Surgery for Optometry
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Optometrists in New Mexico are now allowed to perform certain surgical procedures according to a statute passed in 2007. These include procedures like chalazion removal, punctal plug placement, and lesion removal. Performing surgery requires additional supplies, equipment, training and risks that many optometrists have not pursued due to the investment required. However, embracing these new surgical privileges could expand treatment options for patients and reimbursement opportunities for optometrists' practices. This presentation reviewed the definitions and coding of eye surgery, considerations for pursuing it, basic supplies and instruments needed, example procedures that could be performed, informed consent requirements, and liability issues.
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The updated standards include care recommendations designed to improve health outcomes. The ADA revises these guidelines annually through its Professional Practice Committee (PPC), which consists of experts from various fields including physicians, nurse practitioners, certified diabetes care and education specialists, registered dietitian nutritionists, pharmacists, and methodologists.
The Standards of Care in Diabetes - 2025 is available online as a supplement to the January 2025 issue of Diabetes Care. A mobile application compatible with iOS and Android devices, it offers the latest guidelines, interactive tables, and algorithms for quick reference.
The ADA, a voluntary health organization, has focused on diabetes research and public health for 84 years. With 136 million Americans affected by diabetes or prediabetes, the organization continues to support education, program development, and advocacy efforts.Mastering the Review Article: Structure, Strategy & Success
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Anatomy of the Larynx
Larynx is a cartilaginous structure located in the **anterior neck** at the level of **C3C6 vertebrae**.
* Also called the **voice box**responsible for **phonation**, **airway protection**, and **breathing regulation**.
**Cartilages of the Larynx**
**Unpaired Cartilages:**
1. **Thyroid cartilage**:
* Largest cartilage; forms the **Adams apple (laryngeal prominence)**.
* Composed of two laminae that fuse anteriorly.
2. **Cricoid cartilage**:
* Ring-shaped; **only complete ring** around the airway.
* Located below thyroid cartilage; articulates with thyroid & arytenoid cartilages.
3. **Epiglottis**:
* Leaf-shaped elastic cartilage.
* Covers the laryngeal inlet during swallowing.
**Paired Cartilages:**
1. **Arytenoid**:
* Pyramid-shaped; sit on top of cricoid.
* Attach vocal cords and muscles.
2. **Corniculate**:
* Small cartilages sitting atop the arytenoids.
3. **Cuneiform**:
* Embedded in the aryepiglottic folds; provide structural support.
**Intrinsic Muscles of the Larynx**
> Responsible for controlling **vocal cord movement**.
| Muscle | Action | Nerve Supply |
| **Cricothyroid** | Tenses vocal cords | External laryngeal nerve |
| **Thyroarytenoid** | Relaxes vocal cords | Recurrent laryngeal nerve |
| **Posterior cricoarytenoid** | Abducts vocal cords (opens glottis) | Recurrent laryngeal nerve |
| **Lateral cricoarytenoid** | Adducts vocal cords | Recurrent laryngeal nerve |
| **Transverse & oblique arytenoids** | Closes the posterior glottis | Recurrent laryngeal nerve |
| **Vocalis** | Fine-tunes pitch | Recurrent laryngeal nerve | **Nerve Supply*
* **Motor**:
* All intrinsic muscles (except cricothyroid): **Recurrent laryngeal nerve** (branch of vagus nerve).
* Cricothyroid: **External branch of superior laryngeal nerve**.
* **Sensory**:
* Above vocal cords: **Internal branch of superior laryngeal nerve**.
* Below vocal cords: **Recurrent laryngeal nerve**.
**Blood Supply**
* **Superior laryngeal artery** (branch of superior thyroid artery).
* **Inferior laryngeal artery** (branch of inferior thyroid artery).
**Laryngeal Cavity & Folds**
Divided into 3 regions:
1. **Vestibule** from inlet to vestibular folds (false cords).
2. **Ventricle** between vestibular and vocal folds.
3. **Infraglottic cavity** below vocal cords to trachea.
**Vocal folds (true cords)** involved in sound production.Tuberculosis Nepal 2025 National Plan.pptx
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Yoga postures are commonly depicted in ancient paintings, carvings, and sculptures in almost all civilizations and religions, thus Yoga cant be described as an act of Hinduism. It originated long before any religion on Earth, with the emergence of life on the Planet. All yoga poses are natural, and what is not natural is not yoga; it is油Viyoga.
Besides Vedic Yoga, Hatha, Vinyasa, Ashtanga, Iyengar, Yin, Restorative, Kundalini, Bikram, Sahaj, and Power yoga are some popular types.
Vinyasa油Yoga is the closest form to Vedic Yoga; it is known for its flowing movements, not very rigorous, not too much straining, actions flow with the breath.
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Ad
Surgery for Optometry
- 1. Surgery for OptometrySurgery for Optometry Dwight Thibodeaux, ODDwight Thibodeaux, OD Santa Fe, NMSanta Fe, NM drthib@msn.comdrthib@msn.com
- 2. For reimbursement purposes, theFor reimbursement purposes, the AMA defines surgeryAMA defines surgery Removing an eyelash isRemoving an eyelash is surgerysurgery CPT Codes for surgeryCPT Codes for surgery Eye/Eyelids 6xxxxEye/Eyelids 6xxxx Skin 1xxxxSkin 1xxxx Latin root-Latin root-by handby hand
- 3. 20072007 NM passed statute that expanded and codifiedNM passed statute that expanded and codified list of approved procedureslist of approved procedures Commercial insurance--Good payment turn-Commercial insurance--Good payment turn- aroundaround Medicare/Trailblazer slow payment--politicalMedicare/Trailblazer slow payment--political
- 4. Why not surgery?Why not surgery? ExperienceExperience Space, staffSpace, staff TimeTime Equipment ROIEquipment ROI Risk aversionRisk aversion
- 5. Basic Supplies and InstrumentsBasic Supplies and Instruments Blades, handles, clampsBlades, handles, clamps Gauze pads, tapeGauze pads, tape Syringes, needlesSyringes, needles AnestheticsAnesthetics Surgical scissors, forcepsSurgical scissors, forceps Sterilization methodSterilization method GlovesGloves Sharps and biohazard containerSharps and biohazard container
- 8. RF Ellman UnitRF Ellman Unit Permanent epilationPermanent epilation PunctoplastyPunctoplasty Lesion removal and cauterizationLesion removal and cauterization Costly for small officesCostly for small offices $3-5,000, need lots of procedures to pay off$3-5,000, need lots of procedures to pay off investment-ROIinvestment-ROI
- 10. Develop a card system forDevelop a card system for procedures specific surgical tray.procedures specific surgical tray. At the top of each cardAt the top of each card Physician orders form and procedure reportPhysician orders form and procedure report Informed Consent formInformed Consent form Instruments and materials for procedureInstruments and materials for procedure
- 11. Chalazion inject or I/CChalazion inject or I/C Hot compresses/massageHot compresses/massage Age of lesionAge of lesion Skin pigmentationSkin pigmentation Pediatric patientPediatric patient
- 13. Debridement and Anterior StromalDebridement and Anterior Stromal Puncture for RCEPuncture for RCE Needed for recurrent corneal erosionsNeeded for recurrent corneal erosions Previous corneal injury or corneal dystrophyPrevious corneal injury or corneal dystrophy Non-central areasNon-central areas AlternativePTK, hyperosmoticsAlternativePTK, hyperosmotics
- 14. Lumps and BumpsLumps and Bumps +/- biopsy+/- biopsy LidsLids AdnexaAdnexa ConjunctivaConjunctiva Papillomas, moles, hemangiomasPapillomas, moles, hemangiomas Sehorrehic keratosisSehorrehic keratosis Actinic keratosisActinic keratosis
- 18. PunctoplastyPunctoplasty Snip procedureSnip procedure Cannicular closureCannicular closure Know indicationsKnow indications EpiphoraEpiphora Dry eyeDry eye
- 20. Professional LiabilityProfessional Liability Doctor needs to review policy, AOADoctor needs to review policy, AOA recommendation a good choice (Marsh)recommendation a good choice (Marsh) Informed consentInformed consent Schedule surgery on separate day to giveSchedule surgery on separate day to give patient a chance to consider riskspatient a chance to consider risks
- 21. What isWhat is Infiltrative anesthesia?Infiltrative anesthesia? Nerve block?Nerve block? Field block?Field block?
- 22. Why use epinephrine with xylocaineWhy use epinephrine with xylocaine for injection?for injection?
- 23. Where on the body should you neverWhere on the body should you never use Epi for injection?use Epi for injection?
- 24. What cosmetic eye/adnexal sxWhat cosmetic eye/adnexal sx procedures are approved for OD useprocedures are approved for OD use in NM?in NM?
- 25. How do you determine whatHow do you determine what conditions are covered by insuranceconditions are covered by insurance for any given procedure?for any given procedure?
- 26. When do we need informedWhen do we need informed consent? When not?consent? When not?
- 27. What are the 3 most commonWhat are the 3 most common items to list as potentialitems to list as potential complications in informedcomplications in informed consent for minor sx procedures?consent for minor sx procedures?
- 28. Why would one use a blend ofWhy would one use a blend of xylocaine and marcaine for axylocaine and marcaine for a procedure?procedure?
- 29. What is a vasovagal reaction?What is a vasovagal reaction? What is syncope?What is syncope?
- 30. Define universal precautionsDefine universal precautions
- 31. Can an OD prescribeCan an OD prescribe tranquilizers?tranquilizers? When?When?
- 32. Relative contraindications forRelative contraindications for removal of vascular lesions?removal of vascular lesions?
- 33. Clinical CaseClinical Case 25 yo Native American with chalazion..25 yo Native American with chalazion..
- 34. Why should ODWhy should ODs embrace ours embrace our new law?new law?
- 35. Q&A and Handout ReviewQ&A and Handout Review