The Observer, Vol 28, Issue 4

The Observer
V o l u m e 2 8 , I s s u e 4
M A Y
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Advanced Vitreo Retinal Care
The Optometrist’s Role in for Your Patients
Co‐Management of Refractive Surgery: Part II
Omni Eye Specialists is proud to provide your patients the availability of complete
Retinal Diagnostic Suites at both Omni Eye Specialists locations: 55 Madison
Street, Suite 355 in Cherry Creek and 6881 South Yosemite Street, in Centennial.
We offer the same high level of retinal care that you have come to expect with greater
convenience to your patients. Each clinic is equipped to provide patients with
medical retinal treatment, such as intravitreal injections.
OUR DOCTORS
George J. Pardos, M.D. Gary A. Belen, M.D. by: Vandi Rimer, OD
Anterior Segment and Refractive Surgery Consultation For
Each location isMadison
equippedStreet
with the
latest diagnostic
including:
Companies
technology,
Jason J. Wang, M.D. Miriah Teeter, M.D. · Heidelberg Spectralis OCT with Bluepeak
Laser Autofluorescence Imaging
·
Digital
Photography
Co‐Management Guidelines — The Basics · Fluorescein/Indocyanine Digital Angiography
· Ultrasonography
Once you decide to get involved in refractive surgery co‐management, there Howard Amiel, M.D. Lawrence Spivack, M.D., Emeritus Vandi Rimer, O.D. are some basic guidelines to consider. First of all, find a reputable refractive Surgical procedures are performed at Madison Street Surgery Center (MSSC), locatsurgery center with updated laser technologies to include wavefront and ed on the 2nd floor at 55 Madison Street in Cherry Creek. Our surgeons are able to
provide absolutely state of the art surgical care in a more controlled, comfortable
femtosecond lasers. Also select your surgeon carefully. You will want someone environment for the patient at MSSC.
who is conservative, skilled and compassionate to the patients in the operating Additionally, emergency surgery can be performed in the most efficient possible
manner. Minimizing the interval between diagnosis and treatment allows us to
room. Below are some of the basic calculations you will need to determine if maximize the patient’s outcome in these time sensitive situations.
your patient is a candidate. Salil Shukla, M.D. Sumit A. Sitole, M.D. Thomas R. Cruse, O.D. Madison Street Surgery Center is equipped with the latest in vitreo-retinal surgery
The first calculation ensures the patient’s corneal thickness is adequate for technology. The Constellation Vitrectomy System is the next generation surgical
refractive surgery. system, with numerous design and performance features that help make the surgery
safer and more efficient. Visualization is optimized with our brand new Zeiss LuTake the dioptric power in the highest power meridian and multiply by 15 mera
surgical microscope, which provides superior optics and illumination to prior
for Custom ablation and 12 for conventional ablation. For example a pa‐
scopes.
In short, we have created a brand new vitreo-retinal operating theater from
the tient with ‐6.00 ‐1.00 x 180 will require 7.0 Diopters of correction. Multiply ground up, utilizing the most advanced technology available at every level.

INSIDE THIS
ISSUE:
Surgical Co‐Management 1 FDA LASIK Study 6 Online Referrals 7 Contact Us 8 7.0 x 15 = 105 microns will be ablated for a custom treatment. For a hyper‐
Omni
Eye Specialists provides 24 hour on call service for patients with
retinal
and all ocular emergencies. Simply call 303.377.2020 (or
opic patient with refraction of +2.25 ‐1.25 x 180. This refractive error will 1.800.GO.2.OMNI) and you will be directed to our on call doctor.
require 2.25 Diopters of treatment. Multiply 2.25D x 15 = 33.75 micron abla‐
tion. Cataract Reference Guide 9 Medication Protocols 10 Our NPI Numbers 11 New Brighton Location 12 Doctor Locations 13 
The next step is to determine the residual stromal bed thickness, you will need to know your refractive surgery center’s preference for the flap thick‐
ness. Our preferred thickness is 110 micron depth with the Intralase femto‐
second laser. Using the above example, let’s say the myopic patient has corneal thickness of 550 microns. Is this patient a candidate for LASIK? Do a quick calculation. 550 (total corneal thickness) – 105 (ablation depth) – 110 (laser flap thickness) = 335 microns in the residual bed. (Continued on page 2) P A G E
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What are the benefits of surgical co‐management? (Continued from page 1) 
This is adequate corneal thickness to allow LASIK surgery. You will also need to know your surgery center’s minimum required residual bed thickness. Some surgeons allow 270 micron bed, our preference is 300 microns. Don’t forget about corneal curvature. This is often overlooked by referring doctors. 
The guidelines we use for steepest post‐ operative corneal curvature (hyperopic treat‐
ments) is 47DK, and for myopic treaments 36DK. The steepening treatment is usually a one‐to‐one increase in curvature. For example a +2.25 D hyperope will be steepened by 2.25 D. The myopic flattening is usually 75%. For example a ‐10.00 D myopic will receive 7.5 D of flattening. If you have a +2.25 D hyperopic patient with starting K’s of 46.25 D, they will require an additional 2.25DK of steepening which will leave them at 48.5 DK. 
This patient is NOT a refractive surgery patient due to corneal curvature steeper than our maximum of 47DK. Let’s say the 10.00D myopic patient has starting K’s of 42DK. The calculations are 42DK ‐7.5 DK = 34.5 DK. This patient also does not qualify for LASIK or PRK due to post‐operative K’s being out of parameters (too flat) with a mini‐
mum of 36DK. B 
Both patients can be considered for refractive IOL exchange as a surgical option rather than a corneal ablation treatment. The myopic patient can also consider an implantable collamer lens (Visian ICL by Staar Surgical) as long as there is minimal astigmatism. You can also consider a clear lens exchange with an IOL. Dry eye is an additional important criteria to consider prior to surgery. Dry eye is one of the most common refractive surgery side effects we treat here in the Mile High City. 
Pre‐operative Schirmer’s scores need to be at 10mm preferably. Zone quick at 20mm. The corneal surface must be free of punctate staining. If your patient doesn’t meet these minimum criteria you will need to initiate dry eye treatment. (Continued on page 3) P A G E
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What are the benefits of surgical co‐management? (Continued from page 2) 
Dry eye Syndrome is a medical, billable diagnosis and you can bill for these appoint‐
ments through their insurance, prior to surgery. I strongly advise you do this pre‐
operatively rather than managing dry eye post operatively. The patient may feel dry eye management is part of their post op care and will not be as willing to pay for the co‐pays and insurance billable visits if you manage the dryness AFTER surgery. They are often highly motivated to get the surgery and are willing to do the management prior to sur‐
gery and pay for the appropriate care pre‐operatively. The surgical outcome can be affected by prolonged dry eye and the patient may not be as satisfied with their result. They may need an enhancement in the future due to poor initial healing secondary to dry eye. Pupil size 
Pupil size is now less of a concern with the Custom wavefront technology. However, I still take time to discuss the risks of halo and glare with patients who have a pupil larger than a 7.0 mm . In my own clinical experience, patients will noticed increased halo and glare for the first 2‐3 months then it dramatically decreases over time. I rarely have patients with Custom Wavefront ablations complain of halo and glare beyond 6 months post op. Topography 
A symmetrical corneal topography is, in my opinion, the most important criteria in consideration of refractive surgery for a patient. If the topography is slightly asymmet‐
rical then we consider PRK. If there is any irregular pattern or irregular astigmatism, we decline surgery. 
Topography interpretation requires some practice and a good topographer. Usually the refractive center has the topographer and clinical expertise to determine if a patient is a good candidate for LASIK, PRK or no surgery. You will receive the report from the sur‐
gery center with appropriate surgical recommendations for your patient. Each surgeon has personal preferences on what they feel is acceptable. Once you work with the sur‐
gery center, you will get a better understanding of each surgeons’ preferences and what they are looking for on the topo. (Continued on page 4) P A G E
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What are the benefits of surgical co‐management? (Continued from page 3) 
Subtle topographical clues guide the clinical decision making. At times, this can feel more like an art rather than a science in the clinical decision making. Over time it gets easier. The more patients you manage the better you get at it. Professional Benefits of Refractive Surgery Co‐Management As the market trends increase, more of your patients will be seeking refractive surgery. If you are talking about it to your patients, you are more likely to be involved in the process. It has the potential to be a strong revenue generator which you may have been overlooking. For example, If you co‐manage one patient a week who has both eyes corrected with laser vision correction, your co‐management fee is 500/eye x 2 eyes = $1,000/week x 52 weeks in a year = $52,000 a year for one patient per week. That doesn’t include all the other opportuni‐
ties such as sunglasses, readers, mono vision contact lenses, etc. Don’t underestimate the benefits of refractive surgery co‐management. There is great satisfaction when your patient arrives for the 1‐day follow up and gives you a high five or a big hug because they can see without contacts and glasses. The celebration is very rewarding, especially if you have been seeing this patient and perhaps their family members for many years. You go through the entire process TOGETHER. Once they experience “hassle free vision”, they will send you more of their family and friends for the procedure. This leads to more patients to build your practice. Even better, you didn’t have to spend advertising dollars on the referrals. The best part is sharing the excitement of 20/20 uncorrected vision with your patient. It can be a life‐changing experience for your patient. Don’t miss out on the financial and emotional rewards of sharing this special moment together. 1 ‐ Vision Council Research Department VisionWatch Database, June 2013 “Vision Correction Needs of Refractive Surgery Patients”. Presented at International Vision Expo and Conference Las Vegas website. 2‐Figures 1‐6 U.S. Trends in Refractive Surgery: 2014 ISRS Survey Richard J. Duffey, MD, David Leaming, MD presented at Refractive Subspecialty Day Chicago October 17, 2014. Vandi Rimer, OD Diplomate, American Board of Optometry Omni Eye Specialists at Spivack Vision Center Residency Director‐ Ocular Disease and Ocular Surgery Co‐management Centennial, CO [email protected] 303‐740‐5475 I have no financial interests in the laser technologies or equipment companies. PAGE
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What are the benefits of surgical co‐management? (Continued from page 3) Preferred flap thickness was 100 microns for 68% and 120‐130 for 30% of surgeons surveyed. Only 1% of sur‐
geons now do flap thicknesses at 150‐160 micron depth. (Figure 3) Minimum residual stromal bed thickness required for LASIK is slightly mixed among the surgeons surveyed with 34% at 250 (FDA approval), 23% at 275 and 36% at 300 microns. Our practice falls into the more con‐
servative group at 300 microns. (Figure 4) (Continued on page 5) THE
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What are the benefits of surgical co‐management? (Continued from page 4) (Figure 5) There has been a 22% improved total volume increase for Laser vision correction from 2012‐2013 and has increased by 22% over the past four years. Total laser vision correction volume for 2014 in the ISRS study was 549,000 cases. Surgeons performed 428,000 LASIK procedures and 121,000 PRK procedures in 2014. You can find Part II of this article in our next edition of The Observer, due to be released in July. 1 ‐ Vision Council Research Department VisionWatch Database, June 2013 “Vision Correction Needs of Refractive Surgery Patients”. Presented at International Vision Expo and Conference Las Vegas website. 2‐Figures 1‐6 U.S. Trends in Refrac‐
tive Surgery: 2014 ISRS Survey Richard J. Duffey, MD, David Leaming, MD presented at Refractive Subspecialty Day Chicago October 17, 2014. Vandi Rimer, OD Diplomate, American Board of Optometry Omni Eye Specialists at Spivack Vision Center Residency Director‐ Ocular Disease and Ocular Surgery Co‐management Centennial, CO [email protected] 303‐740‐5475 I have no financial interests in the laser technologies or equipment companies. THE
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Have you heard about the results of the FDA Quality of Life LASIK Study? The facts: 
Most comprehensive study on LASIK ever done by the FDA  Over 500 participants, 2‐part study over the course of 2 years The results: 
For patients who had visual symptoms such as glare, halos, or starbursts prior to sur‐
gery, the study found that these symptoms actually improved after LASIK  At 3 months after LASIK, over 96% of patients were satisfied with their vision! Dr. Pardos and Congresswoman Diana DeGette THE
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Send Patient Referrals and Post Op Forms
Real-Time Online to OES and SVC®
For Omni Eye Specialists (OES) medical or surgical Patient Referrals, visit www.OmniEye.com.
For Spivack Vision Center® (SVC) LASIK and PRK Patient Referrals, visit www,Spivack.com.
S ee o u r
N ew
Referra
l Form
on pag
e8
On either site, select “Referring Clinician”.
On the SVC site, click “Please click here to enter the secure portal
and access our online forms”. Both sites give you the option to log
in, create and account, or use the one time referral. If you log in,
the form will populate your demographics.
Complete the form and submit. You will be given the option to
print your completed form for your records, save as a pdf, or save
the form in Excel.
To submit Post Op Forms, follow the above steps but click onto
Post-Op Reports.
You can have the same login credentials at both sites.
Since the sites are on separate servers, you will need
to establish the credentialing on both the OES and
SVC web site. With your credentials, you can also
download a host of other forms from our library.
Please call with any questions.
New Features to Online Patient Referrals Have you ever wanted to attach a scan or a Visual Field to your patient referral? Now you can. Simply complete the online pa‐
tient referral form (see page 9) and note the new “File Attachment” section toward the end of the form. You can attach a ZIP, JPG, PDF, or PNG file that is under 5MB. If you have more than one file to submit, simply create a ZIP file. There is a link should you need more information on creating ZIP files. Additionally, now you can print your submitted form for your records , down‐
load a PDF ore download to XLS. Hopefully these options will make it easier for you to upload your referral into your EMR. THE
OBSERVER
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Contact Us
We can receive your referrals via email at [email protected] Need to ask us a ques on? Want to alert us to a problem?
You are able to “reach out and touch” us 24 hours a day
through our e‐mail and voice mail systems. While both
email and voice mail systems are monitored, our doctors
prefer email communica on so they can research and re‐
spond to your inquiry.
Here is our e‐mail directory:
Dr. George Pardos: [email protected]
Dr. Gary Belen: [email protected]
Dr. Jason Wang: [email protected]
Dr. Miriah Teeter: [email protected]
Dr. Howard Amiel: [email protected]
Dr. Vandi Rimer: [email protected]
Dr. Salil Shukla: [email protected]
Dr. Sumit Sitole: [email protected]
Dr. Thomas Cruse: [email protected]
Spivack Vision
Center®
LASIK
Patient Brochures!
Secure E‐mail’s:
Dr. Gary Belen: [email protected]
Dr. Howard Amiel: [email protected]
Dr. Jason Wang: [email protected]
Dr. Miriah Teeter: [email protected]
Dr. Salil Shukla: [email protected]
Dr. Sumit Sitole: [email protected]
Dr. Vandi Rimer: [email protected]
Dr. Tom Cruse: [email protected]
Dan Zebarth: [email protected]
Dr. George Pardos: [email protected]
Contact us if you would like some
to provide to your LASIK
candidates.
For our “a er hours” call system, have pa ents call our
regular number (303‐377‐2020) and they will be provided
instruc ons on how to contact the on‐call doctor.
We are always available for you and your pa ents. Our Administrators
Donna White, Omni Eye Specialists
Spivack Vision Center®
303‐398‐7311 [email protected]
Shelley Bakkemo, Omni Eye Specialists
Spivack Vision Center®
303‐398‐7304
[email protected]
Valerie Thiele, Madison Street Surgery Center
303‐398‐7331 [email protected]
Jessica Crutchfield,
Madison Street Financial Services
303‐398‐7316
[email protected]
THE
OBSERVER
OES FAX Numbers
OES Main: 303‐377‐2022
OES Referrals : 303‐329‐7165
OES Surgery Scheduling: 303‐377‐3234
Visit us Online
www.OmniEye.com
www.Spivack.com
www.MadisonStreetSurgeryCenter.com
Omni Eye Specialists Spivack Vision Center® Madison Street Surgery Center Madison Street Financial Services CE Course RSVP Line 303‐377‐2020 303‐SEE‐2020 303‐388‐0599 303‐388‐5353 303‐398‐7337
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Download our new Cataract and IOL Reference Guide Includes:  Step‐by‐step co‐management process  Medication and treatment protocols  Billing information  IOL lens options for your patients  Important documents and forms  Surgery checklist  And more! Just visit www.OmniEye.com and follow the instructions: 
Click the “Referring Clinician” tab at the top 
Click the “Forms Library” link to the left 
You will be asked to enter your credentials. If you haven’t registered for our site, it’s a great way to have online access to forms you use all the time, as well as get important updates on our events! 
Click “2015 UPDATED Cataract and IOL Reference Guide” to download the PDF PAGE
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Our Doctors’ National
Providers
Identifier Numbers Omni Eye Specialists’ Insurance Plans
OES participates in the following insurance plans:
AARP, Aetna, Anthem/BCBS, Assurant Health, BCBS Federal,
Cigna, Cofinity, Coventry Health Care, CNIC, First Health PPO,
GEHA, Great West, Golden Rule UnitedHealthcare, Humana, Med-
Gary A. Belen, M.D. icaid (State Only), Medicare, MultiPlan, PHCS, Railroad Medicare,
Rocky Mountain Health Plan, Tricare, Tricare United Healthcare
1841274933 Jason J. Wang, M.D. 1275514937 Miriah Teeter, M.D. 1316141872 Howard Amiel, M.D. 1306964317 Military, United Health Care, and UMR.
When Not a Participating Provider
We participate with the majority of the metro area insurance carriers and with new exchange plans there may still be programs with
which we are not panel providers with. Please have your patient
contact their insurance member services to confirm coverage.
Vandi Rimer, O.D. 1245295914 Salil Shukla, M.D. 1154595171 Sumit A. Sitole, M.D. 1205088507 Thomas R. Cruse, O.D. Thank you to all who came out to the 2015 Spring Symposium! It was a huge success, and it wouldn’t have been possible without your support. Hope to see you at the next one! 1588919443 Omni Eye Specialists 1699768663 Spivack Vision Center® now
carries Latisse®. Patients can see
a difference within 12 to 16
weeks as their eyelashes grow
longer, fuller and darker with this FDA approved solution.
For more information, please call 303.SEE.2020.
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OmniEyeSpecialistsNewBrightonLocation
Effective April 1, Omni Eye Specialists no longer sees patients at the Platte Valley Medical Offices in Brighton. We have moved to the Marchus Chiropractic Medical Office at: 606 S. 4th Ave. Brighton, CO 80601 At the corner of 4th and Jessup Visit us online for easy resources for both you and your patients. www.OmniEye.com www.Spivack.com www.MadisonStreetSurgeryCenter.com Omni Eye Specialists
Madison Street Surgery Center
Phone: 303.377.2020
55 Madison Street
Denver, Colorado 80206
Spivack Vision Center®
Experience • Technology • Compassion
Omni Eye Specialists South
Phone: 303.SEE.2020
Please consider sharing this newsletter with all the doctors and staff in your office. 6881 South Yosemite Street
Centennial, CO 80112
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