traffic accidents proved to be: sitting in the front car seats, not fastening the seat belt and alcohol intoxication. Prevention of these risk factors would result in a decrease in such a large number of bilateral eye injuries.

Cluster headache is a rare primary headache disorder characterized by recurrent, stereotyped short-lasting attacks of severe, unilateral head pain accompanied by autonomic symptoms.

Ophthalmic features such as conjunctival injection, lacrimation, ptosis and miosis occur in the vast majority of patients with cluster headache, whereas co-existent ocular movement disorders are rare.

To the best of our knowledge, only two documented cases of cluster headache with external ocular movement disorders have been reported. Herein an additional case with this unusual finding and discuss the putative pathophysiology of cluster headache associated with ophthalmoparesis.

Clinical records of patients diagnosed with cat-scratch disease (CSD) in the Uveitis Department of São Geraldo Hospital and the Ophthalmology Department were reviewed from 2001 to 2008 to describe the intraocular manifestations of CSD found at two uveitis reference centers in Brazil.

In the 8-year period, 24 patients with the diagnosis of CSD were identified. Twelve patients were male and 12 female. The mean age was 27.04 years (range 7–56). Sixteen patients (66.6%) presented with a history of a cat scratch and all patients reported cat exposure. Visual acuity ranged from counting fingers to 1.0 in the affected eye. Thirteen patients presented with bilateral disease. Sixteen (66.6%) patients complained of systemic symptoms, including fever, lymphadenopathy, liver and spleen enlargement and rash. All patients presented with serum antibodies (IgG) to Bartonella henselae. A total of 37 eyes were affected. The most common findings were small areas of retinal infiltrates, which occurred in 11 eyes (29.7%) and angiomatous lesions, which occurred in nine eyes (24.3%). Neuroretinitis occurred in only six eyes (16.2%).

The most common findings of CSD in our study were retinal infiltrates and angiomatous lesions. CSD patients may present with significant visual loss. Patients may benefit from systemic treatment with antibiotics.