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Startup Spotlight | Jan/Feb '14

These Are a Few of My Favorite Things

In the beginning, most ideas can seem simple and attainable. However, it is only long after they are carried out that their success can be determined. When I started my practice, my idea was to revamp the entire system—no billers, back offices, or coders—while relying on cloud-based software to do the work for me. The concept was great, but it had never been tested before.

Now, slightly a year after opening the doors to my new practice, I can confidently state that the idea worked not only well, but better than I could have ever anticipated, and I believe that most future practices will follow the model I created. With the successful first year, I found myself in a position to splurge and get the fancy toys I’d always wanted for my practice, while taking advantage of Section 179. Below are the items I purchased at this past AAO meeting.

Cirrus Photo

While my Stratus OCT (Carl Zeiss Meditec) was perfectly functional and enabled me to screen cataract patients, I had always preferred the next-generation machines. With the Cirrus Photo (Carl Zeiss Meditec), I am also able to perform fundus/optic nerve photography through a nondilated pupil in a very short amount of time. The OCT images, now higher resolution, can also be obtained through a nonmydriatic pupil. Image capture times are not only faster than with the Stratus, but the autofocus is so functional that my technician performs less imaging because now even my front desk staff can do it. The footprint of the device is about the same of the original Stratus, so I am able to increase speed, resolution, and information gathered from exams without any change to my office setup.


I already had an Atlas topographer (Carl Zeiss Meditec) and Lenstar (Haag-Streit AG), so why purchase an OPD-Scan III (Marco)? To begin, my autorefractor (which I had purchased used off of eBay) was broken and needed replacing. When patients presented to my office for cataract evaluation, it was too cumbersome to evaluate their corneal astigmatism at their initial visit. Because of this, discussions regarding their candidacy for toric lenses vs multifocal lenses were delayed until the preop visit, leaving many questions in the patients’ minds.

Having replaced the autorefractor with the OPD-Scan III, I am now able to measure corneal topography as well as corneal higher-order aberrations and angle kappa. This has not only greatly increased data collection in a similar amount of time but also allows me to better counsel patients about their lens options on the first visit. Much like the Cirrus Photo, the size of the OPD-Scan III is similar to my autorefractor and did not require any change in room setup.


The ability to perform YAG capsulotomies and iridotomies in the office is certainly convenient and, in cases of angle closure or pupillary block, can be crucial. That said, the number of patients with glaucoma will grow exponentially over the next decade. Patients are not 100% compliant with their eye drops, and those drops can have deleterious effects on the ocular surface. During my past experience at Bascom Palmer, I would not hesitate to offer selective laser trabeculoplasty (SLT) as a treatment for my glaucoma patients, and many of them quickly gravitated toward this option. Since starting my practice, it bothered me that I couldn’t offer them this technology. Once I made the decision to purchase an SLT/YAG combo laser, there was no question that I would select the Ellex Tango. In addition to the traditional outstanding optics and functionality, the design of the laser allows me to roll it up to my regular exam lane chairs. I can also use it with wheelchair-bound patients without any exertion, making this a simple and effective addition to my practice.


In the end, I was able to upgrade my practice to incorporate these best-in-class devices while increasing office workflow. Several airline credit card miles richer, I have no doubt that these latest ideas will result in increased patient satisfaction and practice revenue.

David A. Goldman, MD

David A. Goldman, MD, is the founder of Goldman Eye in Palm Beach Gardens, Florida. Dr.Goldman may be reached at (561)630-7120;david@goldmaneye.com.