optometry optometry - California Optometric Association

Transcription

C A L I F O R N I A
O P T O M E T RY
JULY / AUGUST 2014
VOLUME 41, NUMBER 4
A comprehensive view of professional optometry in California today
COA EVENT REVIEWS
House of Delegates and OptoWest
CLASS OF 2014
The future of optometry
OPTOMETRY IN FOCUS
Back to school and seeing clearly
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An Optometry Owners package policy provides important coverage such as:
Business Liability — Protects your practice against financial loss resulting from claims
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of actual or alleged damage caused to others by you or your employees.
• Premises: Injury to others that occurs at your place of business.
• Tenant Liability: Protects against claims of damages due to fire or other covered
losses caused by you to the premises you rent.
• Hired and Non-owned Auto: Use of hired or non-owned auto by an employee that
results in bodily injury or property damage.
Building and Business Personal Property
• Covers your building and furniture, fixtures, inventory, etc. and helps repair or replace
loss to the above.
Business Income and Extra Expense
• Reimburses actual loss of earnings up to 12 months due to a covered loss. Extra
expenses to continue your practice at another location are covered.
Employee Dishonesty — Protects you from embezzlement or theft by employees
up to the limits in the policy.
Computers and Media — Replaces your computer equipment and business
records if they are destroyed by fire, theft, power surges and viruses, up to the limits
contained in the policy.
Professional Liability — This may be included with your Optometry Owners
package policy or purchased separately. It protects you against losses
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C A L I F O R N I A
A comprehensive view of
professional optometry in
California today.
O P T O M E T RY
JULY / AUGUST 2014
Executive Director
Bill Howe
VOL. 41 NO. 4
Editor-In-Chief
Lee Dodge, OD
Managing Editor
Rachael Van Cleave
Editorial Board
Julie Schornack, OD, FAAO
Michael Mayer, OD
Anne Mika Moy, OD, FAAO
Jasmine Yumori, OD, FAAO
Palmer Lee, OD
Cindy Wang, OD, FAAO
Ellin Wu, OD
Meredith Whiteside, OD, FAAO
Production and Design
Grace Design Studio
Contact California Optometry with your ideas or comments by
sending an email to [email protected], or for more
information visit us online at www.coavision.org.
California Optometry magazine (ISSN0273-804X) is published bimonthly by the California Optometric Association at 2415 K St.,
Sacramento, CA 95816.
Subscription: Six issues at $50.00 per year. Periodicals postage
paid at Sacramento, CA. Copyright © 2014 by the California
Optometric Association. All rights reserved. No part of this
periodical may be reproduced without written consent of
California Optometry magazine. Send subscription orders and
undeliverable copies to the address below. Membership and
subscription information: Write to address below or call
800-877-5738. Postmaster: Send address changes to California
Optometry magazine, 2415 K St., Sacramento, CA 95816.
Views and opinions expressed in columns, letters, articles and
advertisements are the authors’ only and are not to be attributed
to COA, its members, directors, officers or staff unless expressly
so stated. Publication does not imply an endorsement by COA of
the views expressed by the author. Authors are responsible for
the content of their writings and the legal right to use copied or
quoted material. COA disclaims any responsibility for actions or
statements of an author which infringe the rights of a third party.
Contributions of Scientific and Original Articles: California
Optometry is formatted by and published under the supervision
of the editor. The opinions expressed or implied in this publication
are strictly those of the authors and do not necessarily reflect the
opinion, position or official policies of the California Optometric
Association. The author is responsible for the content. The
Association reserves the rights to illustrate, reduce, revise or
reject any manuscript or advertisement submitted. Articles are
considered for publication on condition that they are contributed
solely to California Optometry.
COA Champion Supporters:
Above: California Optometric Association (COA) President John Rosten, OD,
(center), University President Kevin Alexander, OD, Ph.D (left); and Stanley
Woo, OD, MS, MBA Dean, Southern California College of Optometry.
Cover: COA 2014 Board of Trustees (left); The Class of 2014 from the Southern
California College of Optometry at Marshall B. Ketchum University (right).
Content
4 LEADERSHIP CORNER
6 COA BOARD HIGHLIGHTS
8 EDITOR’S NOTE
10 EYE OPENERS
12 COA EVENT REVIEWS
18 MEMBERSHIP MATTERS
20 PRODUCT & SERVICES
22 GOVERNMENT AFFAIRS
24 MEMBER SERVICES
26 CLASS OF 2014
30 ALL EYES ON YOU
32 OPTOMETRY IN FOCUS
35 HEALTH NEWS & VIEWS
38CE@HOME
44 MARKET PLACE
46 WHEN & WHERE
Leadership — What’s it made of?
John Rosten, OD
President
During our COA Legislative Day in Sacramento, I couldn’t help but recognize a very special quality
about those in attendance — everyone in the room was a leader! No, not everyone had a chance
to stand up and talk or to help direct the day’s events, but everyone did show up in a powerful
way. Each and every one had stepped up to help move our profession forward.
For some, it was their first time to the Capitol, for others it was one of many times. Many have
gone the distance, which was especially demonstrated by Dr. Charles Richards from the COA
Mojave Desert Optometric Society, by attending his 29th consecutive COA Legislative Day! But
everyone in attendance, whether as a rookie or as a seasoned vet, was a leader.
So what makes a person a leader? What is it that makes a person step up? Exactly what is the DNA
of leadership?
Leadership Corner
I believe there are three components.
Values
We all carry a set of values as we navigate our way through our personal lives. Perhaps it’s that we
value our health, our families and our spiritual lives, and we’re able to make choices to enhance
these important aspects of our life. In the same way, as an association, we navigate our way
through the many aspects of protecting and enhancing our profession - through our leadership
having a shared core value system in place. These values often consist of such things as our
patient’s health and visual welfare, the independence of our profession and our ability to practice
to the fullest extent of our training
Commitment
Commitment is
not a burden, it’s
a natural response
to our values,
which allows us
to protect and
enhance those
things that are
important to us.
We all make time and expend our resources for the things that matter most. Being a leader
requires us to take that day out of the office to advocate for our profession, to spend that evening
with our local optometric society, or to take that lunch hour to share the benefits of association
membership with a friend and colleague. Commitment is not a burden, it’s a natural response to
our values, which allows us to protect and enhance those things that are important to us.
Passion
Passion means we have a fire in our belly… it drives us and moves us to make a difference in the
lives of others and to make a better world for all of us. It allows us to be optimistic about life and
to encourage others to share that same optimism. With passion, we can’t help but talk to others
about the things that are important to us, whether it’s about that beautiful new child in the family
or that new skill we’ve learned to better serve our patients.
So, when does leadership begin? Well, anytime actually. I’ve known young people who started
very early, and I’ve known others who started very late in life. It isn’t about when, it’s about if. If a
person understands their values, is committed to the process and has a fire in their belly, anything
and everything can happen.
Leadership sometimes occurs naturally, but most often it needs to be learned and practiced. But
exactly how do we do that? For our association, what is the best way to impart this learning and
practice to our doctors? Is it through an annual leadership conference, or through an occasional
small group-learning format or through a well-constructed individual self-study plan for our
doctors? Very soon, our association will begin to answer some of these questions through a focus
group process with doctors participating throughout the state. I’ll be looking forward to sharing
these results with you when they become available.
So… with our values, our commitment and our passion, let’s get ready to rock our world!
4
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COA Board of Trustees
meeting highlights
COA Board Highlights
Beginning this
year (2014),
paraoptometric
staff of COA
members may
become AOA
members at
no cost.
6
On February 18, 2014, the COA Board of Trustees (BOT) met at the COA Office in Sacramento.
The BOT discussed a number of issues and topics that included the following items and
approved motions:
• Motion: To confirm approval of a 2014 Proposed Policy Resolution on COA Presidents’
Council meeting recognition by the COA House of Delegates.
• Motion: To accept the December 31, 2013, year-to-date COA financial statements as presented.
• Motion: For COA to support Optometry Cares® in any way it can to achieve its financial and
branding goals in compliance with the COA Solicitation of Donations for a Third Party policy
with the exception of including a donation request as a line item on the COA dues invoice.
• Motion: To approve the BOT society liaison appointments as presented:
1.COA San Mateo County Optometric Society — Dr. Sage Hider
2.COA Rio Hondo Optometric Society — Dr. Steve Minie
3.COA San Joaquin Optometric Society — Dr. Ranjeet Bajwa
• Motion: The BOT and staff will continue to monitor implementation of the COA Strategic Plan
and will publish it on the COA website.
• Item: Reviewed and responded to recommendations made by the 2013 COA
Presidents’ Council:
Recommended First Priority:
Recommendation A: To Establish the COA Presidents’ Council as an Annual Meeting
“To establish the COA Presidents’ Council as an annual meeting called ‘COA Presidents’
Council’ until otherwise renamed. The COA Presidents’ Council shall establish a task force
comprised of any COA society president or his or her designee in addition to a COA trustee
liaison appointed by the COA president, to make recommendations to COA on the format,
location, cost of the event, eligible attendees and who should comprise the COA Presidents’
Council Committee.”
Status: The COA Board of Trustees has submitted a proposed policy resolution to the 2014
COA House of Delegates which would formally recognize the annual COA Presidents’ Council
meeting and establish a COA Presidents’ Council Planning Committee comprised of representatives from four COA societies and two COA trustees to plan the annual meeting.
No priority requested:
Recommendation B: COA Membership Amnesty Program
“The COA Membership Committee looks into the feasibility of an amnesty program to
encourage those who drop out of COA to renew.”
Status: Refer to the COA Membership Committee for review and recommendation to the
COA Board of Trustees by September 2014.
Recommendation C: COA Trustee College and School Liaisons
“COA to establish a COA trustee liaison to each California school and college of optometry.”
Status: This recommendation has already been accomplished in that the COA Board of
Trustees already assigns a trustee liaison to each California school and college of optometry.
Recommendation D: COA Member Paraoptometric Educational Programs
“The COA Education and Clinical Practices Committee explore methods to deliver educational programs to COA member paraoptometrics at a reduced cost and enact those
recommendations by the date of the 2014 COA Monterey Symposium.”
Status: Beginning this year (2014), paraoptometric staff of COA members may become
American Optometric Association (AOA) members at no cost. AOA makes available a broad
array of educational programs and online aids at little to no cost to the paraoptometric
member. The COA House of Delegates will consider at its 2014 meeting a proposed bylaws
amendment and policy resolution that would align its paraoptometric membership classification with AOA’s by eliminating their dues. In addition, beginning in 2015, COA is replacing
the OptoWest statewide conference with two regional, one-day seminar programs to be
All Eyes
COA
Board
on You
Highlights
offered annually. These programs will feature a full-day
track of education specifically for paraoptometrics. The
greatly reduced overhead of this type of program will
significantly reduce seminar registration costs for
paraoptometrics. In addition, with it being a one-day
program at locations near many optometric offices, it is
believed that most paraoptometrics will be able to drive in
and out of the program in the same day, eliminating
lodging cost and reducing travel and meal costs. Finally,
COA is investigating the development of online paraoptometric educational programs that can be offered 24/7 at a
low cost. Recommendation and status referred to the COA
Education and Clinical Practices Committee to investigate
and report additional recommendations, if any, to the COA
Board of Trustees by December 2014.
Recommendation E: COA Board to revisit the current branch
office law within the next year.
Status: Refer to COA Legislation-Regulation Committee to
research the issue and its impact on optometry and report
its recommendations to the COA Board of Trustees.
The COA BOT met April 3 and 6, 2014, in conjunction with the
joint COA House of Delegates meeting and OptoWest in Indian
Wells. Minutes from those meetings are pending approval by
the BOT and will be released in the next edition of California
Optometry. The next meeting is June, 5, 2014, in Sacramento.
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july/august 2014
7
Change is a good thing
Lee Dodge, OD
I am finding that in our career, change is a good thing. I was naïve to think that after graduating, I knew all there was to know about optometry. Boy, there is so much more. I soon learned
that we have many obstacles facing us in every facet of our profession, but I have also learned
that we all have the opportunity to make positive changes to deal with the negative. Doctors of
optometry are banding together in many ways to face the opposition that seems to be coming
at us from all angles, including patient access, insurance panels and organized medicine. One of
the best groups that I am a part of that combats and aids in these changes is the California
Optometric Association (COA).
Editor’s Note
COA has historically made large changes in the lives of optometrists. The association has
helped us fight legislation opposing optometry, helped us expand our current scope of
practice and done everything in between to aid us in delivering quality patient care. COA has
recently undergone some new changes, including the addition of a new board of trustees
member, new members to local boards, and new committee members, including a new
editor-in-chief of this magazine.
In optometry, change is coming, but shouldn’t be feared. As the new editor-in-chief, I hope to
continue in the footsteps of Dr. Julie Schornack and the other editors before me. I want to work
with COA to get you the information you need to help with the changes ahead. We will try to
address changes in access, technology, clinical information, insurances and more. Along with
our other avenues of communication, including COA’s website, Government Affairs Weekly
newsletter and social media, etc., COA wants you to be constantly informed about your
organization and optometry today in California.
One of the best
groups that I am
a part of that
combats and aids
in these changes
is the California
Optometric
Association.
So whether you are a new graduate or have been practicing for many years, have you thought
about change in your life as a doctor of optometry? New grads will be looking for a job.
Practice owners will make many small changes to improve marketing, attract new patients, and
learn how to treat them in a more efficient manner. As a doctor that has been more established,
are you thinking of hiring an associate or moving toward retirement?
Along with personal changes, we have to keep in mind that there are ways that we all need to
help optometry on a grander scale. Participation in COA and other organizations is almost
essential. So how do you begin with all of these changes? Attend a meeting of your local society.
Volunteer. Speak up about our profession. Always remember that change begins with you.
MISSION STATEMENT
The mission of the California Optometric Association
is to assure quality health care for the public by advancing
all modes of optometry and by providing members with the
resources and support to practice at the highest levels
of ethics and professionalism.
8
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Keratitis-causing bacteria may survive
longer than thought in contact lens solution
A recent study reveals that certain strains of keratitis-causing bacteria can survive longer in
contact lens solution than previously thought, according to a HealthDay. The study, presented
at a meeting of the Society of General Microbiology, found that while most strains died after
ten minutes, the Pseudomonas aeruginosa strain 39016, which is associated with microbial
keratitis, appeared to survive in contact lens solution “for more than four hours.” According to
HealthDay, the study suggests that tests should be done to determine whether contact lens
solutions kill the strain.
Eye Openers
The Eye Openers
section gives
a quick look
at the latest
headlines and
news surrounding
optometry and
eye care.
FDA loosens eyelid weight regulation
According to a story from The Hill, the FDA is adding “another weapon in the Sandman’s
arsenal,” by relaxing the regulation on certain eye weights. People with the rare condition of
lagopthalmos, are unable to completely close their eyes, which can lead to dry eye or even
ulcers or scarring. The weights can be attached or surgically implanted in the eyelid, and make
it easier for a person with the condition to close their eyes when they look down. According to
The Hill, The FDA said its decision would “make it easier for external eyelid weights to get to
market, while still maintaining stringent requirements on the weights that are implanted in
people’s eyes.”
Eye-training computer program may
restore sight to glaucoma patients
According to a recent HealthDay article, a study published in JAMA Opthalmology’s April
edition concluded that a computerized eye-training program can return sight to glaucoma
patients. In the study, the “daily vision workouts restored a significant degree of sight to a
group of glaucoma patients by taking advantage of the brain’s talent for learning new tricks.”
The research team discovered that the “visual workout” for the 30 patients involved in the
study improved “visual field defects by upwards of 20 percent in a matter of months.”
Man from Michigan gets artificial
retinal implant
The Associated Press reported that the fourth person in the US has received an artificial retina
“since the FDA signed off on its use last year.” Roger Pontz of Michigan is a retinitis pigmentosa
patient. Since having the device implanted in his left eye, he has been able to “catch small
glimpses of his wife, grandson and cat.”
10
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COA members at work making policy
for your association
2014 COA House of Delegates meeting summary
Greeted by sunny skies and temperatures in the low 80s, more than 200 COA member doctors
and students of optometry serving as delegates and alternate delegates converged at the
Renaissance Esmeralda Resort & Spa in Indian Wells for the 2014 COA House of Delegates
meeting. Joining this esteemed group of volunteers, representing all 25 COA societies, were
Dr. Mitch Munson, president, and Dr. Robert Layman, trustee, of the American Optometric
Association (AOA), along with other special guests from the eye care insurance industry.
COA Event Reviews
Above: Dr. Page Yarwood,
2014 HOD Speaker
Held in conjunction with the 2014 COA OptoWest conference (see page 16 in this edition for
more on OptoWest), the April 4-5 annual COA governance meeting showcased the introduction, debate and decisions of numerous bylaw amendment and policy resolution proposals to
guide COA in “assur[ing] quality health care for the public by advancing all modes of optometry
and by providing members with the resources and support to practice at the highest levels of
ethics and professionalism.” In addition, Dr. Page Yarwood, speaker of the HOD, led the
adoption of the COA 2014 and 2015 budgets, officer and trustee elections, and a special panel
discussion on the latest developments in health care reform implementation.
Below are the COA bylaw amendment and policy resolution proposals considered and their
final disposition. To read the entire proposals, log onto the “House of Delegates” page under
“CE/Events” on the COA website.
COA Bylaw Amendment Proposals
• Bylaws Amendment Number One, introduced by the COA Board of Trustees (BOT) relating
to COA paraoptometric membership. Passed as amended. (See Policy Resolution One,
below, and page 13 in this edition for more information.)
Conforms the COA paraoptometric membership classification to changes made by the
AOA to its paraoptometric membership category.
Limits paraoptometric membership to those who work for COA/AOA member doctors.
Repeals the COA Paraoptometric Section.
• Bylaws Amendment Number Two, introduced by the COA BOT, relating to COA BOT
composition. Passed as amended.
Changed the fixed number of officers and trustees at 10 to a range of eight to 10.
• Bylaws Amendment Number Three, introduced by the COA BOT, relating to the COA
secretary-treasurer term of office. Failed.
Would have reduced the term of office for the secretary-treasurer from two years to one.
• COA Student Optometric Section Bylaws, introduced by the COA BOT, relating to COA
Student Optometric Section. Passed as presented.
Sets forth the governance structure of the COA Student Optometric Section.
COA Policy Resolution Proposals
• Policy Resolution Number One, introduced by the COA BOT, relating to COA paraoptometric member dues. Passed as presented. (See Bylaws Amendment One, above, and page 13
in this edition for more information.)
Repeals dues for COA paraoptometric members effectively making membership free.
• Policy Resolution Number Two, introduced by the COA Tulare-Kings Optometric Society,
relating to maintaining the intent of the author of a policy resolution. Failed.
Would have required the HOD speaker to appoint the author of a policy resolution to the
reference committee to which it was referred and for the author to present the reference
12
COA Event Reviews
committee’s recommendation relative to that policy
resolution to the HOD.
• Policy Resolution Number Three, introduced by the
COA BOT, relating to the COA Presidents’ Council.
Passed as amended.
Establishes that the COA HOD formally recognize the
annual COA Presidents’ Council meeting consisting of
representatives from each COA society
Establishes the composition of a COA Presidents’
Council Planning Committee to be comprised of two (2)
COA trustees appointed by the COA president and
confirmed by the COA Board of Trustees to serve as
chair and vice chair of the committee; and, representatives from four (4) COA societies chosen at random by
the COA societies, to plan the annual COA Presidents’
Council meeting.
• Policy Resolution Number Four, introduced by the COA
Orange County Optometric Society, relating to the California Vision Project retention. Passed as amended.
Calls for the California Vision Project (CVP) to be
retained as a charitable program of the California
Optometric Association within the entity structure of the
California Vision Foundation.
Directs the COA secretary-treasurer and staff determine
the minimum cost for COA to administer the CVP.
Directs the COA secretary-treasurer negotiate, based
upon the cost study, a fair and reasonable charge to the
CVP for administrative services provided by COA.
Directs that the COA BOT recognize all who donate
services, products and monies to CVP for their 25 years
of assistance to Californians in need.
• Policy Resolution Number Five, introduced by the COA
Orange County and Santa Clara County Optometric Societies, relating to OptoWest. Passed as amended.
Directs the COA BOT to review the possibility of retaining
OptoWest as a multi-day educational meeting held in a
major metropolitan area.
• Policy Resolution Number Six, introduced by the COA
Alameda-Contra Costa Counties Optometric Society,
relating to the annual review of passed policy resolutions.
Passed as amended.
Provides that previously deleted COA HOD policy
resolutions that were categorized as “ongoing or completed” be archived and considered in force.
• Policy Resolution Number Seven, introduced by the
COA Orange County and Santa Clara County
Optometric Societies, relating to COA HOD meetings.
Passed as amended.
Provides that the COA HOD meeting continue as a
two-day meeting.
Free COA/AOA membership for OD’s staff
AOA and COA bylaws have changed. Now all staff are able
to enjoy complimentary Paraoptometric Membership and
have access to training, tools and resources when enrolled
by a member doctor. Enrollment is now open!
Build staff skills & confidence
Improve practice efficiency
Improve patient care
Increase patient referrals
Increase staff retention
Create a competitive edge
Paraoptometric member benefits include:
• Online training program for new hires
• Online continuing education (CE)
• Billing and coding training
• Discounted fees for paraoptometric education materials
• Access to members-only web pages on AOA and
COA websites
• Reduced fees for AOA and COA educational conferences
www.coavision.org
HOW TO ENROLL STAFF:
1.Go to www.aoa.org
2.Under the “Optometrists” tab, click on “My Profile” and
log in
3.Click on “MyAOA”
4.Click on the “Manage Staff” tab
5.Enter information for each staff person (non-OD)
Have Questions?
Need Help?
Contact:
[email protected] or
800-365-2219, ext. 4108
COA will be notified of your
new AOA enrollees and
automatically enroll your staff
as COA paraoptometric
members too!
july/august 2014
13
COA Event Reviews
Meet the COA 2014 Board of Trustees
14
John Rosten, OD
President
Barry Weissman, OD,
PhD, FAAO
President Elect
Stevin Minie, OD
Secretary/Treasurer
Sage Hider, OD
Trustee
Steve Langsford, OD
Trustee
Ranjeet Bajwa, OD,
FAAO, Dipl ABO
Trustee
Jan Cooper, OD, FAAO
Trustee
Ronald Seger, OD,
FAAO
Trustee
Fred Dubick, OD, MBA,
FAAO
Immediate Past President
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COA Event Reviews
OptoWest 2014 review
Thank you to our OptoWest 2014 Sponsors!
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BRONZE SPONSOR:
LUNCH
SPONSOR:
WELCOME RECEPTION
SPONSOR:
EDUCATION
SUPPORTER:
FOOD FOR THOUGHT SPONSORS:
OptoWest 2014 Exhibitors
ABB Optical Group,
formerly ABB CONCISE
Acculens
Alcon Laboratories, Inc.
Allergan
Alpha Viana, Inc
Altair Eyewear
Bausch + Lomb
Blue View Vision
Briot USA
Bruder Healthcare Company
16
California Optometric
Association (COA)
California Vision Foundation
(CVF)
Carl Zeiss Meditec
Carl Zeiss Vision
ClearVision Optical Company
Coburn Technologies
Compulink Business Systems Inc.
Demandforce
ELSEVIER Inc.
Epon Opitical Group
Essilor Instruments USA
Essilor Laboratories of America
Eye Care and Cure
Eye Designs Inc
Eyefinity
EyeMed Vision Care
Freedom Scientific
Genzyme
Heidelberg Engineering
HCPN Alliance
COA Event Reviews
Doctors and optometry industry reps enjoying the OptoWest Welcome
Reception. (L-R) Stephen Porpora, Palmer Lee, OD, Rollie Stenson, and
Matt Earhart, OD.
Mervi Lagattuta, OD, (L) was excited to win a
pair of bebe sunglasses from Altair Eyewear.
She is pictured with Robin Blake of Altair.
Hydrogel Vision Corporation
I-dealoptics
ICoat Company
Internet Matrix, Inc (iMatrix)
Jonathan Paul Eyewear
K-Mars Inc
Konan Medical Usa Inc
Macular Health, LLC
Marchon Eyewear
Marco Ophthalmic, Inc.
Marcolin USA
www.coavision.org
Berkeley Optometry students enjoying the OptoWest Welcome
Reception. (L-R) Kevin Tong, Shreya Malli, Catherine Huang, and
Alfred Vong.
Palmer Lee, OD (R) was the lucky winner of
Primary EyeCare Network’s wine and cheese
basket giveaway. He is pictured with Ryan
Tedlock (L) and Mary Eastwood, OD, (C).
Marshall B. Ketchum University
(MBKU)
Mercer
NovaBay Pharmaceuticals, Inc.
Ocular Nutrition Society
Oculus, Inc.
Ophthalmic Instruments, Inc.
Optos
Optovue, Inc.
Practice Concepts
Practice Consultants
Sharon Silva-Celada, OD, (R) was the lucky
winner of OptoWest 2014. She won multiple
raffles! She is pictured here with Paul
Mudarri of Walman Optical.
Premier Merchant Services
Primary Eyecare Network
ProDesign Denmark
Revolution EHR
Santinelli International Inc.
Shamir Insight Inc.
Shaw Lens Inc.
Solutionreach
Suppleyes Inc
Synemed
Transitions Optical, Inc.
US Optical
Vision Ease Lens
Vision West, Inc.
Vistakon, Inc.
VSP Optics Group
VSP Vision Care
Walman Optical Company
Western University School
of Optometry
Wells Fargo Practice Finance
Younger Optics
july/august 2014
17
You just graduated!
Congratulations!
Now what’s next?
Jodi Haas,
Membership
Development
Manager
Membership Matters
This is an exciting time as you begin to put into practice what you have
learned in optometry school or college. One of your many first steps in
being a doctor of optometry is also making sure that you support your
chosen profession. Optometry can only achieve its goals and ensure its
future through the involvement of its members.
Organized optometry through your state, national and local association is the one venue that
captures the collective voice of optometry. It protects your license to practice, and expands your
scope of practice. The state-national-local association helps to maintain the standards of the
profession and further offers quality education for you to continue developing your skills and
knowledge as you progress through your professional career. Support the future course of
optometry through the advocacy of your profession. Meet other members and network with your
future peers as you establish professional contacts in your local community.
If you plan on becoming licensed in California or are relocating to this state to practice, complete
your Priority membership application today! Priority membership is your commitment to
becoming an active member of AOA, COA and your local society. You will be eligible for all COA
and AOA membership benefits, such as discounts for educational conferences, member-only
rates for association-sponsored insurance programs and members-only resources available on
COA’s and AOA’s websites. And, we can make sure that you continue receiving your subscription
to California Optometry magazine and the e-COA Member News and e-Government Affairs
Weekly communications.
Support the future course of optometry
through the advocacy of your profession.
Become a Priority member by completing and submitting the membership application today –
available to download under the “Membership — Join COA” section at www.coavision.org. Or
simply call Jodi Haas, membership development manager, at 916-266-5038, to update your
information and convert your membership in two minutes or less! This way, you won’t have to
experience a gap in membership. As a 2014 graduate, your dues are waived until January 1, 2015.
If you will be dedicating an additional year towards residency training, you may still maintain your
student membership. Contact COA and apply for Postgraduate membership if you are undergoing graduate study on a full-time basis, and/or engaged full-time as a resident or fellow in a
residency or post-doctoral program.
And if you haven’t already received yours, be sure to download the recently updated and enhanced Optometrist Resource Guide available under “Member Resources” on www.coavision.
org. This guide has been compiled and produced by COA with the new graduate in mind. It offers
practical steps to assist newly graduated doctors of optometry in getting started. This guide also
provides some considerations to help the new practitioner explore different modes of practice.
Job search resources, as well as a timeline and checklist with suggestions for starting a new
practice, are included.
Distinguish yourself now! Help shape your profession through the California Optometric
Association and set the standard in eye care.
18
Membership Matters
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Updated COA OD Resource Guide released
The California Optometric Association (COA) has released the 2014 version of its popular
OD Resource Guide for the exclusive use of its members. Extensively revised and updated, the Guide, which is posted to the COA website under “Member Resources” off
“Membership” on the toolbar, is intended to aid new practitioners entering the practice of
optometry and existing doctors of optometry who wish to change practice focus.
The Guide contains valuable information to inform and assist new and existing doctors of
optometry in establishing and continuing a productive career in the profession, including:
• Obtaining and maintaining a license and certifications to practice optometry
• Insurance coverages
• How to become a provider on public and private panels
• Optometric buying groups
• Practice settings
• Starting a practice
• Employment resources
• Importance of participating in organized optometry
• COA, AOA and local society membership resources and benefits
OPTOMETRIST RESOURCE GUIDE
Practical guide to assist newly graduated doctors of
optometry in getting started and existing practitioners
in exploring new practice opportunities.
Proudly supported by:
The practice of optometry continues to evolve. With that in mind, the Guide will be updated on COA’s website
as developments unfold. Members are encouraged to visit the COA website often for these updates and other
information of value to the California doctor of optometry.
www.coavision.org
july/august 2014
19
Product & Services
Mercer
Save 10% on your Professional Liability insurance by taking qualified courses at Monterey Symposium! Visit Mercer in Booth 108C
for more information. (One discount annually).
Mercer Health & Benefits Insurance Services LLC serves as the
insurance broker and administrator for the COA-sponsored insurance programs. We have a wide variety of programs available to
protect yourself, your family and your employees. Call a Client
Advisor for information on individual and small group health insurance, professional liability, workers’ compensation, level term life,
disability insurance, business owners package and much more.
800-775-2020
www.COAMemberInsurance.com
[email protected]
66755 (9/14) Copyright 2014 Mercer LLC.
All rights reserved.
Mercer Health & Benefits Insurance Services LLC
Vision West
For 25 years, the Vision West Optical Buying Group has
been committed to being “Your Comprehensive Practice
Management Resource for Independent Practice.”
Frame Displays
• 2000+ Optical Displays & Furniture Products
• Complimentary Dispensary Design in 3D
• Quickest Delivery in the Industry
• Easy Installation
• Custom Cabinetry Available!
• Basic Dispensary starting at $2995
877-274-9300
[email protected]
www.framedisplays.com
This means Vision West provides assistance to you every
step of the way to ensure your practice is profitable
throughout your career. We pride ourselves in offering:
• Competitive Product Discounts, no hidden fees
• Live Customer Service
• 24/7 Online Account Access and Practice
Management Tools
• Continuing Education Resources
• “No Fee” Early Credit Service
• Discounted Pharmaceuticals and Supplies
Plus many more exceptional services, programs
and promotions.
800-640-9485
www.vweye.com
VSP
As a VSP Global company, VSP Vision Care has provided high-quality, costeffective eyecare benefits, designed to support and grow optometry since
1955. As the largest not-for-profit vision benefits company in the United
States, VSP partners with a network of 30,000 doctors and 60 million members, connecting members to independent doctors and creating opportunities for them to prosper.
www.vspglobal.com
20
It Fits
Featuring
Silicone Hydrogel Material
or It’s Free!
Now, Get UNLIMITED EXCHANGES on all Metro Optics
Soft Lens Designs for 90 days with no cancellation
charges. This new policy frees the practitioner from
cancellation fees and exchange fees, allowing you to
focus on the patient fit with no risk.
It Fits or It’s Free applies to the full line of our lens
designs including all Definitive SiHy, Hioxifilcon and
Polymcon lens materials.
m u lt i f o c a l s o f t l e n s
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Extended Parameters
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Metro Optics soft lens designs come in virtually
unlimited parameters which include: Spheres (Clear,
Handling Tint and Eye Enhancing Tints of Blue, Green
and Aqua), Torics, Multifocals, Multifocal Torics and a
FDA Cleared Post Refractive Surgery Lens.
Ask your Metro Optics Representative for more
information on this exclusive fit guarantee.
The latest news for optometry-related legislative and advocacy issues in California.
Government Affairs
Children’s vision legislation
Senate Bill 1172 by Senator Darrell Steinberg unanimously
passed the Senate Education Committee in May. The bill would
add a near point acuity test to the current vision screening
process at schools. The bill is sponsored by Vision to Learn, a
philanthropic organization based in Los Angeles that provides
free eye exams to kids who fail the school vision screening. At
the hearing, COA staff testified that the organizations would
support the bill if amended to require a comprehensive eye
examination. COA is concerned about any bill that expands the
current vision screening process that has failed so many
California children. The bill author indicated during the hearing
that he was willing to discuss possible legislation to require an
eye exam before kids enter school.
Two other measures related to children’s vision have been
introduced this legislative session. Senate Bill 430 by Senator
Roderick Wright, which currently mandates an eye exam before
children enter school, is being amended soon in an attempt to
address concerns from opposition groups. COA is in support of
this bill. Also, AB 1840 by Assembly Member Nora Campos
would add a sentence to the Education Code allowing a child’s
vision to be appraised in schools by using an eye chart or any
other technology that has been published in a peer-reviewed
journal. COA is opposed to AB 1840 because it is not clear what
new technologies will be authorized by the bill.
View a recording of the Senate Education Committee hearing
by visiting http://goo.gl/wZe6XD.
Stay connected to government affairs!
Government Affairs Weekly Update
For weekly information on COA’s government and external affairs activities,
watch your e-mail inbox each Wednesday for the Government Affairs Weekly
Update. Archives are available on COA’s website (in the Members Only section,
click Government Affairs, then Weekly Updates).
22
Government Affairs
ODs to comply with new CMS
fingerprinting rule
Harkin bills defeated
Doctors of optometry will have to comply with a new federal policy that
requires fingerprinting for certain high-risk suppliers.
COA and several other organizations
successfully defeated a California bill that
would have delayed the “Harkin amendment”
from taking effect for one year. The Harkin
amendment refers to an amendment by US
Senator Tom Harkin, D-IA, to the Affordable
Care Act that prohibited provider
discrimination. Assembly Bill 1507 by
Assembly Member Dan Logue, R-Chico,
would have allowed individuals and small
businesses to retain their current health plans
for up to one year, to the extent permitted by
federal law, even if those plans don’t meet
ACA requirements. COA opposed the bill
because it would continue to allow health
plans or health insurers to discriminate
against providers.
Doctors of optometry enrolling in Medicare’s Durable Medical Equipment,
Prosthetics, Orthotics and Supplies (DMEPOS) program for the first time will
be categorized as “high risk” and will be subject to a new fingerprinting
requirement. The policy does not apply to those already in the program.
The fingerprinting policy was an anti-fraud program established by the
Affordable Care Act, according to Roger Jordan, OD, chair of the AOA
Federal Relations Committee. Under the policy, “all new enrollees/suppliers
will be classified as high risk and will remain there for their career — no matter
how clean their reputation,” he explains.
Any suppliers who enrolled in the DMEPOS program prior to the implementation of this policy are considered moderate risk, even if they re-enroll. This
means they are not subject to the fingerprinting unless they engage in
inappropriate activities, Dr. Jordan says.
Although eyeglasses are otherwise not covered in Medicare, post-cataract
glasses are considered prosthetics — which is why OD suppliers are subject
to DMEPOS requirements.
Also defeated was a Harkin-related bill that
COA strongly supported. Assembly Bill 2015
by Assembly Member Ed Chau, D-Monterey
Park, would have codified the Harkin
amendment in state law and forced the state
Department of Managed Health Care to
promulgate regulations that would further
define the impact of the law in California.
In a policy statement, CMS explains that Medicare Administrative Contractors
— Noridian for California — will send out notification letters to applicable
providers or suppliers on the fingerprinting requirement. It will include contact
information for a Fingerprint-Based Background Check Contractor (FBBC).
Doctors of optometry receiving such a letter would be required to contact the
FBBC to find out where they get their fingerprints done. This can be accomplished electronically in certain locations, or by submitting an FD-258 form.
The good news is that the Harkin amendment
remains in effect. AOA is working hard at the
federal level to ensure it is fully enforced.
Learn more at: http://goo.gl/ajA1p4.
The policy is being phased in throughout 2014.
CVF SPOTLIGHT
Get involved!
California Vision Foundation, COA’s charitable foundation, needs your
help. If you would like to become involved in the California Vision
Project and provide free eye exams to eligible low-income families, or
contribute financially to the Foundation, please contact Amanda
Winans, California Vision Foundation administrator, at 800-877-5738
and choose option six or via email at [email protected]. Donations
may be made by sending a check payable to the “California Vision
We want to thank Modern Optical
for donating frames to help those
in need.
Foundation,” 2415 K Street, Sacramento, CA 95816. To find out more,
visit our website at californiavision.org.
www.coavision.org
july/august 2014
23
Fireworks safety for summer
Take advantage of special
pricing or services offered to COA
members. For more information on
these member services, visit the Member
Resources section of COA’s website
at www.coavision.org.
Fireworks are synonymous with our celebration of Independence
Day. Yet the thrill of fireworks can also bring pain. On average,
nearly 200 people go the emergency room with fireworks-related
injuries every day during summer. Follow these tips to make sure
your loved ones and you have a safe and enjoyable 4th of July.
• Never allow young children to play with or ignite any type of
firework — even sparklers burn at temperatures around 2,000
degrees Fahrenheit.
• Always have an adult supervise the use of fireworks.
Member Services
• Be sure that any fireworks you purchase are intended for use by
the general public. Some fireworks are made strictly for professional use and could cause serious injury or even death.
COA-sponsored insurance programs
Mercer — Commercial
800-775-2020
[email protected]
COAMemberInsurance.com
Warren G. Bender Company — Personal
916-380-5300 or 800-479-8558
[email protected]
wgbender.com
COA’s preferred eyecare
business group
Vision West Inc.
800-640-9485
vweye.com
Debt collection services
• Don’t carry fireworks in a pocket, purse or backpack, as a single
spark could cause them to ignite.
• Never attempt to re-light or pick up any firework that has not
ignited properly — it may still be dangerous.
• Light fireworks one at a time to prevent confusion and accidents.
• Have a bucket of water or garden hose on hand in case of an
emergency and to douse fireworks before discarding them.
• Keep unused fireworks away from the lighting area to prevent a
spark from accidentally igniting them.
I.C. System
800-279-3511
icsystem.com/associations/coa.htm
Discounted credit card & payroll
processing services
Heartland Payment Systems
916-599-8689 • [email protected]
heartlandpaymentsystems.com
Email & social media services
Constant Contact
constantcontact.com/index.jsp?pn=coavision
Employment law posters
800-866-5737 ext. 237
coavision.org/i4a/pages/index.
cfm?pageID=3597
Classified ads
California Optometry Magazine
800-866-5737 x221 • [email protected]
[email protected]
Continuing education
COA’s CE@Home
800-877-5738 • [email protected]
coavision.org
24
Have questions or need assistance with your personal insurance
needs? Take advantage of the exclusive COA program through
Warren G. Bender Co. and start saving.
Contact us:
Phone 916-380-5300
Email [email protected]
Website www.wgbender.com
COA-sponsored Optometry Owners
Package Program
As an optometrist, your liability exposure isn’t just limited to the practice of optometry. You also need to consider
your risks as a business professional.
Whether you own your building or rent office space, an Optometry Owners policy often provides more complete
coverage at a lower price than separate policies for each kind of coverage. And, if you haven’t compared premiums in a while, you’ll be very surprised at how much you can save.
An Optometry Owners Package policy provides important coverage such as:
• Business Liability — Protects your practice against financial loss resulting from claims of actual or alleged
damage caused to others by you or your employees.
º Premises: Injury to others that occurs at your place of business.
º Tenant Liability: Protects against claims of damages due to fire or other covered losses caused by you to the
premises you rent.
º Hired and Non-owned Auto: Use of hired or non-owned auto by an employee that results in bodily injury or
property damage.
• Building and Business Personal Property
º Covers your building, furniture, fixtures, inventory, etc. and helps repair or replace loss to the above.
• Business Income and Extra Expense
º Reimburses actual loss of earnings up to 12 months due to a covered loss. Extra expenses to continue your
practice at another location are covered.
• Employee Dishonesty — Protects you from embezzlement or theft by employees up to the limits in the policy.
• Computers and Media — Replaces your computer equipment and business records if they are destroyed by
fire, theft, power surges or viruses, up to the limits contained in the policy.
• Professional Liability — This may be included with your Optometry Owners Package policy or purchased
separately. It protects you against losses resulting from errors or omissions in diagnoses or prescription. Apply
for limits of $1,000,000 per incident/$3,000,000 aggregate or $2,000,000 per incident/$4,000,000 aggregate.
We encourage you to contact us today to see how we can help you! Don’t assume the same policy that you
automatically renew each year is still the best coverage for your practice. Some companies are raising their rates
at renewal this year. COA’s sponsored insurance program can make sure that you are getting the coverage you
need at a very competitive price.
To learn more about the Optometry Owners Package Program, visit www.COAMemberInsurance.com or call
800-775-2020. A Mercer client advisor will be happy to assist you.
66658 (7/14) Copyright 2014 Mercer LLC.
All rights reserved.
777 South Figueroa Street, Los Angeles, CA 90017
(800) 775-2020
[email protected]
COAMemberInsurance.com
Mercer Health & Benefits Insurance Services LLC
www.coavision.org
july/august 2014
25
The Class of 2014 — The future
of optometry
The COA congratulates the Class of 2014! While some graduates will leave to practice in other
parts of the country, for those who stay, the COA is working to help optometrists practice to the
full extent of their license. As we end June, the COA is striving to pass SB492 which will expand
what procedures that doctors of optometry can perform. While the COA is working hard for
optometrists, we encourage new graduates to ensure the future of profession by being involved
in the COA and advocating for our profession.
Marshall B. Ketchum’s Southern California
College of Optometry (SCCO)
Class of 2014
At its 110th commencement, SCCO graduated 99 doctors of optometry this year including two
valedictorians. The co-valedictorians, Amy Aldrich, OD, and Lindsay F. Wettergreen, OD,
reflected on the pride they have in the accomplishments of their fellow classmates in their
commencement speeches. Both women will soon begin one-year residency programs along with
25 of their other classmates. Four of the graduates are second generation doctors of optometry.
For more information
about students at all three
optometric schools in
California including lists
of new graduates, visit
COA’s website and under
the media tab click “New
Grads.” Or simply scan
this QR code with your
smartphone.
The Class of 2014 from the Southern California College of Optometry at Marshall B.
Ketchum University. The 99 new doctors of optometry are pictured with (front row),
Stanley Woo, OD, MS, MBA, Dean, Southern California College of Optometry, Marshall B.
Ketchum University (left); and University President Kevin Alexander, OD, PhD (right).
The Platform Party for the 110th Commencement Exercise
of the Southern California College of Optometry at
Marshall B. Ketchum University (SCCO/MBKU). Pictured
(l-r): Robert Rosenow, PharmD, OD, Dean, College of
Pharmacy, MBKU; MBKU President Kevin Alexander, OD,
PhD; Commencement Speaker Stephen Jones, Chairman/
CEO, Snyder Langston, Irvine, CA; Co-Valedictorian
Lindsay Wettergreen, OD; Co-Valedictorian Amy Aldrich,
OD; Chair, MBKU Board of Trustees Glenda Secor, OD;
MBKU Vice President and Dean of Interprofessional
Health Studies John Nishimoto, OD, MBA; and Stanley
Woo, OD, MS, MBA, Dean, Southern California College of
Optometry, Marshall B. Ketchum University.
26
Class of 2014
California Optometric Association President John
Rosten, OD, (center), was a special guest at the
110th Commencement Exercise of the Southern
California College of Optometry at Marshall B.
Ketchum University. Dr. Rosten is pictured with
University President Kevin Alexander, Ph.D (l);
and Stanley Woo, OD, MS, MBA Dean, Southern
California College of Optometry.
University of California, Berkeley School of Optometry (UCBSO)
UCBSO graduated 65 doctors of
optometry in 2014. After four years of
intense study these graduates are ready
to practice to the full extent of their
education. COA congratulates the grads
and the following students who achieved
honors and awards.
Berkeley Optometry Class
of 2014 Awards
Ashley Craven
Gold Retinoscope Award
Ashley Craven
Beta Sigma Kappa Silver Medal
Melissa Moore
Bernhardt N. Thal, OD
VSP Excellence in Primary Care
Scholarship Award
Jackson Lau
Jasdeep Kaur Manik
Alcon Case Study Award
Binocular Vision Clinic, COVD,
and Richmond Products Binocular Vision
and Vision Therapy Award
Jackson Lau
GP Contact Lens
Clinical Excellence Award
Jeffry Wu
Drs. Robert Gordon and
Andrea Silvers Award
Sarah E. Kochik
MiraMed TechBinocular Vision Award
Jeffry Wu
Johnson & Johnson Award of Excellence in
Contact Lens Patient Care
(American Optometric Foundation)
Ashley Craven
Marvin Poston, ODVSP Excellence in
Primary Care Scholarship Award
Jasmine Sima Junge
Hana Bohmer
The William Feinbloom
Low Vision Award
Eschenbach Low Vision Award
(Eschenbach Optik)
www.coavision.org
Ashley Craven
Sophia J. Lee
Truyet T. Tran
Jill Y. Yuzuriha
Low Vision Clinic Award
july/august 2014
27
Class of 2014
Honors In Research
Jenny Chang
Diurnal pattern of tear osmolarity
and its relationship to corneal thickness
and deswelling
Mentor: Meng Lin
Tiana Leung
Factors affecting corneal epithelial
permeability
Mentor: Meng Lin
Ashley Craven
Enhancing coarse and fine stereo vision by
perceptual learning: An asymmetric transfer
across spatial frequency spectrum
Mentors: Roger Li and Dennis Levi
Glen Ong
Characterizing individual retinal layer
thickness changes in adolescents with Type
1 diabetes with and without retinopathy
Mentors: Marcus Bearse and
Anthony Adams
Jasmine Junge
The effect of letter-stroke boldness
on reading speed in central and
peripheral vision
Mentor: Susana Chung
Truyet Tran
Enhancing stereoacuity through perceptual
learning in normal vision: Specificity for
spatial frequency and orientation
Mentors: Roger Li and Dennis Levi
Jill Yuzuriha
Refractive error and ocular
parameters — Comparison of two
SD-OCT systems
Mentors: Lisa Ostrin and
Christine Wildsoet
Jing Zeng
Identifying a genetic modifier of
cataracts in mice
Mentor: Xiaohua Gong
Western University of Health Sciences College
of Optometry (WUCO)
Awards
Alcon Case Report Award
In recognition of a fourth year student who submitted an outstanding case
report on one of several topics which might include contact lenses and lens
care, ocular surface disease, dry eyes, allergy, glaucoma, ocular nutrition,
cataracts, and/or advanced intra-ocular lenses
Nanar Hovasapian
American Academy of Optometry (AAO)
Student Travel Fellowships
In recognition of those students who have fulfilled the requirements to
become a Student Fellow of the American Academy of Optometry which
assists in developing their skills as an optometric or vision science professional
Rubepreet Dosanjh and Aileen Maring
28
Dr. Narbae Avedian (C) with Dean Hoppe (R) and
Dr. Gugelchuck (L)
Class of 2014
Beta Sigma Kappa (BSK)
In recognition of those students who achieved a GPA
of 3.3 or higher throughout their entire optometric
educational experience
Faydim Rassamdana
Narbae Avedian*
Samantha Robertson
Naro Babaian*
Gewon Shu*
Aira-Lynne Canlas*
Desiree Sison
Judy Cao*
Sandy Tran
Jaqueline Chang
Charlene Trinidad*
Jennifer Chau*
Helena Tzou*
Mandeep Daudhria
Brent Wells
Tej Paul Dhaliwal*
Thomas Wong
Jonathan Hall*
Sahar Zokaeim
Nanar Hovasapian*
Lily Huynh
Serena Kooner
Judith Lee*
Aileen Maring
Vinh Ngo*
Aimee Noll*
Silvia Park
Trung Phan
Tyler Phan*
Aloina Pitchkar
*Represents members of BSK all 4 years at WUCO
Dr. Justina Cho & sons
Core Values Award
HOYA Opportunity Scholarship
In recognition of the student who has demonstrated
the University’s Core Values of caring, humanism, and
scientific excellence throughout his/her optometric
educational experience
Elizabeth Suh
In recognition of a 4th year student who has demonstrated a
commitment to working with underserved communities
Wendy Mora
Award of Excellence in Vision Therapy
In recognition of the student(s) who achieved the highest
score on NBEO Part I and Part II Examinations
Part I – Kathryn Dugan
Part II – Kathryn Dugan
In recognition of the COVD student member who is
a graduating optometry student who has
demonstrated a strong interest and clinical skills in the
area of vision therapy
Judy Cao
Designs for Vision, “William Feinbloom Low
Vision Award”
In honor of Dr. William Feinbloom, a pioneer in the
development of low vision devices, and awarded in
recognition of a student who has demonstrated
outstanding achievements in the field of low vision
Tyler Phan
Eschenbach Low Vision Student Award
In recognition of the skills and achievements of a fourth
year student who has shown an aptitude and interest in
the field of low vision and a desire to offer low vision
care upon completion of their studies
Suzanne Kim
www.coavision.org
National Board of Examiners in Optometry
(NBEO) Awards
Optometric Extension Program (OEP) Clinical
Curriculum Award
In recognition of a graduating optometry student who has
demonstrated a strong interest and clinical skills in the area of
behavioral optometry
Jonathan Hall
Salutatorian
In recognition of the student who achieved the second
highest GPA in the graduating Class of 2014
Nanar Hovasapian
Valedictorian
In recognition of the student who achieved the highest GPA
in the graduating Class of 2014
Gewon Shu
july/august 2014
29
Three California projects awarded grants
to help kids see better
Optometry Cares® — the AOA Foundation and the American Optometric Association, have
awarded 2014 Healthy Eyes Healthy People® State Association Grants to all three California
projects that applied. COA congratulates, and is honored to have supported, the grant winners
in the application process: Children Eye Screening (MEND Eye Care Clinic), Free Eye Screenings/Free Glasses for Kids and Marshall B. Ketchum University’s Children’s Vision Initiative.
Grant applicants were asked to focus on “Increas[ing] the proportion of children, aged 18 years
and under, who have received an eye exam by an optometrist over the next 12 months.” Below
is a summary of the three winning projects:
All Eyes on You
• Children Eye Screening (MEND Eye Care Clinic): MEND (Meet Each Need with Dignity), a
San Fernando Valley-based organization dedicated to breaking the bonds of poverty by
providing basic human needs and a pathway to self-reliance, will use the grant to replace
some of the vision clinic’s equipment donated more than a decade ago to permit a more
effective comprehensive evaluation of the patient. The award-winning vision clinic, begun at
the suggestion of the COA San Fernando Valley Optometric Society, has grown from a
closet-sized operation open a half day a week to a large, two-lane facility operating two days
per week.
• Free Eye Screenings/Free Glasses for Kids: The grant will be used to underwrite the
engagement of doctors of optometry to conduct free vision exams and provide free glasses
to children attending William Green Elementary School, a pre-K-5 school serving predomi-
All Eyes on You
features the latest
news about COA
members.
WELCOME! New COA Members
Alameda Contra
Costa County
Catherine Academia
Tracy Chan
Michael Chen
Angela Cheung
Andrea De Souza
Cory Hakanen
Scott Kamena
Gagan Khela
Marilyn Le
Timothy Ng
Laila Osmani
Joshua Shinoda
Thuy Tran
Angela Wong
Victor Wong
Cahuilla
Kathryn Dugan
Nichole Nino
Central California
Jemimah Corpuz
Stephanie Kai
30
Inland Empire
Brian Boyer
Wesley Chew
Nancy Dang
Misha Kim
Melissa Kong
Millie Liu
Phu Nguyen
Quan Nguyen
Puja Parekh
Silvia Park
Trina Patel
Wallace Wong
Jeffry Wu
Kern County
Jolly Mamauag
Keith Miller
Los Angeles County
Cassandra Abram
Elliott Caine
Richard Eusebio
Alice Kim
Jamie Lee
Sahar Zelkha
Orange County
Yaman Almouradi
Carmen Barnhardt
Alexander Bonakdar
Tina Chau
Kathleen Dang
Janet Doan
Jenine-Felicia Esmail
Grace Hsu
Erin Igne
April Kahn
Sara Kim
Razmig Knajian
Lilan Le
Diem Hang Le
Sophia Lee
Varsha Mathur
Kara Mc Eachern
Elizabeth Noh
Aimee Noll
Tracy Park
Kathryn Pham
Andrew Sendzik
Gewon (Julie) Shu
Gregory Smith
Leinah Tran
Henry Vu
Mei-Chuan Margret Yu
All Eyes on You
nantly low-income children in Lawndale, CA. Working in
partnership with the Lawndale Elementary School
District, the Lawndale Rotary Club and doctors of
optometry from the COA South Bay Optometric Society,
free screenings will be offered to the 777 pupils representing a wide spectrum of racial/ethnic groups.
• Marshall B. Ketchum University’s Children’s Vision
Initiative: AOA has identified transportation as a primary
barrier for children to obtain comprehensive eye exams
after failing a vision screening. The Children’s Vision
Program, initiated by Marshall B. Ketchum University’s
Southern California College of Optometry (SCCO), seeks
to eliminate that obstacle by providing free transportation for these at-risk children to the SCCO clinic for a
timely comprehensive eye examination conducted by
doctors of optometry. SCCO has established a partnership with the Santa Ana Unified School District (SAUSD),
where 80 percent of the students are English learners and
90 percent are on reduced or free lunch programs. The
grant will help finance the costs for transportation to the
clinic and the development of targeted vision care and
eye health educational materials.
Rio Hondo
Ana Chang-Smith
Mabel Cheung
Jonathan Hall
Sacramento Valley
Aira Canlas
William Downey
Harissa Michael
Brian Edward Park
Sang Tran
San Diego
Caroline Chang
Anika Dewan
Claire Kosters
Rachel Lee
Esmeralda McClean
Michael Morgan
Samantha Robertson
Desiree Sison
Crystal Tong
My (Kate) Vo
Victoria Vuong
Lisa Wilson
www.coavision.org
San Fernando Valley
Mariana Akoubians
Narbae Avedian
Andrew Babayan
Nanar Hovasapian
Roxana Khorrami
Anna Lam
Tiffany Nguyen
Lilit Yesayan
Grace Yoon
Sahar Zokaeim
San Francisco
Selena Chan
Aya Egger
Simon Lai
Tiana Leung
Cristina Partida
San Gabriel Valley
Daniel Allen
Henry Duong
Michelle Esmaeili
Lorena Forgey
Judith Lee
Jen Liu
Una Ng
Keith Shimizu
June Tse
Teresa Ung
San Joaquin
Vikram Girn
Mathew Lee
Trung Phan
Nissa Miranda
Serene Ngin
Jeanny Nguy
Thanh-Son Nguyen
Aram Rahimimanesh
Rebecca Rodriguez
Patricia Sha
Jacqueline Vu
Isabella Yu
San Mateo
Marianne Florendo
Aaron Kwan
Melissa Moore
Olga Mukha
South Bay
Kathleen Hawley
Shirley Hong
Michelina Timenovich
Sharon Wong
Santa Clara County
Anifa Avakian
Tiffany Chan
Stephanie Chen
Daniel Cheng
Justina Cho
Mary Dougherty
Anna Gardner
Anh-Thy Huynh
Alexander Long
Aileen Maring
Tri-County
Bahar Karbassi
Andy Pham
Brent Wells
Andrew Wilson
Tulare-Kings County
Aakash Shah
Jed Silos
july/august 2014
31
Back to school and seeing clearly
Lernik Mesropian, OD, FAAO
We all recognize the importance of a comprehensive yearly eye exam and the role it plays in
assuring clear vision, comfortable visual experience and healthy eyes. But how often do we as
doctors of optometry stress similar recommendations when it comes to our pediatric patients?
How often do we examine the eyes of our own children? And how many of us urge our healthy
pediatric patients to return for an eye exam in a year or two?
Optometry in Focus
The aim here is to remind us of what we already know to be true about pediatric eye exams, and
share a few tricks and methods for success. The ultimate goal is to encourage more of us to
reach out and prepare the children in our communities for the school year ahead! I want to
touch upon the fact that you can in fact successfully examine the eyes of the young members of
your community…and should! You have the training, the need is there and there is a lot to be
gained by everyone involved.
First, let us quickly review the rationale for examining infants, toddlers and all pediatric patients.
Early detection and treatment of visual limitations can positively affect a child’s potential, development and learning. Due to the plasticity of the visual system, vision and binocularity loss can
often be prevented and treated with much greater ease and success in the early years of life.
Dr Lernik Mesropian
conducted cancer biology
research and was a coauthor of a paper in the
journal of Cell during her
undergraduate years at UC
San Diego. She then
continued her passion for
vision and science during her
four years at UC Berkeley,
where she graduated with a
Doctor of Optometry
degree, and Honors in
Research. She completed
her residency and began her
involvement with pediatric
vision research at SCCO. She
is currently a Fellow of the
American Academy of
Optometry, and practices in
Southern California.
Sure, there are some differences in opinion between groups and professionals about whether
the first exam needs to be a vision screening or if it should be a comprehensive eye exam in the
care of an eye care provider. However, no matter how you look at it, all agree that children with
“at risk” characteristics do need to be examined early and more often, and yet we are still not
seeing all of the children in this group in our practices. Some think the healthcare system is to
blame, or perhaps you think the bad economy is at fault for the low frequency in which you get
to examine a healthy pediatric patient for a routine eye exam. Well, there is more to the story,
and as a doctor of optometry we can make a tremendous positive impact in this matter and in
our communities. The best part is that you can do all that while growing your practice. It truly is
a win-win scenario.
Let us first start with the topic of patient education. Our state and national associations have
made efforts in the past to raise public awareness on the topic of pediatric eye care. Yet, the
reach needs to be stronger and go much further! That is where we all come in. The American
Optometric Association (AOA) states that children should receive eye exams at the age of six
months old, three years old, and again before first grade. They go on to say that exams should
follow every two years thereafter. It is mentioned that children who are at risk need to have eye
exams earlier and more often. This information needs to now reach the eyes and ears of our
current patients!
We can simply start out by asking all of our adult patients if they have any children and encourage them to schedule a comprehensive eye exam for their child in the coming days or weeks. I
am not suggesting we each take 10 minutes to address this topic in detail with each and every
adult patient. This would be neither practical, nor appropriate. I am simply recommending for
us to introduce the parents in our practices to the idea that their young child can also benefit
from a comprehensive eye exam and that you or your colleagues would be delighted to
provide their children with this service in your practice! Skeptical about how effective this can
be? Try it! Many will respond with “My son is already four and I never thought to get his eyes
checked! I’ll make an appointment to bring him in to see you.” Another method that is effortless and still works almost as well is to simply post AOA’s recommendations in your waiting
area or exam room. This will get the conversation started and will cost you no time or money
after the initial setup of the posting.
32
Optometry in Focus
What usually happens next is what I was referring to as the
win-win scenario. You will examine your patient’s child and
get to be the hero of diagnosing a previously undetected
visual limitation, or deliver the good news that their child is
healthy and ready for success. As I am sure you will agree,
parents would love to hear that his or her child is visually
ready for the school year. In the case that a visual limitation is
detected, they will forever be grateful for your recommendations and care.
... parents would love to
hear that his or her child is
visually ready for the school
year. In the case that a
visual limitation is detected,
they will forever be grateful
for your recommendations
and care.
By now I suspect there are at least a few readers rolling their
eyes and thinking, “Ever thought of the fact that I do not feel
comfortable seeing pediatric patients in my practice?” or
“Kids are difficult to examine and my practice is not ready for
big changes to accommodate them.” I am here to say that our
optometric education has in fact prepared us well for pediatric
eye exams and that it is far less stressful than you might
anticipate. Preparation is minimal and a little truly goes a long
way in this case.
As many of us would agree, children are fun little creatures
that want to be entertained and learn new things. This is great
news for us, because if presented correctly, an eye exam is
www.coavision.org
filled with activities that can feed their curiosity. This can
ultimately help us gain their cooperation and allow us to
successfully examine them. With some carefully worded
phrases, you can help get your younger patients excited about
the exam, but still keep them from touching and breaking
everything within their reach. One of my commonly used
phrases when I am walking a young child to my exam room is
along the lines of, “Follow me.” We are going to play some
games in my room over here!” They sense the excitement in
my voice, follow me effortlessly without much hesitation and
usually ask, “What kind of games?” to which I often reply, “All
kinds of games with lights and little windows.” This is what I
call a great start!
In the exam room, I continue to build on their curiosity and
interest. Take our transilluminator for example. Instead of
starting the exam by pointing this rather scary metal instrument with a bright light into the eyes of the child for evaluating their pupils, consider the following: Shine the light on your
hands as you are getting in position to start. Next, ask them to
put out their hand and shine it on a couple of their fingers. No
pain, no worry and it’s a fun moment for them. Then turn the
light beam to your face and shine it on your cheeks and ask to
do the same to their cheeks. At this point, they are just curious
and interested and not too scared at all. They cannot wait to
see what is next. In the process, you have also managed to
gain their trust and decrease their fear of the unknown.
Instead of shining it on their cheeks, you can now freely shine
it on their eyes and complete pupil testing without much
objection from them. From their viewpoint, your examination
no longer feels like a medical process that may end with a,
dare I say it, needle in the arm!
Similar to an adult exam, our job now is to collect the needed
data and properly conclude the state of the patient’s vision and
july/august 2014
33
Optometry in Focus
eye health. For pediatric patients, the most important components include visual acuity, ocular alignment, refractive error,
ocular health, color vision, stereopsis and visual fields. I would
argue that visual acuity is one of the most important components and should be completed with much attention to detail.
Specifically, monocular visual acuity should be collected with
absolute certainty that the covered eye is completely occluded.
I have found that this is best accomplished by the use of one
of two tools available to us: an adhesive eye patch or a pair of
opaque occluder glasses. Both allow for ease and accuracy in
this process and the latter is rather inexpensive and will last
you for years to come.
Perhaps one of the biggest differences between an adult and
pediatric eye exam can arguably be the great concerns that
exists surrounding amblyopia and ocular misalignment for
children. We fear the risks of amblyopia caused by a child’s
refractive error or strabismus. We are also equally concerned
about the effects of strabismus on the child’s cosmetic
appearance and binocular vision. Thankfully, there are some
guidelines we can utilize to help us distinguish between the
prescriptions at which amblyopia is thought to be of greater
risk. The following charts are taken from the AOA’s clinical
practice guidelines on amblyopia. Although the intent of the
chart varies for practitioners, some doctors successfully use
the following as criteria for when to perhaps prescribe and
when to hold off another year before starting the patient on
their first pair of glasses.
Anisometropia
Isoametropia
Hyperopia
>1.00 D
>5.00 D
Myopia
>3.00 D
>8.00 D
Astigmatism
>1.50 D
>2.50 D
Before I conclude, I want to go back to the topic of equipment.
It is true that many fancy tools are available to ease the process
of the examination or perhaps give you more accurate exam
findings. I have already discussed two such tools in the area of
obtaining accurate visual acuities. However, it can all boil down
to your techniques and the following few tools; make sure to
equip your waiting area with some books and magazines to
entertain your younger patients; be sure to encourage your staff
not to schedule more than two siblings at a time for examinations; be sure to have at least one color testing and one stereo
testing booklet available for use with every patient younger than
the age of 19; recommend cycloplegic evaluations as often as
possible, especially with any detection of hyperopia or trouble
with reading; most importantly, enjoy your time with the
pediatric patients and be sure to always ask about school
performance during case history. For your youngest patients, it
34
is imperative to have at least a couple of interesting little finger
puppets or even simple little hand held toys that you can use to
grab their attention and control their gaze as needed. Any little
toy that lights up or makes noise will prove to be priceless to you
during infant and toddler exams.
Be sure to encourage
your staff not to schedule
more than two siblings at
a time for examinations.
This is a short overview of the importance of pediatric eye
examinations, some simple tricks you can employ to complete
the exam successfully and the few extra tools you will need to
do so. There is a lot more to be reviewed and I encourage you
to reach out to your local societies and request speakers be
brought in to cover the topics of pediatric eye exams and
vision therapy in more detail during your upcoming continuing
education seminars. Happy examining to you all!
CONNECT WITH COA!
Why should you connect with COA? Because we are
the source for everything optometry-related in the
State of California! We have informational and
entertaining videos, tweets, posts and more!
“LIKE” US ON FACEBOOK AT:
www.facebook.com/CaliforniaOptometric
“FOLLOW” US ON TWITTER:
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The latest health care issues that affect doctors of optometry.
Changes in protective sports eyewear
Health News & Views
David McCleary, OD,FAAO
The importance of eye protection when playing sports cannot
be overstated. According to the National Eye Institute, sports
account for 40 percent of all eye injuries in kids 11-14 and is
the leading cause of unilateral vision loss in all age groups.
With 60 percent of kids between the ages of 5-18 playing
organized sports, the American Optometric Association,
American Academy of Ophthalmology and the American
Academy of Pediatrics have all encouraged greater use of
sporting eyewear protection.
So what constitutes protective eyewear? That job falls primarily into the hands of the American National Standards Institute
(ANSI). ANSI is a private, non-profit organization that develops
guidelines for a wide range of products, including eyeglasses.
These guidelines are called “standards.” Standards are
voluntary for a given industry to uphold. The standard for
protective eyewear is Z87.1-2010, implemented in 2010.
The significance of Z87.1-2010 is notable for a couple reasons.
First, it was the first update to the ANSI safety eyewear
standard since 2003. Second, it turned the 2003 standard on
its head. The 2003 standard was organized by type of eye
protector, for example: spectacles, goggles, etc. The 2010
standard is organized by the type of hazard, for example:
impact, splash, etc. For sport safety, impact standards are the
primary concern for eye care professionals.
Contrary to popular belief, minimum lens thickness is no
longer part of the standard, as long as the lens can pass the
drop ball test. The 2010 standard also includes a new way to
categorize impact resistance. Previously, lenses were rated as
either “basic” or “high impact” protection. In the 2010
standard, these have been changed to “non-impact” and
“impact.” Those rated as “impact” pass a higher velocity and
heaver drop ball test. How can you tell if a lens is “impact”
rated? “Impact” rated lenses are marked “Z87+.” “Non-impact” grade lenses are marked simply “Z87” without the “+.”
Compliance with standards is based on a manufacturer’s own
in-house quality control procedures. Independent certification is not required.
The American Society for Testing and Materials (ASTM)
created its own standard for certifying sport eyewear and is
becoming the new standard in the sport eyewear industry.
Originally created specifically for racquet sports, its F803
standard covers racquetball, handball, tennis, lacrosse, field
hockey, baseball and basketball. In this system, a 3.0mm center
lens thickness is required. Whereas ANSI Z87.1 was created for
occupational safety eyewear and is applied to sport eyewear,
the ASTM F803 was created specifically for sport eyewear and
has stricter eligibility requirements. The American Academy of
Ophthalmology recently went as far as to call ANSI Z87.1 “not
satisfactory” for eye-injury risk sports, recommending the
ASTM standard instead.
When examining children active in sports, remember the
three “musts:”
1) MUST prescribe. Write ANSI or ASTM on the prescription
and educate why.
2) MUST warn. Google “duty to warn” to find forms you can
have a parent sign if they refuse ANSI or ASTM safety
eyewear. It will emphasize the importance and may assist
you in avoiding post-care troubles.
3) MUST inspect. Ensure the safety glasses you order are
imprinted with the proper insignia designating it as
impact rated.
Health News & Views
Secrets of coding
Coding cataract co-management
One goal that every doctor of optometry should have is establishing the
concept of “patients for life.” There is
no better way to do this than through
William Rogoway,
the co-managing of our cataract
OD, DABFE
patients. Usually, it is the doctor of
optometry who finds the cataracts
upon routine visual examination. These cataract patients are
most likely established patients in our office who we have seen
for years. Because of this, the patient looks to us as their
primary eye care provider. Acting in this capacity, it is up to us
to guide the patient through the cataract procedure, bring him
or her back to our office, and continue to offer that person the
excellent care we have always provided for him or her.
Box #19 labeled “Additional Claim Information.”
1.This information must contain the start and stop dates of
the co-managing.
2.Do not include the surgery date as part of the
co-managing time.
3.With Noridian, the maximum number co-manage days
is 89.
Keep in mind that there are multiple coding opportunities
when thinking of co-managing cataract patients with PPO
insurance. These can include the initial exam, consultations
with the patient if surgery is needed in the near future, office
visits to treat lid conditions or ocular surface disease, cataract
co-managing, other office visits if needed after the 90-day
co-management period, and the post-surgical customized
prescription eyewear. This is followed by their routine yearly
eye exams and eyewear as needed thereafter.
Line #1 — Box 24b labeled “Place of Service.” The Medicare
code for an office is 11.
Other places of service, like a rest home, will have a
different code.
At the beginning of this year, after successfully billing Palmetto
for co-managing services for several years, some California
ODs were surprised to find that Noridian was rejecting their
co-managing claims when filed with the Palmetto’s format. As
you recall, Noridian took over from Palmetto mid-year 2013
and Noridian was accepting claims filed both ways until
December 31, 2013. After that time, Noridian only wanted the
co-managing claims filed their way. The difference is slight but
critical. So here are the necessary changes that have to be
made in order to get those Noridian co-managing claims paid.
Co-managing coding tips
Let us say, for example, that the initial cataract surgery was for
the right eye, done January 15, 2014, with surgical code CPT
66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure)), manual or
mechanical technique (e.g., irrigation and aspiration or phacoemulsification) with diagnosis code 366.16 (Senile Cataract).
The 1500 form is completed the same for Palmetto and
Noridian except there are three data fields that are Noridian
specific. (At this point, it is best to have a blank 1500 form in
front of you for reference.)
36
Information for box #19 would look like:
01/16/2014 – 04/13/2014
Line #1 — Box 24a labeled “Dates of Services.” The “From”
and “To” date is the date of the surgery. It should read
01/15/2014 to 01/15/2014.
Box 24D is CPT codes and modifiers. The CPT code is 66984
with modifiers 55 and RT.
Under CPT, put 66984 and Modifiers 55 RT.
Modifier 55 tells Noridian that this is a co-managing billing
and RT indicates that the right eye had the surgery.
Box 24F is the charge — Log your fees for co-managing
the case.
To determine what to place in this box, take whatever you
charge per day for co-managing times the number of days
the co-managing lasts and enter the resulting dollar figure in
this box.
Box 24G is marked days or units. The number in this box is
always 1.
You are supplying 1 unit of co-managing.
Do not report the number of days as units.
When billing for the second eye within the 90-day co-management period of the first eye, the modifier 55 changes to 79.
Since the specific eye has to be indicated, the modifier will
change to LT and look like: 79 LT.
This is how Noridian wants to see their co-managing claims
submitted. For further reference check Noridian’s webpage
reviewing the 54-55 modifiers. http://goo.gl/hWjVMx
Good luck and keep on coding.
Health News & Views
Medi-Cal update
Donny Shiu, OD, Medi-Cal Vision Care program consultant
There are a couple relevant Medi-Cal updates and clarifications
to report. Medi-Cal’s Vision Services Branch received many calls
from beneficiaries and providers asking about the status of
Medi-Cal vision benefits. Unfortunately, there is no change to
the existing policy on vision benefits. Adult eye appliance
services remain non-covered for those ages 21 and over. This
will continue, according to the governor’s May revised budget
proposal for fiscal year 2014-15. There is no proposed funding
for the restoration of the adult optical benefits.
Since your patient does not have COV: “V” for vision services
or “Comprehensive,” the OHC is not covering vision services,
so you can treat this patient and bill Medi-Cal directly for
vision services.
DEAR DR. SHIU: A parent brought her child into our
office for an exam. The eligibility verification presented
us with the message, “Medi-Cal eligible w/ no SOC and CCS
services require prior authorization.” What does it mean?
—Johnny from San Francisco
ICD-10 Implementation Delayed
The federal government has postponed the October 1, 2014,
implementation of ICD-10 codes in all billing activities pursuant to the Protecting Access to Medicare Act of 2014. The
state Department of Health Care Services is awaiting direction
from the Centers for Medicare & Medicaid Services on a new
compliance date. According to the federal statute, this
implementation may not be prior to October 1, 2015.
The following are providers’ questions for you to review.
DEAR DR. SHIU: I have a patient that has full Medi-Cal
benefits along with other health coverage, United
Healthcare. Specifically, the POS (Point of Service) printout
shows that the patient has Other Health Coverage (OHC) United
Healthcare Cov. Code: V and Scope of Coverage code COV: O,
I, M, P. Can we treat this patient and do I bill the other health
insurance first for vision services before I bill Medi-Cal?
—Chris from San Diego
DEAR CHRIS: Besides Medi-Cal, this beneficiary appears
to also have another private health plan that provides or
pays for their health care services. The other health coverage
might be through commercial health insurance companies,
PPOs, HMOs, in this case, United Healthcare. Usually, when
requesting eligibility verification for a beneficiary, the Medi-Cal
verification system will provide you with the OHC and COV
codes if available to Medi-Cal.
In your example:
OHC Code V corresponds to “coverage other than those
specified (variable).”
The coverage (COV): O, I, M, P means that Healthnet HMO
covers Hospital Outpatient (O), Hospital Inpatient (I), Medical
and Allied Services (M), and Prescription Drugs/Medical
Supplies (P) for the patient.
www.coavision.org
DEAR JOHNNY: The California Children’s Services (CCS)
program provides health care services, including diagnostic, treatment, dental, administrative case management,
physical therapy and occupational therapy services, to children
from birth up to 21 years of age with CCS-eligible medical
conditions. Examples of CCS-eligible medical conditions
include, but are not limited to: cystic fibrosis, sickle cell
disease, hemophilia, cerebral palsy, heart disease, cancer,
infectious diseases producing major sequelae, traumatic
injuries and handicapping malocclusion.
Approximately 90 percent of CCS clients are Medi-Cal
eligible. For these clients, the Medi-Cal program reimburses
services authorized by CCS. As in your case, you may treat this
patient under the Medi-Cal program.
The remaining 10 percent are enrolled in CCS only. The
verification message may say, “CCS eligible, CCS services
require prior authorization.” CCS-only clients are funded
equally by the state and a client’s county of residence. The
CCS program requires authorization for health care services
related to a child’s CCS-eligible medical condition. Providers
may need to submit Service Authorization Requests (SARs) to a
CCS county or state office, except in emergency. Please
contact your county CCS office or the Medi-Cal Phone Support
(800) 541-555 for assistance.
I hope you find this information useful.
If you have suggestions, comments or would like to submit
questions to COA Medi-Cal update, please use the following address:
Department of Health Care Services
Pharmacy Benefits Division/Vision Services Branch
1501 Capitol Avenue, Suite 71.5144
PO Box 997413, MS 4604, Sacramento, CA 95899-7413
E-mail: [email protected]
july/august 2014
37
John Tassinari, OD, FAAO,
FCOVD, Dip BV Ped &
Perception Section AAO
CASE REPORT:
Occlusion therapy for amblyopia
Reduced visual function associated with amblyopia can be improved with occlusion therapy.
A five-year-old boy with combined strabismus anisometropic amblyopia is treated with several
types of occlusion therapy during a 10-month treatment program. Best corrected visual acuity
improved from 20/200 to 20/50-.
History
CE@Home
Dr. John Tassinari is a 1987
graduate of the Southern
California College of
Optometry at Marshall B.
Ketchum University (SCCO).
He completed his residency
at SUNY Optometry in
pediatrics and vision therapy
in 1988. He now teaches part
time at SCCO and practices
part time. One of his career
highlights was obtaining
Diplomate status in the
Binocular Vision and
Perception Section of the
American Academy of
Optometry in 2006.
Charlie received his first eye exam from a primary care optometrist at age five years. The chief
complaint at that exam was crossed eyes. Examination, including cycloplegic refraction and
dilated fundus exam, resulted in the following diagnoses: anisometropic hyperopia, astigmatism each eye, constant right esotropia, and OD amblyopia in the right eye. Charlie’s optometrist found unremarkable ocular health and prescribed the cycloplegic refraction (OD +5.50
-1.00 180, OS +3.00-0.75 175), occlusion of left eye with an adhesive patch, and referred him
to the Southern California College of Optometry, Optometric Center of Los Angeles for
consideration of vision therapy (VT).
At the VT consultation, Charlie presented as a quiet, friendly five-year-old Latino boy who was
compliant with the spectacle wear, but poorly compliant with occlusion. Pregnancy, birth, major
developmental milestones and Charlie’s general health were unremarkable. The strabismus
onset per parental report was at age four — the eye turn was “not that noticeable and not
always there.” His parents sought eye care after noticing further progression and observing
Charlie’s eyes were much straighter with the glasses and that he sometimes looked over his
glasses. She continued to be concerned about his poor vision with the right eye. Charlie’s
resistance and his inability to function with the patch over the left eye proved to be a challenge.
Diagnostic Data
The VT consult led to a diagnosis of constant right esotropia that was partially accommodative
and combined strabismic anisometropic amblyopia OD. Distance retinoscopy with the habitual
glasses in place resulted in plano each eye and near point retinoscopy (monocular estimate
method) was +0.25 each eye. These results confirmed that he was wearing the optimal spectacle prescription with the constant right esotropia measured 12 prism diopters compared to 25
without spectacle correction. During corrected monocular visual acuities (VA) at far, Charlie was
slow to abduct OD upon covering OS. He used a random searching strategy and, after much
pointing and prompting, he finally located and identified the single 10/100 HOTV letter. His
decreased BCVA of 20/200 was further confirmed using the Wesson Psychometric Acuity cards
(Optometric Extension Program). Charlie saw none of the 20/212 tumbling E targets at 10 feet.
Abnormal counter interaction1, a “crowding effect” on this test caused a worse VA than single
letter presentation with HOTV. Near VA with Lea numbers (Precision Vision) was 20/200 – 2/5 at
40cm. Visuoscopy augmented the diagnosis of severe / deep amblyopia. It ranged from two to
three degrees of steady nasal eccentric fixation. Sensory fusion testing using red lens in dark
and lit room resulted in constant OD suppression.
The first step in the treatment plan was to initiate full time direct occlusion of the left eye in a
manner that promoted compliance. To that end, 1% atropine sulfate ophthalmic ointment
(Bausch & Lomb) was prescribed for left eye and the left spectacle lens was converted to plano
DS. This type of direct occlusion, optical blur/pharmacological penalization, rendered Charlie’s
left eye undercorrected for distance by 5.50D sphere and 1.00 cylinder. Left eye was further
penalized at near because of atropine induced cycloplegia. A strategic advantage of this type
of occlusion was that Charlie could not circumvent it in any way.
38
CE@Home
Six days later, Charlie presented with a widely dilated left
pupil, a preference to fixate with OD and a positive report
from mother about his improved visual function as the days
passed. Although the first full day was difficult for Charlie, on
day 2 “he began playing with his brother as usual.” His OD VA
was 20/100 with single letter HOTV, 20/155 with Wesson
Psychometric Acuity cards, and 20/160-1/5 at near. Another
monocular vision test, contrast sensitivity, (M&S Technologies)
was introduced and Charlie achieved 32% contrast with single
20/100 HOTV letters. At this same visit, Charlie’s monocular
saccades, pursuits and accommodation were tested and all
were abnormal with OD. Visuoscopy again showed nasal
eccentric fixation. Monocular color vision (Color Vision Testing
Made Easy, Bernell) was normal for each eye.
The first step in the
treatment plan was to
initiate full time direct
occlusion of the left
eye in a manner that
promoted compliance.
Weekend atropine ointment in the left eye continued for 12
weeks with progress evaluations occurring every 3 weeks. At
the second visit, direct opaque occlusion of the left eye with a
clip-on occluder (Bernell) was prescribed to be worn during
near eye-hand activities (build puzzles, Legos, coloring books
etc.). This home-based monocular VT was to be done two
hours per day. This treatment plan led to slow and steady
improvement in monocular vision to 20/80 HOTV, 20/97
Wesson Psychometric Acuity, and RS20/80 at 40cm. Contrast
sensitivity was 25% with 20/80 letters. At the fourth visit,
Charlie showed no improvement compared to the prior visit.
Because of this plateau, treatment was intensified by implementing a formal office-based VT program. Office VT visits
were scheduled once weekly for 60 minutes. The occlusion
regimen was modified in the following way: Atropine ceased,
the left sphero-cylinder spectacle lens was inserted, and a
20/100 graded occlusion foil (Eye Care and Cure) was applied
to the back side of the left spectacle lens. Upon application,
Charlie began to fixate with his right eye. Behind the occlusion
foil, the left eye assumed an esotropic posture. This occlusion
method, direct full time translucent with a graded filter,
continued for 30 weeks. Ten weeks into the office-based VT
program, the 20/100 occlusion foil was replaced with a 20/70
occlusion foil because his OD VA improved. Direct opaque
occlusion continued to be employed part time for certain
monocular VT procedures. For example, Hadinger brush VT2 to
improve foveal fixation OD were accomplished with OS
completely occluded with an opaque elastic band patch.
www.coavision.org
Another type of occlusion filter was employed during office VT
for several procedures. A filter was placed in front of Charlie’s
normal eye (OS) and conditions were arranged such that the
normal eye (OS) could not see the target for the VT procedure
because of the filter. But, OS saw all other items in the field.
OD, the amblyopic eye, could see the VT target. This type of
VT is known as monocular-fixation-binocular-field (MFBF).3 One
MFBF activity Charlie completed employed the right vectogram from the left/right pair of clown vectograms (Bernell).
Charlie wore polaroid filter glasses with the right filter removed. Under these conditions, OD saw the clown vectogram,
but, because of the left polarized filter, OS could not see the
target. It looked blank when viewed with OS. Charlie located
and identified the target details (letters of the alphabet) with
the target in motion and at his threshold VA.
Charlie’s VT continued for a total of 30 office visits. Sensory
fusion testing during that time span resulted in additional
diagnoses of anomalous correspondence and suppression.
Periodic testing also showed improved monocular vision and
slight improvements in binocular vision. Repeat cycloplegic
refraction on visit 15 by Charlie’s primary optometrist revealed
no additional latent hyperopia and a minor change in the
astigmatism. His VT program expanded to binocular VT
procedures for esotropia (including sensory fusion). Corrective
BO Fresnel was tried at week 10 and then again at his 30th VT
visit. Charlie adapted to prism within 10 minutes of prism
application. VT concluded when there were no further
improvements in monocular and binocular vision between visit
july/august 2014
39
CE@Home
25 and 30. Eye muscle surgery was discussed briefly for the
residual esotropia, but the lack of cosmetic concern prompted
the parents to decline. A maintenance occlusion regimen was
assigned to prevent regression. Charlie’s final best corrected
VA with OD was 20/60 with Wesson Psychometric, 20/50-2/5
at far with a conventional full chart and 20/50 at 40cm.
Discussion
Functional amblyopia is a condition in which best corrected
visual acuity is worse than 20/20 in the absence of disease and
the presence of an amblyogenic factor such as constant unilateral strabismus or anisometropia.4 Disease processes such as
congenital cataract can cause amblyopia via form deprivation.
Functional amblyopia is the most common cause of monocular
vision impairment in children and young adults.4 Its incidence is
0.4% per year during the preschool years resulting in a prevalence of 2% of the general population.4
With the best spectacle correction, the fulcrum of a treatment
plan for amblyopia is arranging conditions so the patient
purposefully uses the amblyopic eye to seek, identify and
extract relevant visual information to guide action and
thought. Occlusion of the normal eye (NE) readily accomplishes this arrangement. NE occlusion can be simple and straightforward. The patient can simply peel and stick an adhesive
patch on face to cover NE. Alternative and more complex
occlusion options and strategies shown in Table 1, Table 2, and
illustrated in the previous case report. Clinicians select the
occlusion form, type and schedule based on diagnosis and
therapy is judiciously modified during treatment. Human
factors come into play such as age, temperament of the child
and parenting style. Another practical yet limiting factor is
whether or not the child is a full-time eyeglass wearer. Clip-on
and translucent occluders are impractical with patients who
have no spectacle correction.
Functional amblyopia is
the most common cause
of monocular vision
impairment in children
and young adults.4
After decades of research on occlusion therapy for amblyopia,
the Pediatric Eye Disease Investigator Group (PEDIG) and their
Amblyopia Treatment Studies5 clarify the efficacy of various
treatments for amblyopia with an emphasis on occulusion. One
of their early studies showed that more occlusion is not necessarily better than less.6 Young children (age three to seven years)
with moderate amblyopia were separated into two groups. The
first group was prescribed direct opaque occlusion for two
hours per day and the other six. Both were instructed to engage
40
in active eye-hand activities while occluded. After four months,
the groups had similar gains in acuity. Another PEDIG study has
shown that atropine penalization is on par with traditional
opaque patching methods in terms of safety, efficacy and
acceptance by patient/parent.7 The question of age and
amblyopia treatment has also been answered by PEDIG8 and
other studies. Without a doubt, the potential for improved
vision in amblyopia is present at any age.9-12 PEDIG is funded by
the National Eye Institute and doctors of optometry are well
represented on the research teams. The PEDIG public website
(http://pedig.jaeb.org) is loaded with information including
completed and ongoing research on amblyopia.
Table 1
Occlusion Types
LIGHT TRANSMISSION FORM OF OCCLUSION
Opaque adhesive patch, elastic band patch, clip-on
occluder, sleeve occluder
Translucent graded filters (Bangerter foils, cling patch),
nail polish on spectacle lens
Optical Blur atropine penalization, over-plus spectacle or
contact lens, colored filter, polarized filter
Table 2
Occlusion Placement Occlusion Schedule
Direct Occlude Normal Eye (NE) Full Time 1 eye is occluded
all waking hours
Indirect Occlude Amblyopic Eye (AE) Part Time Some
waking hours both eyes have Alternating
Mix of occluding NE and AE no occlusion
Partial Occlude sector of visual field
Research recommend two hours of part time direct opaque
occlusion of NE for any type of amblyopia, taking into account
the challenges of compliance when prescribing occlusion
therapy. If patient is a spectacle wearer, consider prescribing a
clip-on occluder. If the patient is not a spectacle wearer,
consider an adhesive patch or elastic band patch. An alternative
to the 2-hour per day treatment plan, can be 15 hours per week
of occlusion. This flexible schedule recognizes that there will be
days when occlusion is not feasible and the child can make up
for it on another day. If the child will not comply with opaque
occlusion, atropine penalization is a very good second choice
(see box for atropine penalization guidelines). Follow-up
evaluations for amblyopia occlusion therapy answer a simple
question: Has visual function with AE improved? If yes, continue
the same treatment plan until the amblyopia is cured. Therefore,
it is helpful to have multiple measures of visual function to
properly modify treatment plans as necessary. For example,
distance VA with a standard Snellen chart may show no change.
But, improvements in visual function per contrast sensitivity and
eye movements would lead to the overall conclusion that
CE@Home
indeed, sufficient progress has occurred to warrant continuation
of the present treatment plan. It is also helpful to have distance
and near VA charts with small increments between VA levels. A
patient may improve from 20/200 to 20/160 but a VA chart that
jumps from 20/200 to 20/100 will not show that increment of
improvement. The Wesson Psychometric acuity cards have a
broad range of small increments and control for the crowding
effect.1 The tumbling E optotypes expand the age range that
can be tested. This test is my preferred method for measuring
distance VA in amblyopia. If a progress evaluation shows no
improvement in visual function on all measures and compliance
has been good, then the treatment plan should be intensified.
Increased hours of occlusion is one way, another is to enroll the
patient in an active office-based VT program as was done with
Charlie in the case report presented.
ATROPINE PENALIZATION METHOD OF OCCLUSION
Purpose: Cycloplegia to induce optical blur in normal
eye so that amblyopic eye is used for visual tasks.
Method: 1% atropine sulfate solution (2, 5, or 15 ml) or
ointment (3.5g) in normal eye. Maximal therapy is once
daily dosage with minus add for normal eye. Standard
therapy is one dose two days per week with or without
minus adds.
Possible side effects: Allergic or irritation reaction of
skin/conjunctiva, thirst, fever, tachycardia, irritability,
cutaneous flush, somnolence, excitement, convulsions.13
Advantages: Inconspicuous, child cannot circumvent,
compliance evident to clinician (mydriasis), ease of
application for parents, latent nystagmus remains latent.
Disadvantages: Possibility of side effects, cannot easily
suspend NE blur (e.g. remove patch) for visually demanding tasks such as reading or ball sports.
The progression is noted, form and schedule of the occlusion
therapy can evolve during treatment toward simplicity for the
doctor and the patient. Consider a first grader with anisometropic amblyopia with a best corrected VA of 20/80 in the
amblyopic eye following six weeks of full-time SRx wear.
Part-time direct opaque occlusion of NE with a clip-on occluder yields improvement to 20/50 over a two-month period.
20/50 VA may very well be sufficient for the child to function in
school.14 Occlusion therapy can intensify from part time direct
opaque to full-time direct transluscent with a graded filter, eg
20/70, applied to NE. The filter is applied to the back side of
www.coavision.org
the NE spectacle lens and the patient simply wears his or her
glasses all waking hours as before. Check the patient in one
month and if VA has improved further, let’s say to 20/30,
remove the 20/70 foil and apply a 20/50. Now, the child will be
quite functional and further improvements can take place. At
this stage of occlusion therapy, it is advisable to wait longer for
the next progress evaluation. Improvement from 20/30 to
20/25 or 20/20 can take two to six months. This hypothetical
case example of anisometropic moderate amblyopia represents the type of amblyopia that any primary care optometrist
can manage. If amblyopia does not improve to 20/20 the
patient should be referred to an optometrist who specializes in
VT. If the child should also demonstrate normal binocular vision
(stereopsis, second degree fusion, vergence skills) and be free
of visual performance symptoms (e.g. difficulty keeping place
while reading, difficulty copying) then the primary care
optometrist does not need to refer the patient for VT.
Another consideration when prescribing occlusion therapy for
amblyopia is whether or not to assign specific VT activities while
occluded. Krumholtz and Fitzgerald researched this question
and their study showed that occlusion therapy coupled with VT
is superior to occlusion alone on 2 counts.15,16 Stereopsis after
treatment is better and regression of gains in visual function is
less likely when VT augments occlusion therapy. There are also
three pragmatic reasons to assign VT with occlusion. First, most
parents are eager to assist with therapy and will ask for guidance regarding activities to do while their child is occluded.
Mazes, coloring books, puzzles and snap-together toys are all
activities that require the child to activate a wide range of visual
skills which will promote and develop better visual function with
AE. Second, the assigned activities can be a reward for the
child. The parents can gift the child a new game or toy that can
only be played while the occluder is in place. Compliance with
occlusion improves if parents work on an activity with the child
during occlusion time, (i.e. play tic tac toe with very small grids
or build a puzzle together). Third, activities can be targeted to
specific monocular skills that are deficient. Amblyopia is not just
a VA deficit. Other monocular visual functions such as, saccades,
pursuits, accommodation, spatial perception, contrast sensitivity, may also be underdeveloped.17 VT can be prescribed that
targets the deficient visual skills.
The final consideration in occlusion therapy for amblyopia is
length of time for total course of occlusion therapy. After the
amblyopia has been treated maximally and no further
improvements are possible (or needed because monocular
vision is normal), abrupt and complete termination of occlusion
can lead to regression.5,17,18 To prevent regression, assign part
time direct occlusion for 10 hours per week. Recheck in six
weeks. If no regression, taper to five hours per week for a
month and then no occlusion. If regression occurs, carefully
check binocularity and refraction. Refractive changes should
july/august 2014
41
CE@Home
be compensated for and abnormal binocularity warrants VT
emphasizing binocularity. If the optimal SRx is in place and
binocularity is normal, some children need maintenance
occlusion until they are 10-14 years old. Invariably, they will
grow out of their susceptibility to regression. Regression is
more likely during the first year after cessation of therapy, in
constant unilateral strabismus and younger children.5,18,19 It is
less likely in cases of anisometropia, older children and
patients with good binocularity.
Among the various conditions that can cause vision loss,
amblyopia has the good fortune of being wholly preventable if its cause is diagnosed and treated at or near onset
has great prognosis. Unlike age related diseases that cause
vision loss (e.g. glaucoma, AMD), it has the unfortunate
attribute of occurring early in childhood and saddling the
individual with abnormal vision for a lifetime if untreated or
treated too late. Individuals with amblyopia have a higher
risk of vision loss in NE than in the general population in
becoming blind.5 Amblyopia decreases stereopsis which
may detract from driving and near eye-hand tasks and
cause occupational exclusions.4 It also lowers surgical
success rate for esotropia. 20
The case report presented above, Charlie, demonstrates a
suboptimal outcome because treatment began too late.
Because Charlie’s initial VA was so poor, his final best
corrected VA was no better than 20/50, it is probable he
had constant right esotropia and anisometropia for two or
more years before his first eye exam. The esotropia was
small enough in magnitude to escape detection by his
pediatrician and his parents which led to a period of
uncorrected refractive error. Two tests — cyloplegic
retinoscopy and unilateral cover test — performed when he
was an infant or even at age three years in compliance with
recommended guidelines21 could have led to earlier
diagnosis and a better prognosis. It is incumbent upon all
primary eye care providers to recommend routine comprehensive eye exams performed by a pediatric eye care
provider at age six months and three years to prevent
vision loss associated with amblyopia.
REFERENCES
1. Rutstein RP, Paum KM. Anomalies of binocular vision. Diagnosis and
Management. St. Louis: Mosby, 1998: 21-23.
2. Cotter SA. Vision therapy techniques. In Coloroso EE, Rouse MW.
Clinical Management of Strabismus. Boston: Butlerworth-Heinemann, 1993: 329-30.
3. Press LJ. Amblyopia therapy. In: Press LJ ed. Applied Concepts in
Vision Therapy. St. Louis: Mosby, 1997:192-200.
4. Rouse MW, Cooper JS, Colter SA et. al. Care of the patient with
amblyopia. St. Louis: American Optometric Association. 2004: 2.
5. Rutstein RP. Contemporary issues in amblyopia treatment. Optometry 2005; 76(10): 570-8.
6. Repka MX, Beck RW, Holmes JM, et. al. A randomized trial of
patching regimens for treatment of moderate amblyopia in children.
Arch Opthalmol 2003; 121:603-11.
7. Pediatric Eye Disease Investigator Group. Two-year follow-up of a
6-month randomized trial of atropine vs. patching for treatment of
moderate amblyopia on children. Arch Ophthalmol 2005; 123: 149-57.
8. Pediatric Eye Disease Investigator Group. Randomized trial of
treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol 2005; 123:437-47.
9. Birnbaum MH, Koslowe K, Sanet R. Success in amblyopia therapy as
a function of age: a literature survey. Amer J Optom Physio Optics
1977; 54(5): 269-75.
10. Wick B, Wingard M, Cotter S, Scheiman M. Anisometropic amblyopia: is the patient ever too old to treat? Optom Vis Sci 1992; 60(11):
866-78.
11. Mohan K, Saroha V, Sharma A. Successful occlusion therapy for
amblyopia in 11 to 15 year old children. J Pediatric Ophthalmol
Strabismus 2004; 41(2): 89-95.
12. Simmers AJ, Gray LS. Improvement of visual function in an adult
amblyope. Optom Vis Sci 1999; 76(2): 82-87.
13. Jaanus SD, Carter JH. Cycloplegics. In Bartlett JD, Jaanus SD eds,
Clinical Ocular Pharmacology 3rd ed. Boston: Butterworth-Heinemann, 1995: 167-72.
14. Langford A, Hug T. Visual demands in elementary school. J Pediatric
Ophthalmol Strabismus 2010; 47(3): 152-6.
15. Krumholtz I, Fitzgerald D. Efficacy of treatment modalities in
refractive amblyopia. J Amer Optom Assoc 1999; 70(6): 399-404.
16. Fitzgerald DE, Krumholtz I. Maintenance of improvement gains in
refractive amblyopia: a comparison of treatment modalities.
Optometry 2002; 73(3): 153-59.
17. Press LJ. Amblyopia. J Optom Vis Develop 1988; 19: 2-15.
18. Rutstein RP, Fuhr PS. Efficacy and stability of amblyopia therapy.
Optom Vis Sci 1992; 69 (10): 747-54.
19. DeWeger C, Van Den Brom HJ, Lindeboom R. Termination of
amblyopia treatment: When to stop follow-up visits and risk factors
for recurrence. J Ped Ophthalmol Strab 2010; 47 (6): 2010.
20. Weakly DR. Holland DR. Effect of ongoing treatment of amblyopia
on surgical outcome in esotropia. J Ped Opthalmol Strab 1997; 34 (5):
275-78.
21. Scheiman MM, Amos CS, Ciner EB. Pediatric eye and vision examination 2nd ed. St. Louis; American Optometric Association. 2002: 32.
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42
CE@Home
CE Questions
1. The patient described in the case report, “Charlie” had all of
the following diagnoses except.
a. Refractive amblyopia OD due to anisometropia.
b. Strabismus amblyopia OD due to constant right esotropia.
c. Nasal eccentric fixation OD.
d. Anomalous correspondence per red lens test.
2. While under the influence of atropine in his left eye, Charlie
no longer had constant esotropia.
a.True
b.False
3. The occlusion method called ‘filter’ was utilized to treat
Charlie’s OD amblyopia. Which of the following is true
regarding the filter method of occlusion as it was used in the
case report?
a. The filter was placed in front of the normal left eye so
that Charlie could not see the VT target with his left eye
but could see it with the amblyopic right eye.
b. The filter was placed in front of the normal left eye so
that Charlie could see the VT target with his left eye but
could not see it with the amblyopic right eye.
c. The filter was placed in front of the amblyopic right eye
while the normal left eye was occluded.
d. The filter was placed in front of the amblyopic right
eye so that the amblyopic eye could only see it if he did
not suppress.
4. Which of the following is TRUE regarding topical atropine
utilized for amblyopia?
a. It is only available as a 1.0% solution.
b. It is classified as an “optical blur” method of occlusion.
c. A possible adverse drug reaction is bradychardia.
d. The drug is instilled topically in the amblyopic eye.
5. A patient has bilateral hyperopia, OD esotropia, OD
amblyopia, and a high AC/A ratio. She wears glasses for the
hyperopia and a bifocal ADD. She is orthophoric (no
esotropia) through the bifocal add but has constant right
esotropia when viewing above the bifocal add at all distances.
You place translucent adhesive tape above the bifocal on the
left spectacle lens. The adhesive tape applied in this manner
is what type of occlusion?
a. Indirect alternating
b. Alternating optical blur
c. Direct partial part-time
d. Full time optical blur
6. A patient is emmetropic OD, 4.00D hyperopia OS, and has
functional amblyopia OS. You prescribe +4.00 spherical soft
lenses to each eye. This type of occlusion is called Direct
Optical Blur.
a.True
b.False
7. A patient with functional amblyopia has 20/200 best
corrected visual acuity measured with a distance VA chart
that has the following increments: 20/200, 20/100, 20/70,
20/50, 20/40. 20/30, 20/25, 20/20, 2015. You prescribe part
time direct opaque occlusion. At follow-up the acuity in the
amblyopic eye again measures 20/200. Which of the
following conclusions are true?
a. The baseline VA was worse than 20/100 but not worse
than 20/200.
b. At follow-up, it is certain there was zero improvement.
c. At follow-up, it is uncertain if there was improvement.
d. Both A and C are true conclusions.
8. The Amblyopia Treatment Studies have clearly
demonstrated that more hours of assigned occlusion lead
to a better outcome.
a.True
b.False
9. Deficient contrast sensitivity and deficient accommodation
would be unexpected findings in a diagnosis of functional
amblyopia.
a.True
b.False
10. A seven-year-old patient with anisometropic refractive
amblyopia improves from 20/120 to 20/20 over the course of
nine months. Part-time direct opaque occlusion for 15 hours
per week was a key ingredient of the treatment plan. At the
nine-month exam during which you find 20/20, which of the
following is the best clinical patient management plan?
a. Instruct the patient to discontinue glasses but continue
part time occlusion.
b. Evaluate the patient’s binocular vision and ask about
symptoms related to visual function.
c. Instruct the patient to cease occlusion therapy. You
host a party with streamers, balloons, and face painting
d. Instruct the patient to continue with full time glasses
and continue occlusion. The assigned occlusion
schedule is 10 hours per week.
e. Both B and D are correct.
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answers is September 17, 2014.
Mail: COA — Education Coordinator
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Email:[email protected]
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july/august 2014
43
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practices. Alissa Wald, OD, a successful practice owner, with her
husband, Scott Daniels, and their
national team of agents bring over
75 years combined experience in
management, financing and the
hands-on skills of building a large
private practice. Practice Concepts
is the only west coast company
offering this winning combination
of business and practice expertise.
We’re in practice to advance
your practice.
• Nationwide practice sales
• Extensive business
management expertise
• Advanced marketing strategies
• National database of
qualified buyers
• Doctor owned
• Agents located nationwide
1101 Dove St., Ste. 225
Newport Beach, CA 92660
T: 877-778-2020
F: 949-390-2987
www.practiceconcepts.com
Please see our display ad for
current listings.
Help wanted
Needed: full time Optometrist
We are a growing general
ophthalmology group practice,
currently with five office locations
in the Southern California/LA
County area. We are in search of
an additional full time medical
Optometrist to see patients
in our Lancaster, Long Beach,
and El Centro office. Spanish
language skills are helpful, but not
required. We offer a great working
environment with solid support,
competitive compensation and
comprehensive benefits. This
is an exceptional opportunity
for someone looking to gain
significant clinical experience in a
busy office, and work alongside
extremely knowledgeable senior
physicians. compensation: Upon
Experience
Thanks,
Chris
626-269-5312
____________________________
www.montereysymposium.com
2014
N O VE MBE R 7– 9
How will you:
– Grow your practice?
– Prepare for health care reform?
– Make sure you get paid?
Monterey Symposium will give you all of
the tools you need to do this and more!
44
Buying?
Growing?
Selling?
Whether you are ready to buy, grow or sell a professional
business, Practice Concepts practical approach, experience
and straight-forward thinking provides the support you need
and proven results that you can always rely on for success!
PracticeS For Sale
•
Buyer ServiceS
•
aPPraiSalS
•
Partner Buy-inS
•
coacHinG
Call for a FREE & Confidential Market Evaluation!
8 7 7 •7 7 8 •2 0 2 0
JUST REDUCED! RETAIL OPTICAL STORE FOR SALE: Los Angeles, CA
This well-established optical boutique is located in the high end area of Brentwood in Los
Angeles where the tight knit community loves to support local businesses. Annual gross
revenue is over $185K with tons of potential. (ID#76501)
JUST REDUCED! OPTOMETRY PRACTICE FOR SALE: Northern Idaho
This great practice is located in northern Idaho, situated along the Washington/Idaho
border. Annual gross revenue is over $545K on 4 doctor days per week and weekday office
hours only - lots of room for potential growth. Real estate also available. (ID#76512)
OPTOMETRY PRACTICE FOR SALE: Central CA
This busy practice is located in a residential / industrial area in the agriculturally-rich, San
Joaquin Valley. This is a turnkey practice with great cashflow, plus the real estate is also
available for sale. This is a tremendous opportunity. (ID#76505)
NEW! OPTOMETRY PRACTICE W/ 2 LOCATIONS: Southwest Nebraska
This well-established practice has 2 locations in beautiful, Southwest Nebraska. Combined
annual gross revenue is over $1.2 million with over $430K in owner profit! Real estate is
available for sale or lease. (ID#76525)
OPTOMETRY PRACTICE FOR SALE: Coachella Valley, CA
Boasting about $200K adjusted net, this practice is located in the sunny Coachella Valley
of California in a free standing building. Annual gross revenue is over $425K on weekday
hours only. Seller owns the building which is also available for sale or lease. (ID#76504)
OPTOMETRY PRACTICE FOR SALE: Monmouth County, NJ
This 37 year old practice is located in an upscale, suburban area near the New Jersey
shore. The office is situated in a condo unit on a main highway. Annual gross revenue is
over $435K on 3 1/2 doctor days per week. (ID#76503)
OPTOMETRY PRACTICE FOR SALE: Coastal LA County, CA
This well-established practice is situated 3 miles from the Pacific Ocean and 3 miles from
LAX on a busy street with excellent visibility and rear parking. Annual gross revenue was
over $630K in 2012, and has great growth potential. (ID#76508)
OPTOMETRY PRACTICE FOR SALE: Upstate NY
This practice was started cold since 1939, and has been family owned since. This office is
situated in a historic area with high visibility and high foot traffic. Over $275K gross in 2013.
Plenty of room for growth. (ID#71028)
BOUTIQUE OPTOMETRY PRACTICE FOR SALE: West Hollywood, CA
Location, location, location! This boutique style practice is located in one of the most
desirable cities in California -- West Hollywood. Annual gross revenue was over $395K in
2012 and is currently on the rise. (ID#76506)
OPTICAL FRANCHISE FOR SALE: Upstate NY
Location, location, location! This well-established optical franchise is located in Upstate
New York in a high traffic area on a corner lot. Annual gross revenue is over $1 million.
(ID#76507)
NEW! OPTOMETRY PRACTICE FOR SALE: LA County, CA
This great, well-established practice is a staple in the community of Long Beach. Located in
a free-standing building in a highly desirable area, with plenty of parking - a rare find in LA
County. Annual gross revenue is over $820K with plenty of room for growth. (ID#76529)
OPTOMETRY PRACTICE FOR SALE: Western Ohio
Located just north of Dayton, this well established practice features equipment upgrades, a
spacious 5,000 square foot office and a very strong net profit. Annual gross revenue is over
$850K. The free-standing building is available for sale or lease. (ID#76523)
OPTOMETRY PRACTICE FOR SALE: San Diego County, CA
Location, location, location! This well-established practice is located in a highly-desirable,
trendy neighborhood in San Diego surrounded by shops and restaurants. Annual gross
revenue was almost $400K in 2012, with tons of room for growth potential. (ID#76511)
OPTOMETRY PRACTICE FOR SALE: Vermont
Location, location, location! This great, 40 year old practice is located near the state capitol
in a professional building surrounded by breathtaking views. Annual gross revenue is over
$550K with plenty of room for growth. (ID#76491)
JUST REDUCED! OPTOMETRY PRACTICE FOR SALE: Western Colorado
This well-established practice is located in Western Colorado on a main street in a
picturesque downtown neighborhood. Annual gross revenue is over $400K, with plenty of
room for growth. This one won’t last. (ID#76518)
COMING SOON!
RETAIL OPTICAL BOUTIQUE FOR SALE: Palm Beach County, FL
Annual gross revenue is over $275K with plenty of room for growth. (ID#76527)
OPTOMETRY PRACTICE FOR SALE: Near Atlanta, GA
This great, 10-year-old practice is located on the first floor of a new medical building that is
adjacent to the regional hospital. Annual gross revenue jumped to over $750K in 2013, from
just over $500K in 2012. (ID#76500)
OPTOMETRY PRACTICE FOR SALE: Near Houston, TX
Annual gross revenue is over $420K. (ID#76531)
For more information go to: PracticeConcepts.com
COA EVENTS
If you have an event you would
November 7-9, 2014
Monterey Symposium
Monterey Marriott
350 Calle Principal, Monterey, CA 93940
831-649-4234
like to promote, please send
your listing to Kale Elledge at
[email protected].
View more upcoming events at:
www.coavision.org.
When & Where
July
20
SDCOS Golf Tournament
619-663-8439
[email protected]
www.sdcos.org
24-26
SVOS Tahoe Summit (12 Hours CE Credit)
Hyatt Regency, Incline Village, NV
916-447-0270
[email protected]
www.svos.info
August
21
SDCOS Optometric Jeopardy: Systemic Medications and Anterior Segment
The Handlery Hotel and Resort
619-663-8439
[email protected]
www.sdcos.org
Get listed in
California
Optometry
If you have events
you would like printed in
our When & Where
section, please email
Amanda Winans at
[email protected]
with your event, the
date and a contact
number, email/website.
46
September
14
SDCOS Glaucoma Grand Rounds, and Diabetic Eye Disease
The Handlery Hotel and Resort
619-663-8439
[email protected]
www.sdcos.org
21
SBOS CE Seminar
Double Tree Hotel on Hawthorne Blvd., Torrance , CA
310 535-6188
[email protected]
www.southbayoptometricsociety.com
Summer has arrived...
and Practices are Sizzlin’!
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at Historically Low Rates
Time to jump in
and be cool!
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and backed by the full faith and credit of the United States Government
NCUA
National Credit Union Administration, a U.S. Government Agency
Non-profit
www.visionone.org • (800) 327-2628
Optometric Bill
ing T
ool
s
The most commonly used
information in easy-to-use formats.
2014 Common Diagnosis Codes Card
2014 Customized Medicare Fee Schedule
2014 PQRS Quick Reference Card
2014 Medicare Quick Reference Card
Updated annually!
Pr i m ar y
Eye c a re
N e t work
To order, please call
800-444-9230
www.PrimaryEye.net
$AVE MONEY WITH OUR
PREMIUM VENDOR$
Vision West members can save even more money by increasing their purchase
volumes with our Premium Vendors. In addition to our already low discounts,
Vision West has negotiated “Money Saving” deals with our Premium Vendors:
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Login to the member section at www.vweye.com for details of this program or
call our Customer Service Department at 800.640.9485.

optometry optometry - California Optometric Association

Transcription

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