Comanaging phakic IOLs

Transcription

August 2014
VOL. 6, NO. 08
OptometryTimes.com
Vault Assessment
THIS IS WHY eye care practitioners cornea
prefer our lenses more than all other
ICL vault
multifocal contact lenses.1
NC law bans
limited service,
material fees
Insurers and health plans
now may not cap charges
on non-covered items
By Colleen E. McCarthy
Content Specialist
FAR
Raleigh, NC—North Carolina Governor Pat McCrory recently signed into law a bill that prohibits insurers and health benefit plans from
limiting the fee an optometrist can charge patients on services or materials, unless those
services or materials are covered by reimPRECISION PROFILE DESIGN
bursement under the plan or insurer contract.
“We thought that it was extremely imporCompare the cornea and the vault
INTERMEDIATE
tant to take a stand and
take back some degree of control on some of the things going
Focus on Refractive Surgery author Dr. Bill Tullo continues his discussion of phakic IOLs this
NEAR
on in our practices,” says Charles Sikes, OD,
month with co-management information, including outcomes, perioperative care, and complication
president of North Carolina State Optometric
management. Visian ICL induces fewer high-order aberrations in high myopes as compared to LASIK,
Society (NCSOS). “A lot of people are strugand it provides 98 percent UCVA at 20/20. Perioperative care is similar to that for cataract surgery, and
gling more and more to get things to work
although all intraocular surgery carries risks for sight-threatening complications, phakic IOLs are showing
well financially in their practices, but insurAIRcomplication
OPTIX® AQUA
Contact
Lenses
SEE
PAGE 18
an excellent safety profile with
ratesMultifocal
below one percent.
ers want to dictate how we can compete on
provide clear binocular vision near through far.
services and materials that they don’t even
cover. We felt that was out of bounds.”
Plasma Surface Technology:
Precision Profile Design:
‡
2†
•
Full
range
of
ADD
powers
According to Dr. Sikes, NCSOS was heav• Superior wettability
blended seamlessly across
and deposit resistance3††
ily involved in the nearly two-year process of
the lens
passing the law.
• Consistent comfort
far
4
The law states, “No agreement between an
from day 1 to day 30
intermediate
near
insurer or an entity that writes vision insurance and an optometrist for the provision of
vision services on a preferred or in-network
basis to plan members or insurance subscribhavecontact
an opportunity
to review, and if necesByAsk
Bobyour
Pieper
sales representative about the #1 multifocal
lens.5
ers in connection with coverage under a standsary correct, any information on their finanalone
vision plan, a medical plan, or health
cial
dealings
with
industry
prior
to
public
rehe U.S. Centers for Medicare and Medicinsurance policy may require that an optomaid Services (CMS) is on track to begin lease. However, they must act promptly, the
etrist provide services or materials at a fee
publicly releasing information on in- CMS emphasizes.
limited or set by the plan or insurer unless
Authorized under the Physician Payments
dustry-physician financial relationship
the services or materials are reimbursed as
through its new National Physician Payment Sunshine Act provisions of the federal Affordcovered services under the contract.”
Transparency Program: Open Payments web- able Care Act, the Open Payments initiative
™
DRIVEN BY SCI ENCE
The new law is effective Oct. 1, 2014, and
will for the first time make financial interacsitePERFORMANCE
on Sept. 30.
See Open payments on page 10
will affect contracts entered into, amended,
Beginning in July, healthcare practitioners
^ ACUVUEôn
^
*Dk/t = 138 @ -3.00D. † Compared to ACUVUE^ OASYS^ and PureVision^ contact lenses. ††Lipid deposit resistance compared to Biofinity,^ PureVision,
OASYS,
ACUVUE
or renewed
or âfter
that
date.
ADVANCE^ and Avaira^ contact lenses. ‡Image is for illustrative purposes and not an exact representation. ^ Trademarks are the property of their respective owners.
“I’m
very
proud
of
our
membership
and
Important information for AIR OPTIX® AQUA Multifocal (Iotrafi lcon B) contact lenses: For daily wear or extended wear up to 6 nights for near/far-sightedness and/or presbyopia. Risk
of serious eye problems (i.e., corneal ulcer) is greater for extended wear. In rare cases, loss of vision may result. Side effects like discomfort, mild burning,
stinging may
occur.
the orNCSOS.
Had
it
not
been
for
a
very
tight,
References: 1. In a survey of 308 eye care practitioners; Alcon data on file, 2013. 2. Ex vivo measurement of contact angles on lenses worn daily wear using CLEAR CARE ® Cleaning &
dedicated
of ofleaders
31, 2014
Sept.
2014 3. Nash
Sept.
2014M, Mowrey-McKee
Disinfecting
signifi
cance
demonstrated at the Aug.
0.05 level;
Alcon data
on fi15,
le, 2009.
W, 30,
Gabriel
M. Agroup
comparison
various and optometrists
Junefor
1, cleaning
2014 and disinfection;July
15,
2014
Aug.
1, 2013 Solution
silicone
lenses; lipidfor
and protein
a result
dailyposted
wear. Optom (scheduled)
Vis Sci. 2010;87:E-abstract
105110. 4. Eiden
Davisof
R, Bergenske P. Prospective study of lotrafilcon
(scheduled)
FirstSB,
posting
Registration
Opendeposition
Paymentsasreport
forof2013
Industry hydrogel
who
answered
when
they were called on to
B lenses comparing 2 versus 4 weeks of wear for objective and subjective measures of health, comfort and vision. Eye & Contact Lens. 2013;39(4):290-294. 5. Based on a third-party industry
Close of
Close of dispute
public reports
CMS
Enterprise
Enterprise
Portal
entities
began
report,
12 months
ending
Decemberto
2013;
Alcon data
on for
file.physician-review,
contact
their
representatives
about the bill,”
physician
resolution
Portal begins
registration
thesafety
use ofinformation.
Enterprise
collecting
the instructions
See product
for complete
wear, care,for
and
says
Dr.
Sikes.ODT
review period
period.
Portal’s Open Payments system opens
required
data
© 2014
Novartis 1/14 AOM14017JAD
Sunshine Act ‘Open Payments’
reports available for review
CMS advises healthcare practitioners to act promptly
T
August 2014
VOL. 6, NO. 08
OptometryTimes.com
Vault Assessment
Insurers and health plans
now may not cap charges
on non-covered items
cornea
By Colleen E. McCarthy
Content Specialist
ICL vault
Compare the cornea and the vault
Focus on Refractive Surgery author Dr. Bill Tullo continues his discussion of phakic IOLs this
month with co-management information, including outcomes, perioperative care, and complication
management. Visian ICL induces fewer high-order aberrations in high myopes as compared to LASIK,
and it provides 98 percent UCVA at 20/20. Perioperative care is similar to that for cataract surgery, and
although all intraocular surgery carries risks for sight-threatening complications, phakic IOLs are showing
an excellent safety profile with complication rates below one percent. See page 18
Sunshine Act ‘Open Payments’
reports available for review
CMS advises healthcare practitioners to act promptly
By Bob Pieper
T
he U.S. Centers for Medicare and Medicaid Services (CMS) is on track to begin
publicly releasing information on industry-physician financial relationship
through its new National Physician Payment
Transparency Program: Open Payments website on Sept. 30.
Beginning in July, healthcare practitioners
Aug. 1, 2013
Industry
entities began
collecting the
required data
magenta
cyan
yellow
black
June 1, 2014
Registration for
CMS Enterprise
Portal begins
have an opportunity to review, and if necessary correct, any information on their financial dealings with industry prior to public release. However, they must act promptly, the
CMS emphasizes.
Authorized under the Physician Payments
Sunshine Act provisions of the federal Affordable Care Act, the Open Payments initiative
will for the first time make financial interac-
July 15, 2014
Open Payments report for 2013 posted
to Enterprise Portal for physician-review,
registration for the use of Enterprise
Portal’s Open Payments system opens
See Open payments on page 10
Aug. 31, 2014
(scheduled)
Close of
physician
review period
NC law bans
limited service,
material fees
Sept. 15, 2014
(scheduled)
Close of dispute
resolution
period.
Sept. 30, 2014
First posting of
public reports
Raleigh, NC—North Carolina Governor Pat McCrory recently signed into law a bill that prohibits insurers and health benefit plans from
limiting the fee an optometrist can charge patients on services or materials, unless those
services or materials are covered by reimbursement under the plan or insurer contract.
“We thought that it was extremely important to take a stand and take back some degree of control on some of the things going
on in our practices,” says Charles Sikes, OD,
president of North Carolina State Optometric
Society (NCSOS). “A lot of people are struggling more and more to get things to work
well financially in their practices, but insurers want to dictate how we can compete on
services and materials that they don’t even
cover. We felt that was out of bounds.”
According to Dr. Sikes, NCSOS was heavily involved in the nearly two-year process of
passing the law.
The law states, “No agreement between an
insurer or an entity that writes vision insurance and an optometrist for the provision of
vision services on a preferred or in-network
basis to plan members or insurance subscribers in connection with coverage under a standalone vision plan, a medical plan, or health
insurance policy may require that an optometrist provide services or materials at a fee
limited or set by the plan or insurer unless
the services or materials are reimbursed as
covered services under the contract.”
The new law is effective Oct. 1, 2014, and
will affect contracts entered into, amended,
or renewed on or after that date.
“I’m very proud of our membership and
the NCSOS. Had it not been for a very tight,
dedicated group of leaders and optometrists
who answered when they were called on to
contact their representatives about the bill,”
says Dr. Sikes.ODT
ES476611_OP0814_CV1.pgs 07.31.2014 02:43
ADV
The attraction is natural.
Proclear® 1 day contact lenses
naturally attract water for a fresh,
hydrated lens-wearing experience.
Proclear 1 day lenses use exclusive PC Technology™ to
recreate the phosphorylcholine found naturally in human
eyes. So, like eyes, they capture a protective film of water.
No wonder they’re the only daily lenses with the FDA
indication, “May provide improved comfort for contact
lens wearers who experience mild discomfort or
symptoms related to dryness during lens wear.”*
Ask your CooperVision sales representative about
current programs and promotions.
Natural comfort by design
coopervision.com
magenta
cyan
yellow
black
*Evaporative Tear Deficiency or Aqueous Tear Deficiency (non-Sjogren’s only).
©2014 CooperVision, Inc.
ES471187_OP0814_CV2_FP.pgs 07.25.2014 01:41
ADV
| AUGUST 2014
EditorialFrom
Advisory
the Editors
Board
3
Intravitreal injections by optometrists?
By Ernie Bowling, OD,
FAAO
Chief Optometric Editor
Our profession has had to fight for the privilege
of caring for our patients with ocular disease.
With optometry as a legislated profession, these
battles have occurred in every state and, as a
result, optometric practice acts vary widely.
Ophthalmology does not have to endure such
travails. Ophthalmologists can do pretty much
whatever is in their purview, as is their right. Much has been made of the possible shortage of healthcare providers due to changes in
healthcare delivery, and as a consequence,
some policy makers are looking to “physician extenders” to fill the perceived gap. One
possible use of physician extenders caught
the eye of an optometrist friend of mine, and
he enlightened me.
The article, “Implementation of a NurseDelivered Intravitreal Injection Service” was
published in the June 2014 issue of Eye. The
purpose of this study was “to introduce nursedelivered intravitreal injections to increase
medical retina treatment capacity in the United
Kingdom.”1 A “rigorous training schedule”
was developed that included “mandatory attendance at a full (one) day intravitreal injection (IVI) course, including practical train-
ing on pig eyes in a wet lab.” Following the
completion of this one-day course, the nurse
observed and shadowed the consultant ophthalmologist for 20 injections. Then the nurse
performed 20 injections under the supervision of an ophthalmologist. At the end of the
training period of 100 injections, the nurse
was graded and deemed competent.
Over 4,000 nurse-delivered IVIs were followed over a two-year period. The only complication seen was subconjunctival hemorrhages in 5.7 percent of patients. The authors
concluded, “Our preliminary results of a series
of 4,000 nurse-delivered injections associated
without serious vision-threatening complication is indicative that this procedure can be
safely administered by a nurse.” No cases of
post-intravitreal anti-VEGF endophthalmitis
occurred in this study.
Age-related macular degeneration is the
most common cause of visual loss and blindness in patients over 50 years of age in the
developed world.2 As the population ages, the
need for therapeutic intervention with this
disease will only increase. Some states currently allow some form of ocular injections
in their practice acts, but the regulations are
restrictive and rare. The results of this study
clearly show that nurses, with appropriate
training and supervision, can administer this
procedure safely and effectively. The question
readily follows: why can’t optometrists? The
answer surely is we can. We have far more
training in ocular anatomy and physiology
than do nurses, and optometrists are more
familiar with AMD, as we see the condition
in our offices daily.
And in areas where retinal specialists are
widely distributed geographically, it would
make even more sense. Optometrists would
need to be trained in the procedure, and the
U.K. training model appears to be a good one.
You can’t argue with their results. With the
changing U.S. healthcare landscape, perhaps
it is time for ophthalmology and optometry
to work together to provide contiguous care
in this area, much as we now comanage cataract procedures. It would be a nice change
to cooperate and find common ground with
ophthalmology instead of undertaking a protracted, costly legislative battle. No one wins in
those situations, least of all our patients, and
our patients are truly our only concern.ODT
References
1. DaCosta J, Hamilton R, Nago J, et al.
Implementation of a Nurse-Delivered Intra-vitreal
Injection Service. Eye. 2014;28(6):734-40.
2. Augood CA, Vingerling JR, de Jong PT, et al.
Prevalence of age-related maculopathy in older
Europeans: the European Eye Study (EUREYE).
Arch Ophthalmol. 2006;124:529–35.
Want to read more from Dr. Bowling? Turn to
page 14 for his take on ocular allergies.
What’s your question today?
Gretchyn M. Bailey, NCLC,
FAAO,
Editor in Chief, Content Channel
Director
Did you have a clinical presentation that was
a head scratcher today?
Did you wonder how or why a diagnostic
test is performed?
Did something interesting come up during a discussion with one of your students/
mentors/mentees/colleagues?
If you’re asking about something, chances
are your colleagues are, too. Look into it,
figure it out, and write about it! This is the
advice I gave to Southern College of Optometry faculty members during a recent invited
presentation about publishing in non–peer-
magenta
cyan
yellow
black
reviewed journals. By far, the biggest question I was asked was, “How do I start?”
The best thing to write about is your passion. Do you love the challenge of working
with children and contact lenses? Then don’t
write about secondary glaucomas! If you have
great ideas about how to talk with patients
in the optical, don’t chain yourself to the
desk to crank out a piece on implementing
ICD-10. Go with what you know. You’ll have
a more enjoyable time writing about it, and
the end result will be better, too.
Alternatively, researching a topic in order
to learn more or answer a question is another
way to begin your professional publishing
career. Documenting the process you went
through to figure out Mrs. Jones’s IOP spike
can help your colleagues learn just what you
did. You don’t need to be an expert on the
topic if you position the article as a journey
of learning.
Don’t make the mistake of thinking, “Nobody will want to read about that.” Or, “Somebody already wrote about that.” Consider this:
Daily disposable contact lenses launched almost 20 years ago (has it been that long?), and
we’re still writing about them. And you’re
still reading about them. Every practitioner
doesn’t read every article in every journal,
I’m sorry to say. A good article idea isn’t
limited to one time around. Remember, if
it’s interesting to you, it likely is interesting
a bunch of other people as well.
So get started! The good people at Optometry Times would be delighted to help you
publish your first (or tenth) article. Drop me
a line with your question or idea from today:
[email protected]
ES475279_OP0814_003.pgs 07.30.2014 02:13
ADV
4
Editorial Advisory Board
August 2014
CHIEF OPTOMETRIC EDITOR
Vol. 6, No. 8
CONTENT
CONTENT CHANNEL DIRECTOR Gretchyn M. Bailey, NCLC, FAAO
Ernest L. Bowling, OD, MS, FAAO
Jeffrey Anshel, OD, FAAO
Renee Jacobs, OD, MA
Diana L. Shechtman, OD, FAAO
Ocular Nutrition Society
Encinitas, CA
Practice Management Depot
Vancouver, BC
Nova Southeastern University
Fort Lauderdale, FL
Sherry J. Bass, OD, FAAO
Alan G. Kabat, OD, FAAO
Joseph P. Shovlin, OD, FAAO, DPNAP
SUNY College of Optometry
New York, NY
Southern College of Optometry
Memphis, TN
Northeastern Eye Institute
Scranton, PA
Justin Bazan, OD
David L. Kading, OD, FAAO
Kirk Smick, OD
Park Slope Eye
Brooklyn, NY
Specialty Eyecare Group
Kirkland, WA
Clayton Eye Centers
Morrow, GA
Marc R. Bloomenstein, OD, FAAO
Danica J. Marrelli, OD, FAAO
Laurie L. Sorrenson, OD
Schwartz Laser Eye Center
Scottsdale, AZ
University of Houston College of Optometry
Houston, TX
Lakeline Vision Source
Austin, TX
Crystal Brimer, OD
Katherine M. Mastrota, MS, OD, FAAO
Joseph Sowka, OD, FAAO
Crystal Vision Services
Wilmington, NC
Omni Eye Surgery
New York, NY
Nova Southeastern University College of
Optometry
Fort Lauderdale, FL
Mile Brujic, OD
John J. McSoley, OD
Bowling Green, OH
University of Miami Medical Group
Miami, FL
[email protected] 215/412-0214
CONTENT SPECIALIST Colleen McCarthy
GROUP CONTENT DIRECTOR Mark L. Dlugoss
GROUP ART DIRECTOR Robert McGarr
ART DIRECTOR Lecia Landis
P U B L I S H I N G/A DV E R T I S I N G
EXECUTIVE VICE PRESIDENT Georgiann DeCenzo
VP, GROUP PUBLISHER Ken Sylvia
GROUP PUBLISHER Leonardo Avila
ASSOCIATE PUBLISHER Erin Schlussel
NATIONAL ACCOUNT MANAGER Rebecca Hussain
NATIONAL ACCOUNT MANAGER Diane Carpenteri
DIR. OF BUSINESS DEVELPMENT, HEALTHCARE TECHNOLOGY SALES Margie Jaxel
ACCOUNT MANAGER, HEALTHCARE TECHNOLOGY Patrick Carmody
ACCOUNT MANAGER, CLASSIFIED/DISPLAY ADVERTISING Karen Gerome
Benjamin P. Casella, OD
Casella Eye Center
Augusta, GA
●
Loretta B. Szczotka-Flynn, OD, MS, FAAO
University Hospitals Case Medical Center
Cleveland, OH
ACCOUNT MANAGER, RECRUITMENT ADVERTISING Joanna Shippoli
BUSINESS DIRECTOR, EMEDIA Don Berman
SPECIAL PROJECTS DIRECTOR Meg Benson
Ron Melton, OD, FAAO
Educators in Primary Eye Care LLC
Charlotte, NC
Michael A. Chaglasian, OD
Marc B. Taub, OD, MS, FAAO, FCOVD
Southern College of Optometry
Memphis, TN
DIRECTOR OF MARKETING & RESEARCH SERVICES Gail Kaye
Illinois Eye Institute
Chicago, IL
Pamela J. Miller, OD, FAAO, JD
Highland, CA
Tammy Pifer Than, OD, MS, FAAO
SALES SUPPORT Hannah Curis
A. Paul Chous, OD, MA
Patricia A. Modica, OD, FAAO
REPRINTS 877-652-5295 ext. 121, [email protected]
Chous Eye Care Associates
Tacoma, WA
SUNY College of Optometry
New York, NY
University of Alabama at Birmingham
School of Optometry
Birmingham, AL
Douglas K. Devries, OD
Laurie L. Pierce, LDO, ABOM
Eye Care Associates of Nevada
Sparks, NV
Hillsborough Community College
Tampa, FL
Outside US, UK, direct dial: 281-419-5725. Ext. 121
LIST ACCOUNT EXECUTIVE Renée Schuster
PERMISSIONS/INTERNATIONAL LICENSING Maureen Cannon
J. James Thimons, OD, FAAO
Ophthalmic Consultants of Fairfield
Fairfield, CT
PRODUCTION
William D. Townsend, OD, FAAO
Steven Ferucci, OD, FAAO
Stuart Richer, OD, PhD, FAAO
Sepulveda VA Ambulatory Care Center
and Nursing Home
Sepulveda, CA
Dept of Veterans Affairs Medical Center
North Chicago, IL
VA New York Harbor Health Care System
Brooklyn, NY
Ben Gaddie, OD, FAAO
Gaddie Eye Centers
Louisville, KY
David I. Geffen, OD, FAAO
Advanced Eye Care
Canyon, TX
CI RCU L ATION
CORPORATE DIRECTOR Joy Puzzo
DIRECTOR Christine Shappell
MANAGER Wendy Bong
William J. Tullo, OD, FAAO
Eyecare Consultants Vision Source
Englewood, CO
TLC Laser Eye Centers/
Princeton Optometric Physicians
Princeton, NJ
Jack L. Schaeffer, OD
Walter O. Whitley, OD, MBA, FAAO
John L. Schachet, OD
Murray Fingeret, OD
SENIOR PRODUCTION MANAGER Karen Lenzen
Schaeffer Eye Center
Birmingham, AL
Virginia Eye Consultants
Norfolk, VA
Leo P. Semes, OD
Kathy C. Yang-Williams, OD, FAAO
Gordon Weiss Schanzlin Vision Institute
San Diego, CA
University of Alabama at Birmingham
School of Optometry
Birmingham, AL
Jeffry D. Gerson, OD, FAAO
Peter Shaw-McMinn, OD
WestGlen Eyecare
Shawnee, KS
Southern California College of Optometry
Sun City Vision Center
Sun City, CA
CHIEF EXECUTIVE OFFICER: Joe Loggia
EXECUTIVE VICE-PRESIDENT, CAO & CFA: Tom Ehardt
EXECUTIVE VICE-PRESIDENT: Georgiann DeCenzo
EXECUTIVE VICE-PRESIDENT: Chris DeMoulin
EXECUTIVE VICE-PRESIDENT, BUSINESS SYSTEMS: Rebecca Evangelou
EXECUTIVE VICE-PRESIDENT, HUMAN RESOURCES: Julie Molleston
SR VICE-PRESIDENT: Tracy Harris
VICE-PRESIDENT, GENERAL MANAGER PHARM/SCIENCE GROUP: Dave Esola
VICE-PRESIDENT, LEGAL: Michael Bernstein
VICE-PRESIDENT, MEDIA OPERATIONS: Francis Heid
Roosevelt Vision Source PLLC
Seattle, WA
VICE-PRESIDENT, TREASURER & CONTROLLER: Adele Hartwick
Advanstar Communications Inc. provides certain customer contact data (such as customers’ names, addresses, phone numbers, and e-mail addresses) to third parties who wish to
promote relevant products, services, and other opportunities that may be of interest to you. If
you do not want Advanstar Communications Inc. to make your contact information available
to third parties for marketing purposes, simply call toll-free 866/529-2922 between the hours
of 7:30 a.m. and 5 p.m. CST and a customer service representative will assist you in removing
your name from Advanstar’s lists. Outside the U.S., please phone 218/740-6477.
OPTOMETRY TIMES does not verify any claims or other information appearing in any of the
advertisements contained in the publication, and cannot take responsibility for any losses or
other damages incurred by readers in reliance of such content.
OPTOMETRY TIMES cannot be held responsible for the safekeeping or return of unsolicited
articles, manuscripts, photographs, illustrations or other materials.
Library Access Libraries offer online access to current and back issues of Optometry Times
through the EBSCO host databases.
To subscribe, call toll-free 888-527-7008. Outside the U.S. call 218/740-6477.
OFFICIAL PUBLICATION SPONSOR OF
Milton M. Hom, OD, FAAO
Azusa, CA
Optometry Times Mission Statement
Optometry Times is an optometry-driven publication that disseminates news and
information of a clinical, socioeconomic, and political nature in a timely and accurate
manner for members of the optometric community.
In partnership with our readers, we will achieve mutual success by:
●
●
●
Being a forum for optometrists to communicate their clinical knowledge, insights, and discoveries.
Providing management information that allows optometrists to enhance and expand their practices.
Addressing political and socioeconomic issues that may either assist or hinder the optometric community, and reporting those issues and their potential outcomes to our readers.
How to Contact Optometry Times
EDITORIAL
24950 Country Club Blvd.,
Suite 200, North Olmsted, OH 44070
440/243-8100 or 800/225-4569
FAX: 440/756-5227
magenta
cyan
yellow
black
SUBSCRIPTION
SERVICES
Toll-Free: 888/527-7008
or 218/740-6477
FAX: 218/740-6417
ADVERTISING
PRODUCTION
485 Route 1 South, Building F, Suite
210, Iselin, NJ 08830-3009
732/596-0276
FAX: 732/596-0003
131 W. First St.,
Duluth, MN 55802-2065
800/346-0085
FAX: 218/740-7223218/740-6576
OPTOMETRY TIMES (Print ISSN: 0890-7080, Digital ISSN: 2328-3904) is published monthly (12 issues) by Advanstar Communications Inc., 131 W. First Street, Duluth, MN 55802-2065. Subscription
rates: $49 for one year in the United States & Possessions; $59 for one year in Canada and Mexico,
and $89 for one year for all other countries. Periodicals Postage paid at Duluth MN 55806 and additional mailing offices. POSTMASTER: Please send address changes to OPTOMETRY TIMES, P.O. Box
6089, Duluth, MN 55806-6089. Canadian G.S.T. number: R-124213133RT001, PUBLICATIONS MAIL
AGREEMENT NO. 40612608, Return Undeliverable Canadian Addresses to: IMEX Global Solutions,
P. O. Box 25542, London, ON N6C 6B2, CANADA. Printed in the U.S.A.
©2014 Advanstar Communications Inc. All rights reserved. No part of this publication may be
reproduced or transmitted in any form or by any means, electronic or mechanical including by
photocopy, recording, or information storage and retrieval without permission in writing from
the publisher. Authorization to photocopy items for internal/educational or personal use, or the
internal/educational or personal use of specific clients is granted by Advanstar Communications
Inc. for libraries and other users registered with the Copyright Clearance Center, 222 Rosewood Dr.
Danvers, MA 01923, 978-750-8400 fax 978-646-8700 or visit http://www.copyright.com online. For
uses beyond those listed above, please direct your written request to Permission Dept. fax 440-7565255 or email: [email protected].
ES474957_OP0814_004.pgs 07.29.2014 23:55
ADV
Digit
| AUGUST 2014
DATA E XCHANGE
Do you see children
in your practice?
Yes, I have a
pediatrics
specialty
I see children now & again,
but I don’t target my
practice to them
No, I
avoid seeing
pediatric
patients
17%
28%
17%
39%
Yes, I have a family
practice & see kids on a regular basis
Optometry Times Resource Center
Contact Lenses and Lens Care
l
5
Marijuana is not a proven treatment
for glaucoma, says AAOphth
The American Academy of Ophthalmology (AAOphth)
has reiterated its stance on medical marijuana for the
treatment of glaucoma, stating that it finds no scientific
evidence that marijuana is an effective long-term
treatment for the disease, particularly when compared
to the current prescription medication and surgical
treatment available.
The academy based its position on analysis by the
National Eye Institute and the Institute of Medicine
and cautions that marijuana has side effects that could
endanger a patient’s eye health.
Read more about AAOphth’s stance on medical marijuana
for glaucoma on our website.
Your go-to place for the latest information on fitting, lens care,
and other conditions that affect successful contact lens wear.
OptometryTimes.com/AAOMarijuana
http://ow.ly/zLFCM
Top Headlines Now
ODTonline
Unlicensed OD sentenced for fraudulent billing
OptometryTimes.com/UnlicensedOD
Help elderly maintain independence with 7 sight-saving tips
OptometryTimes.com/SightSavingTips
No charges in Visine poisoning in Michigan
OptometryTimes.com/VisinePoisoning
VISION THERAPY: TOP
TOOLS OF THE TRADE
Optometry Times App
Get access to all the benefits Optometry Times offers
at your fingertips. The Optometry Times app for iPad and iPhone
is now free in the iTunes store.
Follow us on Twitter
to receive the latest
news and participate
in the exchange.
TWITTER.COM/OPTOMETRYTIMES
magenta
cyan
yellow
black
LIKE US!
FACEBOOK.COM/OPTOMETRYTIMES
Dr. Marc Taub discusses some of the tools
he uses with vision therapy patients in his
practice. The tools range from simple to high
tech, but each brings benefits to the patients
and helps keep them engaged. For more on
vision therapy tools from Dr. Taub, check out
his story on page 22.
http://ow.ly/zKn7B
RESPONDING TO BAD
ONLINE REVIEWS
DO YOU ALWAYS
FOLLOW UP?
PD REQUESTS: HOW
DO YOU RESPOND?
Dr. Justin Bazan shares how
he responds to negative online
reviews. For more, go to page 20.
Dr. Mile Brujic and Dr.
Jason Miller debate on
contact lens follow-ups.
http://ow.ly/zKE28
Lisa Frye, ABOC, explains how
her office responds to requests for
PD measurements.
http://ow.ly/zKnLq
http://ow.ly/ym3M4
ES476619_OP0814_005.pgs 07.31.2014 02:52
ADV
6
Optometry News
In Brief
AOA names Jon Hymes
as executive director
St. Louis, MO—The American Optometric Association (AOA) Board of Trustees named Jon
Hymes as the organization’s executive director.
Hymes has served as AOA’s interim executive director since February. For the preceding nine years, he managed the organization’s
Washington, DC, office, the base of operations
for its federal, state and third-party advocacy
teams. He will continue to be based there.
Hymes succeeds Barry Barresi, OD, PhD,
executive director from 2007 through 2013,
who resigned to join Ocuhub, a subsidiary of
TearLab Corporation.
Hymes appointed Renee Brauns, AOA’s chief
operating officer, to the newly-created position
of associate executive director, effective July
29, 2014. Brauns, who acted as interim deputy
executive director this year, joined the AOA in
1999 and has overseen St. Louis operations as
chief operating officer since 2010.
Hymes joined the AOA in 2005 as Washington
Office Director and has been the organization’s
lead advocacy strategist He spent a decade on
Capitol Hill as a Congressional chief of staff
and legislative and communications aide. For
five years, he advised Rep. Norman Lent (RNY) He is a graduate of Syracuse University.
J&J offers patient resource
on UV protection
Jacksonville, FL—To help eyecare professionals
educate parents about the risks that may be
associated with ultraviolet (UV) exposure to
the eyes and steps they can take to minimize
UV exposure, Johnson & Johnson Vision Care,
Inc. has launched a free educational resource,
The Sun & Your Eyes: What You Need to Know.
“By helping patients become better educated
about the potential year-round risks of exposure to the eyes to UV rays and the importance
of choosing proper eyewear that provides comprehensive UV protection, we can lessen the
risk for ocular UV exposure and help protect
the long-term eye health of our patients and
their families,” says Millicent Knight, OD, head
of professional affairs, Johnson & Johnson Vision Care, Inc. North America.
The resource includes important information
on the unexpected sources of UV radiation exposure, as well as practical advice for reducing
the risks of UV exposure to share with your
patients. It also offers guidance on what to look
magenta
cyan
yellow
black
AUgUST 2014
for in selecting sunglasses to help protect eyes
from the sun, along with information about UVblocking contact lenses, which can provide an
important measure of additional protection for
individuals who wear contact lenses.
Google Glass now part of
drchrono platform
Mountain View, CA—Drchrono Inc. has integrated
Google Glass into its EHR platform to build the
first wearable health record (WHR).
“The iPad was a new consumption device
that changed the world, and now we are seeing that doctors want to use more and more
hands-free technology. Glass is one of the first
of its kind to do this,” says Michael Nusimow,
CEO and co-founder of drchrono. “A physician wants to practice medicine and not be
burdened with all of the paperwork that goes
on in the practice. We knew this would be an
important app to integrate into our EHR platform, and we’re excited to now offer this to
doctors using drchrono.”
Drchrono says doctors could use Glass to:
Take pictures in any setting that will be
pulled into the patient’s medical record
without having to touch anything that
could contaminate the doctor’s hands
Record videos of patient encounters or
surgeries to document, so that medical
staff and scribes can code in asynchronous time offline, and view the video
to add codes after the encounter
Stream data of patient encounters in
real time so that doctors can have other
physicians, patients’ family members,
or scribes watching anywhere the physician can focus on the patient
Flip through patient profiles on the
heads-up display—physicians can
quickly preview a list of all of the patients they are seeing for the day
Getting real-time notifications about
who has come into the office
Review hands-free medical data
Electronic device use
linked to tear film changes
Japan—Office workers with prolonged digital
device use may have a change in the makeup
of their tear film, which is similar to that of
an individual with dry eye disease (DED), according to a Japanese study recently published
in JAMA Ophthalmology.
The study looked at the relationship between the concentration of mucin 5AC (MUC5AC) in an individual’s tear film, hours
worked, and the frequency of ocular symptoms. Participants included 96 young and
|
middle-aged Japanese office workers, who
completed a survey on their work hours and
the frequency with which they experienced
ocular symptoms. DED was diagnosed as
definite or probable, or it was not present,
and then tear fluid was collected.
The study found that the concentration of
MUC5AC was lower in those with definite
DED (nine percent of participants) and in
those with symptomatic eye strain. This discovery lead the study’s author to conclude
that office workers with prolonged computer
usage, those with increased frequency of
eye strain, and those with DED have a lower
MUC5AC concentration in their tear film.
Diabetes-related eye
damage detected by
new technique
Bloomington, IN—Researchers from the Indiana
University School of Optometry have detected
early warning signs of potential diabetes-related vision loss.
Stephen Burns, PhD, professor and associate
dean at the IU School of Optometry, designed
and built an instrument, which uses small mirrors with tiny moveable segments to reflect light
into the eye to overcome the optical imperfections of a patient’s eye. It takes advantage of
adaptive optics to obtain a sharp image, and
also minimized optical errors throughout the
instrument. Using this approach, the tiny capillaries in the eye appear quite large on a computer screen. These blood vessels are shown in
a video format, allowing observation of blood
cells moving through the blood vessels. After
imaging each patient’s eye, highly magnified
retinal images are then pieced together with
software, providing still images or videos.
“We set out to study the early signs, in volunteer research subjects whose eyes were not
thought to have very advanced disease. There
was damage spread widely across the retina,
including changes to blood vessels that were
not thought to occur until the more advanced
diseases states,” says Ann Elsner, PhD, professor and associate dean in the IU School of Optometry and lead author on the study.
The observed changes in the study, which
was published in Biomedical Optics Express,
included corkscrew-shaped capillaries, which
were not just a little thicker, but instead the
blood vessel walls had to grow in length to make
these loops. The changes are visible only at a
microscopic level, but some of these patients
already have sight-threatening complications.
“It is shocking to see that there can be large
areas of retina with insufficient blood circulation,” says Dr. Burns. “The consequence for
See In brief on page 8
ES476604_OP0814_006.pgs 07.31.2014 02:39
ADV
&
magenta
cyan
yellow
black
ES471175_OP0814_007_FP.pgs 07.25.2014 01:40
ADV
8
Optometry News
In brief
Continued from page 6
individual patients is that some have far more
advanced damage to their retinas than others
with the same duration of diabetes.”
Because the microscopic damage has not
been observable prior to the study, it is unknown whether improvement in control of disease would stop or reverse any of the damage.
Worse outcomes linked
to newer corneal
transplant techniques
A study recently published in Ophthalmology
found that newer lamellar techniques have worse
survival and visual outcomes than penetrating keratoplasties.
The study, conducted by the Australian Corneal Graft Registry, looked at 13,920 penetrating keratoplasties, 858 deep anterior lamellar
keratoplasties (DALKs), and 2287 endokeratoplasties performed between January 1996 and
February 2013 from long-standing national corneal transplantation register. Researchers used
Kaplan-Meier functions to assess graft survival
and surgeon experience, the Pearson chi-square
test to compare visual acuities, and linear regression to examine learning curves.
The investigators found that from 1996 to
2006, the number of corneal grafts remained
stable (mean 926), but the number increased
over the course of the next six years, reaching 1,482 in 2012, revealing a need for 264 additional corneal donors throughout Australia.
According to the study, this increase in procedures correlates with a shift in practice, with
surgeons performing an increasing number of
DALKs, endothelial grafts, and pseudophakic
bullous keratopathy after 2006 and a declining number of penetrating grafts.
However, when researchers looked at outcomes, they found there was little benefit with
the newer techniques when the procedures were
matched by era and indication. Penetrating grafts
had significantly better survival and visual outcomes compared with DALKs performed for
the same indication during the same period.
Endokeratoplasties had significantly worse
survival than penetrating grafts performed for
the same indication during the same time. Compared with penetrating grafts, endokeratoplasties had significantly worse visual outcomes
when performed for Fuchs’ dystrophy (P <
.001). However, they had significantly better
visual outcomes when performed for pseudophakic bullous keratopathy.
Surgeons with more than 100 registered keratoplasties had better survival of endokerato-
magenta
cyan
yellow
black
AUgUST 2014
plasties compared to less-experienced surgeons.
However, keratoplasty failure occurred even
after 100 grafts among high-volume surgeons.
“The new procedures of lamellar keratoplasty that have evolved over the past two decades have been adopted enthusiastically by
corneal surgeons worldwide,” write the study’s
authors. “Although outcomes have been promoted as being significantly better than those
of the well-established alternative of penetrating keratoplasty, the evidence for this claim is
unconvincing outside of single-center studies.”
VSP individual plans now
available for sale
Rancho Cordova, CA—VSP Vision Care recently
announced its individual vision plans are now
available for sale by insurance brokers in the U.S.
The company launched a pilot program late
last year to allow insurance brokers to sell individual plans directly to consumers, but has
now expanded the program to brokers in all 50
states. Brokers can sell the plans through a website hosted by VSP where clients can self-enroll.
“Millions of people are without vision coverage, and we want to increase access to care
for those who wouldn’t otherwise be covered
through an employer,” says Ken Stellmacher,
senior vice president and general manager of
VSP Individual Plans. “Also, with adult vision
care not offered as part of the new public health
insurance exchanges, this is a great avenue to
make vision care easily accessible to consumers.”
Cataract surgery
improves Alzheimer’s
patients’ quality of life
Copenhagen—A study presented at the Alzheimer’s Association International Conference 2014
in Copenhagen found that cataract surgery can
slow the decline in cognition and improve quality of life for people suffering from Alzheimer’s
and other dementias.
Alan J. Lerner, MD, of Case Western Reserve
University and University Hospitals Case Medical Center reported interim results from an
ongoing clinical trial to determine the effects
of cataract surgery on visual acuity, cognitive
measures, and quality of life in patients with
dementia. Study participants were divided into
two groups—one group was had surgery immediately after being recruited for the study,
while the other group had delayed surgery or
refused surgery. Vision and cognitive status,
mood, and capability to complete daily activities are evaluated at baseline and six months
after recruitment, or six months after surgery.
|
Preliminary results from 20 surgical and eight
non-surgical study participants found that the
surgical group had significantly improved visual acuity and quality of life, reduced decline
in memory and executive functioning, and improvements in behavioral measures compared
to the non-surgical group. The study also found
levels of perceived burden for caregivers in the
surgical group showed improvement.
“These preliminary results indicate that improved vision can have a variety of benefits for
people with dementia and their loved ones,
both visual and non-visual,” says Lerner. “Our
findings need to be verified in a larger study,
but they suggest the need to aggressively address dementia co-morbidities such as visionimpairing cataracts, while balancing safety and
medical risks. If the results hold up, it will significantly affect how we treat cataracts in individuals with dementia. Other interventions
to offset sensory loss including vision and
hearing—may help improve quality of life for
people with dementia and their caregivers.”
Nicox to acquire Aciex
Therapeutics
Sophia Antipolis, France—Nicox recently announced
that it has signed an agreement to acquire all
outstanding equity of Aciex Therapeutics, Inc.,
an ophthalmic development pharmaceutical
company based in the United States.
Nicox says the acquisition will broaden the
company’s therapeutic development pipeline,
which will now include:
AC-170 for allergic conjunctivitis, which
has completed two phase 3 trials and for
which Nicox plans to seek a pre-NDA
meeting before submitting a New Drug
Application
AC-155, in development for post-operative
inflammation and pain, which is expected
to enter phase 2 studies in 2015
A collaborative research agreement with
Portola Pharmaceuticals, Inc. for small
molecule dual Spleen Tyrosine Kinase
(Syk)/Janus Kinase (JAK) inhibitors for
potential topical ophthalmic treatments
A portfolio of clinical and pre-clinical product candidates targeting areas like ocular
allergy, dry eye, and other inflammatory
eye conditions
A proprietary manufacturing process that
can be used to repurpose existing drugs
by producing novel, patentable nanocrystalline forms
According to Nicox, Aciex shareholders will
received an upfront payment of $65 million
in newly-issued Nicox shares, plus contingent
value rights giving right to shares, for a potential additional value of up to $55 million.ODT
ES476603_OP0814_008.pgs 07.31.2014 02:39
ADV
Your patients protect their skin.
Help protect their eyes.
Many patients are unaware of the long-term implications that may be associated
with cumulative day-to-day ultraviolet (UV) exposure to eye health.1
UV-blocking contact lenses worn in addition to sunglasses and a wide-brim hat
can provide an additional layer of protection against UV radiation.2
Educate your patients about
ACUVUE® Brand Contact Lenses—
the only major brand to block
at least 97% of UVB and 81% of
UVA rays as standard across the
entire line.*†
To learn more, visit
acuvueprofessional.com.
*UV-blocking percentages are based on an average across the wavelength spectrum.
ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort.
Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete
information. Complete information is also available from VISTAKON® Division of Johnson & Johnson Vision Care, Inc., by calling 1-800-843-2020 or by visiting acuvueprofessional.com.
†
Helps protect against transmission of harmful UV radiation to the cornea and into the eye.
WARNING: UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses, because they do not completely cover the eye and surrounding
area. You should continue to use UV-absorbing eyewear as directed. NOTE: Long-term exposure to UV radiation is one of the risk factors associated with cataracts. Exposure is based on a number of factors such
as environmental conditions (altitude, geography, cloud cover) and personal factors (extent and nature of outdoor activities). UV-blocking contact lenses help provide protection against harmful UV radiation. However,
clinical studies have not been done to demonstrate that wearing UV-blocking contact lenses reduces the risk of developing cataracts or other eye disorders. Consult your eye care practitioner for more information.
References: 1. The big picture: eye protection is always in season. The Vision Council Web site. http://www.thevisioncouncil.org/sites/default/files/VCUVReport2013FINAL.pdf. Accessed May 7, 2014. 2. Chandler H.
Ultraviolet absorption by contact lenses and the significance on the ocular anterior segment. Eye Contact Lens. 2011;37(4):259-266.
ACUVUE®, 1-DAY ACUVUE® MOIST®, 1-DAY ACUVUE® TruEye®, ACUVUE® OASYS®, HYDRACLEAR®, INNOVATION FOR HEALTHY VISION™, and VISTAKON® are trademarks of Johnson & Johnson Vision Care, Inc.
© Johnson & Johnson Vision Care, Inc. 2014
magenta
cyan
yellow
black
ACU-43878J
May 2014
ES471190_OP0814_009_FP.pgs 07.25.2014 01:41
ADV
Optometry News
10
Open payments
tion between industry and healthcare practitioners a matter of public record.
The act requires manufacturers of covered
pharmaceuticals, medical devices, biologics,
and medical supplies that are covered by
Medicare, Medicaid, or S-CHIP programs,
as well as group purchasing organizations
(GPOs), to report detailed information about
payments or other “transfers of value” worth
more than $10 to physicians and teaching
hospitals.
What practitioners
need to do:
1 Keep track all of all interactions
with industry involving payments or
transfers of value to ensure accuracy.
2 Register for a CMS Enterprise Portal
account. Register to use portal’s
Open Payments sections.
3 Review draft payment information
posted to the CMS Enterprise Portal
beginning July 15 and, if necessary,
dispute any inaccurate payment
information within 45 days.
4 Be ready to address questions about
Open Payments information when it
is publicly released this fall.
The initial Open Payments reporting period
was Aug. 1 to Dec. 31, 2013. Manufacturers
and GPOs were to submit reports on financial
relationship during that period to the CMS by
March 31, 2014.
Reports are compiled in the new Enterprise
AUgUST 2014
Identification Management (EIDM) system database. The EIDM can be accessed through
the CMS Enterprise Portal, which was introduced in June to provide information or facilitate data exchange for a number of emerging
agency programs.
The reports will remain available for review for 45 days following their initial posting on the portal. Practitioners will have 60
days following the initial posting of the report to formally dispute inaccuracies and
attempt to resolve them. That means the
review period for the initial round of Open
Payments reports will end on about Aug.
30 with the dispute resolution period to end
about Sept. 15.
CMS urges practitioners to keep a detailed
log of financial interactions with industry
in order to have a record against which
Open Payments reports from industry can
be checked. The agency is offering healthcare practitioners free mobile phone apps
that have been designed specifically for this
purpose (see box).
Resolving a dispute may involve working
with industry representatives to correct data,
according to CMS. Should a practitioner and
industry representatives be unable to resolve
a dispute by the close of the 60-day dispute
resolution period, the report will be posted online as “disputed” while the affected parties
continue to attempt to resolve discrepancies.
The Open Payments website will be updated
at least annually, according to the agency.
Healthcare practitioners must register to
use the Enterprise Portal. Portal registration
is open now and generally requires just a few
minutes. However, access to the portal’s Open
Payments section requires a second registration process, which may be more time-consuming, the agency says.
CMS officials urge practitioners to open a
basic Enterprise Portal account and become
acquainted with the portal as soon as possible. Doing so will help ensure practitioners
can begin reviewing Open Payment reports
quickly.ODT
|
Open Payments
reporting
Under the federal National Physician
Payment Transparency Program,
manufacturers and group purchasing
organizations are required to report to
the government payments or transfers of
value to physicians including:
– Consulting fees
– Compensation for services other
than consulting, such as speaker
fees
– gifts
– Entertainment
– Food and beverage
– Travel and lodging
– Educational materials, including
journal reprints
– Ownership and investment interest
However, a few types of payments
are exempt:
– Honoraria for speaking at certified
and accredited CME programs
– Educational materials that directly
benefit patients
– Buffet meals provided to all
participants of a large-scale
conference
– Discounts or in-kind items for the
provision of charity care
Author Info
Bob Pieper is a freelance healthcare writer. He is
the former senior editor for AOA News.
CMS offers Open payments app to track data
The Centers for Medicare and Medicaid
Services (CMS) offers a mobile app for the
Open Payments program to help physicians
track much of the data necessary for
successful program reporting.
magenta
cyan
yellow
black
The Open Payments Mobile for Physicians app allows healthcare practitioners
to track contact information for industry,
share information with industry representatives, and track payments and other
transfers of value in real-time. A corre-
sponding app is available
for product manufacturers and group
purchasing organizations (gPOs).
Both the physician and industry apps are
available free through the iOS Apple Store
and google Play Store.
ES476612_OP0814_010.pgs 07.31.2014 02:43
ADV
| August 2014
Editorial Advisory
Opinion
Board
11
The third carotenoid—mesozeaxanthin
(Z -RS) and who needs to consume it
By Stuart Richer, OD, PhD
Stuart Richer, OD, PhD, FAAO, is director of ocular
preventive medicine at James Lovell Federal Health
Care Facility in Chicago. He is also associate professor
of family and preventative medicine at Chicago
Medical School and assistant clinical professor
at University of Illinois at Chicago department
of ophthalmology and visual science.
Reach him at [email protected].
We all need it. Beyond this simple statement
is a mile of commercial controversy with
some prominent optometrists declaring that
we must choose eye supplements containing
all three carotenoids, including the two isomers of zeaxanthin—namely zeaxanthin (Z)
and mesozeaxanthin (MZ). On
face value, this seems reasonable. But has it been scientifically proven? No.
There are 600 carotenoids in
nature—50 commonly found
in fruits and vegetables, and
20 in the human blood stream.
Of these 20, the retina specifically selects
two to comprise the macular pigment. This
process actually begins when a fetus is still
in the womb. Thus, only two dietary carotenoids make up the macular pigment of the
human retina: lutein (L) from leafy greens
like spinach, kale, and collard greens, and
Z (specifically the RR isomer) from orange
peppers, paprika, and corn. The ratio of carotenoids in the blood serum is approximately
4 L/1 Z/0 MZ. Notice that there is no MZ in
blood. That is, there is no MZ in the U.S. diet
unless one happens to eat an egg originating from Mexico, where MZ originated as an
egg yolk colorant added to chicken feed. One
could also consume several hundred pounds
of fish skin to achieve a physiologically significant dietary dose.
The MZ found in eye health supplements
is a chemical synthetic derivative produced
from a heat-induced, base-catalyzed conversion of L. It is important to note that this is a
synthetic process, not simply an extraction
of a material from a natural source. While
formulas with MZ have been shown to raise
macular pigment and improve vision,1 the MZ
naturally occurring in the human eye is derived from L metabolically within the retina
without MZ supplementation.2,3 MZ has not
been found in other non-retinal human tissues, especially in brain tissue where L and
Z are believed to play important, but as yet
undefined, roles. In the center of the fovea,
there are equal concentrations of L, Z, and
MZ. There is no question that MZ is important.
These are the scientific concerns:
There is a competition in absorption
among L, Z, and MZ that is well recognized. This reduces serum levels of L
and Z. This is important because L, especially, is the major carotenoid in the
human brain. Universally better brain
function has been recently associated
with higher L cerebral concentrations
in infants and centenarians.4,5 Thus, by
taking eye health supplements contain-
600
magenta
cyan
yellow
black
carotenoids are found in nature. 50 are
commonly found in fruits and vegetables,
and 20 in the human blood stream.
Of these 20, the retina specifically selects
two to comprise the macular pigment.
ing all three macular carotenoids, we
could theoretically increase the amount
of macular pigment in the eye only to
find cerebral function is compromised.
MZ has been studied only in combination with L and Z—never alone. Therefore, it is impossible to attribute any of
the activity seen in trials employing the
combination of L, Z, and MZ to the activity of MZ itself since it is impossible
to separate the functionality of these
three macular pigments.
When a consumer buys an AREDS 2-type
of supplement from a big box store labeled
as containing “zeaxanthin isomers” (i.e. a
combination of Z and MZ,) there is no assurance that the product contains significant
amounts of Z—the component used in the
AREDS 2 supplement. Furthermore, some
products labeled as containing Z may actually contain little—instead they contain MZ
in place of Z. Doctors and consumers both
deserve clear labeling of products in order
to ensure they are getting what they expect
in an eye health supplement. There is a distinct need for forthright discussion of the
scientific issues associated with MZ. Simple
proclamations suggesting three pigments are
better than two are misleading.ODT
Disclosure: Dr. Richer is the International
Scientific Director for the Zeaxanthin Trade
Association (ZTA).
References
1. sabour-Pickett s, Beatty s, Connolly E, et al.
supplementation with three different macular
carotenoids in patients with early age related
macular degeneration. Retina. 2014 May 30.
2. Johnson EJ, Neuringer M, Russell RM, et
al. Nutritional manipulation of primate
retinas, III: Effects of lutein or zeaxanthin
supplementation on adipose tissue and
retina of xanthophyll-free monkeys. Invest
Ophthalmol Vis Sci. 2005 Feb; 46(2):692-702.
3. Widomska J, subczynski WK. Why has Nature
Chosen Lutein and Zeaxanthin to Protect
the Retina? J Clin Exp Ophthalmol. 2014 Feb
21;5(1):326.
4. Vishwanathan R, Kuchan MJ, sen s, Johnson
EJ. Lutein is the Predominant Carotenoid in
Infant Brain: Preterm Infants Have Decreased
Concentrations of Brain Carotenoids. J Pediatr
Gastroenterol Nutr. 2014 Mar 31.
5. Johnson EJ, Vishwanathan R, Johnson MA,
et al. Relationship between serum and Brain
Carotenoids, α-tocopherol, and Retinol
Concentrations and Cognitive Performance in
the Oldest Old from the georgia Centenarian
study. J Aging Res. 2013
Midwestern University unveils plans for new optometry school
Downers Grove, IL—Midwestern University in
Downers Grove, IL, has announced plans
to open a new optometry school. The university’s campus in Glendale, AZ, is already
home to the Arizona College of Optometry.
The university recently unveiled its plans
to build a new office and classroom building to act as the future home of the col-
lege, which will enroll 50 students per year.
According to university spokesperson Jill
Blair-Smith, the university has not yet received state approval for the program. The
program’s implementation could be more
than two years away.
Downers Grove is located about 20 miles
west of Chicago.ODT
ES476675_OP0814_011.pgs 07.31.2014 03:21
ADV
12
dvisory
Board
Opinion
August 2014
|
Optometry practice: 25 years ago vs. now
By Frederick Frost, OD
Dr. Frost is an OSU graduate and has been in practice
for 25 years with a specialty in geriatrics.
Contact him at [email protected].
I recently achieved 25 years in private practice. This commentary is being written by
voice dictation on my laptop—something I
could not even imagine 25 years ago when I
started. When I started college, I’d seen only
one computer in my life, a Macintosh Plus,
which was the only computer in my entire
dormitory in college.
When I think back to 25 years ago, I used
to book only one patient per hour, as the doctor before me had done. Eighty percent of
our receipts came from optical sales, which
were mostly cash sales then. In fact, on my
first day of practice, I had only one appointment that day at 4:30 p.m.—the latest appointment. I was not allowed to use therapeutics because we had just recently gotten
diagnostics in Ohio. I remember sitting at
my desk all day being overwhelmed, having no idea what I should do. I was fresh out
of school and, quite frankly, I was scared to
death. No clinical instructor to consult, no
classmate to ask questions, totally on my
own. There was no pachymeter, no OCT, no
retinal tomography, no GDx; state-of-the-art
was the Humphrey Visual Field Analyzer.
I remember early on when I got a fax machine and was absolutely amazed I could
insert a piece of paper, and it would appear
somewhere else magically. Mobile phones
were extremely rare, and I didn’t have one
for many years until I got one of the old Motorola phones that were about half the size
of my iPad Mini.
Contact lenses had just started moving to
disposables, and things were changing. The
doctor before me did not fit contact lenses,
and I remember needing to purchase a keratometer, slit lamp, as well as a soft contact
For all of you
starting out in
optometry, I can promise
you this: when you reach
your 25th year as I have,
you will not be practicing
in any way that you can
imagine.
lens vial crimper (remember those?).
There was no public Internet, and advertising was limited to the Yellow Pages, newspaper, and the sign in front of your office. I
remember having to balance the checkbook
by hand, after I received the paper statements in the mail. There were no electronic
deposits, just putting checks and cash in the
bank. I had a copier in the office but could
not even imagine that I would have a scanner someday. Billing, what little there was,
was paper claims and mail.
When I visited nursing home back then,
I had a 300-pound case to carry my equipment, including portable refractor arm, that
I wheeled up a handicap ramp in my van.
My portable tonometer was a Makay Marg!
All records were done by on paper, which
meant carrying all the paper files for all
my patients to each nursing home. I performed 10 to 15 exams per day, which was
a lot back then.
Tomorrow, when I go to the nursing home,
I’ll be rolling in one single small luggage bag
that weighs about 20 pounds and has all the
equipment I used to have—and more. My records will be electronic, and quite a bit of
my work will be entered by voice/templates
rather than by typing. I will be seeing about
30 patients tomorrow, which I can now do
thanks to technological advances.
For all of you starting out in optometry, I
can promise you this: when you reach your
25th year as I have, you will not be practicing in any way that you can imagine. I
still love optometry, even more than I used
to, and I can tell you that at 25 years, you
can see the end as well as the beginning.
You should appreciate every day you have
in practice because it will all be gone in the
blink of an eye.ODT
This article originally appeared as a post
on ODWire.org and republished with permission from the author.
Google Glass moves into the operating room
Chicago—According to a recent article in
the Bulletin of the American College of
Surgeons, Google Glass could change the
way surgeons provide care in the operating room. This comes after some members of the American College of Surgeons
were selected to be among the first to test
out the device.
The article painted a picture of a surgeon using the device to record video
during an operation to send out to a colleague for a second opinion. Or, Google
magenta
cyan
yellow
black
Glass could allow the surgeon to view
magnetic resonance imaging (MRI) images without stepping away from the operating table.
In the future, the device could also
allow surgeons to:
• Make a patient safety checklist
• Transmit surgical video in real time
• Provide point-of-view teaching or training opportunities
• Provide patient information during
surgery
While the device is still in the early
stages of implementation within the medical community, the first Google Glass-assisted operation was performed last year
by Rafael Grossmann, MD, FACS, during
a percutaneous endoscopic gastrostomy.
However, there are still concerns about
Health Insurance Portability and Accountability Act (HIPAA) compliance and security concerns that need to be addressed
before the device becomes an operating
room regular.ODT
ES476676_OP0814_012.pgs 07.31.2014 03:21
ADV
| August 2014
Editorial Advisory
Opinion
Board
13
Letters
To the Editor
My FAvORItE APP
Jotnot Scanner
JotNot Scanner turns your
smartphone into a minicopy machine by taking
pictures of documents
and converting them to
PDF files that you can
e-mail or store for later
use. It’s a great way to
keep a digital format of
important documents.
I can use it at home
too—I just scanned my daughter’s artwork
from school and uploaded the images to
make a photo book keepsake. Now if only
I can bring myself to throw away the originals I could really de-clutter my life!
—Leslie O’Dell, OD, FAAO
Hanover, PA
iHealth launches world’s
smallest blood glucose
monitor for iPhone, Android
Mountain view, CA—iHealth has launched
a glucose monitor for iPhone and Android smartphones. According to the
company, iHealth Align is the world’s
smallest and most portable mobile
glucometer.
The U.S. Food and Drug Administration-approved device retails for $16.95.
The user inserts a test strip into the small,
teardrop-shaped device that plugs directly into a smartphone. Using the free
iHealth Gluco-Smart app, users can log
their glucose measurements and view
trends and statistics over the span of
seven, 14, 30, or 90 days.
The app can also set up reminders for
medication, record insulin doses and
pre/post meals or fasting, and keeps
track of the quantity of test strips and
their expiration date—which the company says it sells at or below the typical insurance co-pay contribution.ODT
magenta
cyan
yellow
black
Profession violation?
I agree wholeheartedly with Dr. Timothy J.
Smith’s letter strongly condemning NBEO’s
board certification (“Plea for NBEO,” May
2014). Perhaps this enterprise is motivated by our continuing inferiority complex regarding ophthalmology. But while
we try to become more “medical,” more
non-optometrists perform refractions in
ophthalmology offices. Shouldn’t we be
more concerned about this violation of our
profession?
Alfred Jan, OD, MA
San Jose, CA
Another EHR solution
Thank you for your article “EHR Roundup” in
the June issue of Optometry Times. This article brought up some good points about the
future of EHR implementation by optometrists and gave a good overview of a few of
the EHR products in the eyecare market.
I wanted to add one other software,
QuikEyes, to your list. QuikEyes was developed in 2006 to provide an affordable,
easy-to-use EHR option for small to medium-sized private and corporate-affiliated
optometry practices. QuikEyes is cloudbased and includes an optometry-specific
EHR module, practice management (with
inventory) module and a fully embedded
patient communications (text/e-mail) module. The software is designed to allow OD
users to purchase only the specific modules needed for their practice.
QuikEyes is a complete ambulatory certified EHR for Stage 1 Meaningful Use and is
currently awaiting Stage 2 certification from
InfoGard.
Matt Lowenstein OD
Founder, President, QuikEyes, Inc.
Overland Park, KS
I will be applying to optometry schools
this summer, and I can honestly say that
Optometry Times has really given me
an edge on the application process. I
have read about the problems faced by
optometrists, the changes in the industry,
and new solutions to everyday eye care
problems; all of which will be great assets
in proving to optometry schools that I am
serious about becoming an optometrist.
I really appreciate this publication, and
I just wanted you to know that it has
made a great impact on my career goals.
Thank you again for all that you do!
Susan Sunny
University of Illinois
at Urbana-Champagin
Class of 2015
Manual keratometry helps
diagnose keratocones
I loved Dr. Katherine Mastrota’s article on
manual keratometry (“Why keratometry
is important,” June 2014 iTech).
I can’t tell you how many early
keratocones are missed by automated
keratometry.
Frank Pirozzolo, OD
Staten Island, NY
For the record
In “EHR roundup” in our June issue, pricing was not included for MaximEyes. The
information that should have been listed
is: Starts at $375 per month (includes customer support)
Optometry Times regrets the omission.
Like something we published?
Hate something we published?
Have a suggestion?
Optometry Times
gives a leg up in
application process
Thank you for adding me to the e-mail
list for Optometry Times this past year. I
have been reading all of the articles that I
receive in the e-mails; they have all really
helped me to understand optometry and
all of its related components a lot better.
WE WAnt
tO HEAR FROM yOu!
Send your comments to
[email protected].
Letters may be edited for length or
clarity.
ES476683_OP0814_013.pgs 07.31.2014 03:22
ADV
14
Focus on
Allergy
August 2014
|
Nonpharmacologic care for ocular allergies
Grandma’s common-sense home remedies can help to offer relief
Allergic diseases have greatly increased in industrialized countries. About 30 percent of people suffer from allergic symptoms, and from 40 to 80 percent of these have ocular symptoms.1 We all prescribe topical medicines for our patients with
ocular allergies; their use has become almost second nature.
These medications do a truly remarkable
job of helping our patients who suffer
from seasonal or perennial ocular allergies. I like to temper these pharmacologic
recommendations with some commonsense ideas that will complement the
pharmacological treatment and greatly
alleviate the patient’s symptomatology.
Prevention
As with any allergy, the first step for
successful management of either the
seasonal or perennial forms of ocular
allergy should be prevention, or avoidance of the allergens that trigger symptoms. Avoidance of allergens can result
in up to a 30 percent decrease in allergy
symptoms.2 Advise your patients to stay
indoors when pollen counts are highest,
usually in midmorning and the early
evening. Pollen is one of the most common allergens, and unfortunately it is
one of the most difficult to avoid. Keep
windows closed and run the air conditioner instead of window fans because
window fans can draw in pollen and
mold spores. The dust in buildings contains a mixture of potential allergens,
including fabric fibers, feathers, animal
and human dander, bacteria, particles
of food, plants and insects, and microscopic dust mites (Dermatophagoides
species).3
Use high-quality furnace filters that
trap common allergens, and replace the
filters frequently. Clean floors with a damp
mop because sweeping tends to stir up
allergens. Limit the use of pillows, bedding, draperies, and other linens, such
as dust ruffles and bed canopies. Consider using blinds instead of curtains for
window covers. To prevent mold from
growing inside your home, keep the humidity under 50 percent. That might require the use of a dehumidifier, especially
in a damp basement. Clean your kitch-
magenta
cyan
yellow
black
cold compresses and/or ice packs because
patients find that the cool temperature
quells the allergy-associated itching and
burning. Artificial tears and preservative-free lubricants may be soothing,
and they dilute and wash away allergens in the eye. Refrigerating eye drops
prior to their use may provide additional
relief of symptoms. Try to not rub the
ens and bathrooms with a five percent
eyes. Increased levels of tear tryptase
bleach solution to cut down on mold.
have been reported following eye rubIn a warm, humid house, dust mites can
bing, indicating increased mast cell dethrive year-round in bedding, upholstery,
granulation.4 Rubbing the eye releases
carpets, and the like. Their protein waste
products stimulate
histamine from the
the allergic reaction.
mast cells, which
Limit dust mite expotentiates the alposure by encasing
lergic response, and
By Ernie Bowling,
your pillows in alavoiding eye rubOD, FAAO
lergen-impermeable
bing can reduce the
Chief Optometric Editor
covers. Wash bedtime course of the
ding frequently in
disease.5
water that is at least
If t he pat ient
130°F. Old mattresses are often teeming
wears contact lenses, consider tempowith allergens, so if your mattress is
rarily discontinuing contact lens wear
more than a few years old, think about
during the peak allergy season, or conreplacing it with a new one.
sider switching to daily disposable conIf a pet is causing the allergies, adtact lenses.
vise the patient to keep the home free of
There are a lot of environmental modpet dander and keep pets off the furniifications a patient can make to help alture. Clean carpets regularly and thorleviate his ocular allergies. Reminding
oughly to remove dust and allergens,
the patient of these will go along way
and consider replacing area rugs and
toward alleviating his suffering not only
carpets, which trap and hold allergens,
during peak allergy season but yearwith hardwoods, tile, or other flooring
round.ODT
materials that are easier to clean. Try
to keep the pet outside as much as posReferences
sible. For goodness sakes, keep the pet
1. Kari O, saari KM. updates in the treatout of your bed. Wash your hands imment of ocular allergies. J Asthma
Allergy. 2010 Nov;3:149-58.
mediately after petting any animals, and
remove and wash clothing after visiting
2. Bielory L. update on ocular allergy
friends with pets.
treatment. Expert Opin Pharmacother.
2002 May;3(5):541-53.
When the patient is outdoors, recommend wraparound sunglasses to help
3. Ronge LJ. Ocular allergies: Fight the
Mite. Available at: wew.aao.org/
shield eyes from allergens, and a widepublications/eyenet/200402/feature.
brim hat can likewise reduce the amount
cfm. Accessed 6/12/2014.
of allergens blowing into the eyes. Re4. Butrus sI, Ochsner KI, Abelson MB, et
mind the patient to drive with the car
al. the level of tryptase in human tears.
windows closed during allergy season.
An indicator of activation of conjunctival
Another strategy for minimizing allermast cells. Ophthalmology. 1990
gen exposure is to have the patient wash
Dec;97(12):1678-83.
her hands and brush her hair more fre5. Azari AA, Barney NP. Conjunctivitis:
quently and to change clothes when she
a systematic review of diagnosis and
comes in from outdoors.
treatment. JAMA. 2013 Oct;310(16):
Regardless of the allergen, recommend
1721-9.
ES474958_OP0814_014.pgs 07.29.2014 23:54
ADV
SOMETIMES DREAMS NEED A PARTNER
• Up to 100% Financing
• Dedicated Construction Team
• Construction Lending Experts
• Other Financing Options include:
Acquisitions, Expansions & Refinancing
©2014 Live Oak Banking Company. All rights reserved. Member FDIC
magenta
cyan
yellow
black
liveoakbank.com/healthcare • 877.890.5867
ES477298_OP0814_015_FP.pgs 07.31.2014 23:21
ADV
16
Focus on
Lens Care
August 2014
|
The harsh reality of contact lens care compliance
Americans fall short on lens care. Know the why behind the behavior
Hopefully, we have at least one person in our offices investing
the time to educate each and every contact lens wearer on how
to properly care for his lenses, and furthermore, ensuring that
every established wearer is carrying out those instructions appropriately. We also like to think that our beloved patients are
taking that instruction to heart: washing their hands, rubbing
and rinsing their lenses, cleaning and replacing their cases,
and never, ever topping off.
But the harsh reality is that overall compliance is relatively poor. Research has
uncovered the astonishing apathetic behaviors of patients time and time again,
but we have yet to use that information to change future behavior. A recent
study may help shed some light on how
to elicit better habits from our contact
lens wearers.
By the numbers
Recently, Dumbleton1 looked at the most
common shortfalls of contact lens compliance by administering an online questionnaire to 100 contact lens wearers. Inaccurate use of lens care, failure to clean
or discard the lens case, introduction of
tap water, and inadequate hand washing
were among the most common discretions. In this study, 27 percent admitted
to topping off their solution, while only
39 percent reported rubbing and rinsing their lenses every night. Twenty-two
percent said they never clean
their case, and 67 percent of
those who do rinse it with
tap water. An astonishing 76
percent routinely (and inappropriately) recap their case.
Regrettably, the percentage
of patients claiming to wash
their hands every time before
removing their lenses was a mere 45
percent, and not all of them use soap!
For many, hand washing was stimulated
only by the urge to remove an obvious
residue, such as makeup or food. How do we rank?
We pride ourselves in our cleanliness;
however, a glowing 89 percent of the con-
magenta
cyan
yellow
black
tact lens wearers surveyed in Saudi Arabia “appropriately” washed their hands
before handling their lenses. How can
they be better at this, considering 80
percent of the beauty shops in the study
admitted to selling contact lenses without an Rx, and 61.4 percent dispensed
them with no instructions at all? Yet in
the U.S., our patients buy their lenses
from authorized distributors and receive
their training from us, but only 45 percent wash their hands every time before
removing their lenses.2
In the Maldives, a whopping 61 percent of those surveyed were deemed to
exhibit poor hand hygiene, and 36 percent reported exposing their lenses to
water. Interestingly, approximately 90
percent of those surveyed saw themselves as average or better contact lens
wearers. This is yet another sign that
patients don’t see deviations in lens care
and hygiene as being consequential.3
By Crystal M. Brimer, OD, FAAO
Dr. Brimer is in private practice in
Wilmington, NC, and has special interests in
contact lenses and dry eye. E-mail her at
[email protected]
Among 500 healthcare workers in Pakistan, only 33 percent changed their solution
daily, while 42 percent used the same solution for more than two weeks. (Only 24
percent claimed to know proper cleaning
techniques). Even among these low standards, 82 percent claim to have adequate
hand hygiene prior to handling lenses.4
We think of hand washing as it ap-
plies to microorganisms, but there is another factor to consider. Dermal lipids
can be transferred to the surface of the
lens. One study analyzed the amount
of lipids transferred to the lens after a
novel hand wash and a thorough hand
wash, compared to no hand wash. Fluorescein spectroscopy revealed, on average, 14 fluorescence units (FU), six FU,
and 28 FU, respectively. This indicates
a four-fold increase in lipid deposition
for those who didn’t wash up.5
76%
of lens wearers
surveyed in the U.S.
said they routinely
(and inappropriately)
recap their case.
The why behind the behavior
Dumbleton1 didn’t just look at compliance rates, she took it one step further
and explored the reasons behind the
behavior. Participants who were ranked
as “generally compliant” or “generally
noncompliant” were asked to participate in separate focus groups. This was
done in an attempt to understand the
motivating factors that influenced their
level of compliance. She deemed the two
biggest influencers of both groups as
education, or lack thereof, and consequence of behavior.
Firstly, those who were generally compliant had clearly been given precise instructions to follow, while many of the
noncompliant patients had no knowledge of proper behavior. Tilia6 compared
the overall compliance of contact lens
wearers receiving verbal direction vs.
those receiving both written and verbal instructions. We shouldn’t need a
study to tell us that the latter method
is more effective, but he found that patients receiving only verbal instructions
were about twice as likely to inappropriately rinse their cases with tap water
(a habit that causes a substantial rise in
the presence of gram-negative bacteria
in the case).
Secondly, actual consequences and perceived consequences may be two different things. On the lens, noncompliance
may cause deposition and dehydration.
ES474974_OP0814_016.pgs 07.29.2014 23:55
ADV
| August 2014
In the eye, it can lead to corneal staining,
conjunctival injection, papillae, and even corneal ulcers, both infectious and sterile. Some
patients may internalize an increased risk for
infection on some level, but it seems their
behavior was more significantly affected by
their perception of other, more immediate,
consequences: blur, visible deposits, and discomfort. Patients are more likely to change
their lenses or amp up their cleaning regimen when they experience more dryness or
a drop in their end-of-day comfort.1 However,
research shows the majority of noncompliant
tendencies are not associated with contact
lens-related dry eye. Inappropriate replacement schedules, inadequate rub and rinse,
topping off, and even the omission of hand
washing did not seem to negatively affect
their dry eye score or their clinical presentation of dryness.7
How do we change behavior?
How can we use this research to our advantage in a clinical setting? Clearly, education
is a principal factor, and the burden to deliver that education lies, primarily, on our
shoulders, as eyecare providers. However,
the required investment of staff and time
is far outweighed by the benefit of preparing our patients for a lifetime of successful lens wear. This week, raise awareness
among your staff and delegate who in the
office will have this crucial conversation
with the patient.
None of Dumbleton’s focus groups seemed
to have an understanding of the imminent
risk imposed by improperly caring for their
lenses. Even the compliant patients were more
motivated by the perception of their immediate comfort and vision.1 This is key information, indicating that we may be more effective in motivating patients by touting the
added benefits of compliance (better vision
and comfort) vs. the imposed risks of noncompliance.ODT
Khan sA. Contact lens use and its
compliance for care among healthcare
workers in Pakistan. Indian J
Ophthalmol. 2013 Jul;61(7):334-7.
5. Campbell D, Mann A, Hunt O, santos
LJ. the significance of hand wash
compliance on the transfer of dermal
lipids in contact lens wear. Cont Lens
Ant Eye. 2012 Apr;35(2):71-7.
7. Ramamoorthy P, Nichols JJ.
Compliance factors associated with
contact lens-related dry eye. Eye
Contact Lens. 2014 Jan;40(1):17-22.
Extraordinary
choices.
Extraordinary
vision.
Change the way your patients
see the world.
1. Dumbleton KA, spafford MM, sivak A, Jones
LW. Exploring compliance: a mixed-methods
study of contact lens wearer perspectives.
Optom Vis Sci. 2013 Aug;90(8):898-908.
3. gyawali R, Nestha Mohamed F, Bist J, Kandel
H, et al. Compliance and hygiene behaviour
among soft contact lens wearers in the
Maldives. Clin Exp Optom. 2014 Jan;97(1):43-7.
4. Khan MH, Mubeen sM, Chaudhry tA,
magenta
cyan
yellow
black
17
6. tilia D, Lazon de la Jara P, Zhu H,
Naduvilath tJ, et al. the effect of
compliance on contact lens case
contamination. Optom Vis Sci. 2014
Mar;91(3):262-71.
References
2. Abahussin M, Alanazi M, Ogbuehi KC,
Osuagwu uL. Prevalence, use and sale of
contact lenses in saudi Arabia: survey on
university women and non-ophthalmic stores.
Cont Lens Ant Eye. 2014 Jun;37(3):185-90.
Focus on
Lens Care
For patients who want more than an
ordinary clear lens, the wide array of
Transitions® adaptive lenses™ offers an
option for everyone. Transitions lenses
seamlessly adjust to changing light
conditions while reducing glare, so your
patients always see life in the best light.
See how to recommend the right lens at
9 out of 10 people who wear
Transitions lenses love them.
TransitionsPRO.com/products
Transitions, the swirl and XTRActive are registered trademarks and
Transitions Adaptive Lenses, Signature, Vantage and Life well lit are
trademarks of Transitions Optical, Inc. ©2014 Transitions Optical, Inc.
Photochromic performance is influenced by temperature, UV exposure
and lens material. Transitions Drivewear sun lenses are optimized for
sunlight response. They should not be used for night driving. Drivewear
is a registered trademark of Younger Mfg. Co.
1
%
UV BLOCK
Life well lit
ES474973_OP0814_017.pgs 07.29.2014 23:55
™
ADV
18
FOcus On
Refractive Surgery
August 2014
|
Part 2: Phakic IOLs
Comanaging non-corneal surgery
Last time we discussed the benefits of phakic intraocular
lenses (IOLs), including patient selection criteria for both anterior chamber and posterior chamber lenses. Now, let’s discuss the comanagement of phakic IOLs including outcomes,
perioperative care, and complication management.
Visual outcomes
Visian ICL (Implantable Collamer Lens)
induces fewer high-order aberrations
compared to LASIK in high myopia,
resulting in better quality of vision in
low luminance.1 U.S. military studies
show that Visian ICL provides 98 percent uncorrected visual acuity (UCVA)
at 20/20, resulting in a 99 percent patient satisfaction rate.2 Thirty-four percent of soldiers gained at least one line
of best-corrected visual acuity (BCVA).3
One hundred percent of more than 200
U.S. soldiers report that Visian ICL provided better vision than their previous
spectacles, enabling them to function
and perform better.2
Perioperative care
Perioperative care for phakic IOL patients
is very similar to that of patients who
undergo cataract surgery. Because toric
phakic IOLs are not currently available
in the U.S., a plan to correct significant
residual astigmatism (spectacles, LASIK,
PRK, LRI [limbal relaxing incisions])
should be in place prior to surgery.
Preoperative evaluation is also similar
to cataract surgery. Soft contact lenses
should be removed one to two weeks
By William Tullo, OD
Dr. Tullo is the vice president of
clinical services for TLC Vision
and adjunct assistant clinical
professor at SUNY College of
Optometry.
prior to pre-op evaluation and one day
prior to actual surgery. Hard or rigid
gas permeable contact lenses must be
removed four to six weeks prior to preop evaluation. These patients can be
transitioned to soft contact lenses during this period if they cannot tolerate
vision with spectacles.
Preoperative medications typically
include topical antibiotic prophylaxis
(qid x five to seven days). After surgery,
continue the topical antibiotic for one
week, add a topical steroid (two to four
weeks) and a topical NSAI (two to four
weeks). After surgery, patients should be
instructed to refrain from eye makeup,
heavy lifting, and swimming for one
week and to wear clear plastic shields
at bedtime for three to five days.
If your patient is having a Visian ICL
implanted, laser peripheral iridotomy
is performed one to two weeks prior to
Vault Assessment
cornea
ICL vault
Compare the cornea and the vault
magenta
cyan
yellow
black
Figure 1. The first
examination at two
to four hours includes
UCVA, biomicroscopy,
and IOP check.
Ensure that the IOL
is centered, attached,
and properly vaulting
the crystalline
lens. Also look for
anterior chamber
inflammation.
Pre-operative
examination
– Ocular/systemic health history
– Medications/allergies
– UCVA
– Manifest refraction with BCVA
– Cycloplegic refraction
– Binocular evaluation
– Biomicroscopy
– Dry eye evaluation
– IOP
– Dilated retinal examination
– White-white measurements (Visian
ICL)
– Anterior chamber depth
– Endothelial cell count
– Topography/tomography
ICL implantation. One or two holes are
created in the superior iris near the superior limbus to allow unimpeded flow
of aqueous fluid after ICL implantation.
Patients are usually given a topical steroid
for one week after surgery. You should
monitor the patient for intraocular pressure (IOP) spike and inflammation within
24 hours of iridotomy. After phakic IOL surgery, post-operative patient care includes examination
two to four hours after surgery, then one
day, one week, one month, and three
months after surgery (Table 1). The first
examination at two to four hours includes UCVA, biomicroscopy, and IOP
check. You must ensure that the IOL is
centered, attached (Verisyse), and properly vaulting crystalline lens (Visian)
(Figure 1), as well as look for anterior
chamber inflammation. Early IOP elevation is most often caused by retained
viscoelastic or non-patent iridotomy. Retained viscoelastic material can often be
resolved by “burping” the wound at the
slit lamp, while a non-patent iridotomy
requires return to YAG laser to enlarge
opening(s).
ES476039_OP0814_018.pgs 07.30.2014 22:45
ADV
Refractive Surgery
| August 2014
TABLE 1
Post-op examination
2-4 Hours
1 Day
1 Week
1 month
3 months
YES
YES
YES
YES
YES
X
X
YES
YES
YES
Biomicroscopy
YES
YES
YES
YES
YES
IOP
YES
YES
YES
YES
YES
DFE
X
X
X
X
YES
UCVA
Refraction
w/BCVA
TABLE 2 Visian ICL post-
market data 2011
Excessive vault
0.52%
Inadequate vault
0.23%
Lens opacity > 6 months
0.57%
ICL exchange
0.77%
Biomicroscopy is essential to
rule out infection or endophthalmitis and ensure IOL centration
and ICL vaulting. Proper vaulting
of the Visian ICL is between 0.5 to
1.5 times the thickness of the cornea. Inadequate vault can result
in crystalline lens opacification,
while excessive vaulting can result in elevated IOP. Dilated retinal
exam can wait until one or three
months post-op, provided BCVA is
unchanged, no excessive inflammation noted, and no symptoms of
photopsia or floaters arise.
Complications
Many studies show excellent safety
profile of the phakic IOLs currently
available in the United States.4 All
intraocular surgeries have the potential for serious vision-threatening
complications. One U.S. military
study in Ft. Hood, TX, of 141 eyes
reported zero percent complications
in a young myopic population. In
2011, Staar Surgical reported Visian post-market safety data with
complication rates below one percent (Table 2).
Anterior chamber lenses can potentially increase the risk of corneal
decompensation and pigment dispersion. Posterior chamber ICLs can
increase the risk of glaucoma and
anterior subcapsular cataract. All
phakic IOLs also can cause retinal
detachment or endophthalmitis. A
magenta
cyan
yellow
black
long-term study of 617 consecutive myopes who underwent ICL
implantation demonstrated a rate
of retinal detachment of 0.32 percent.5 A literature review of 2,592
eyes with Visian ICL implantation
showed the most common complication was cataract in 5.2 percent,
often due to improper ICL sizing
resulting in insufficient lens vaulting of the crystalline lens.6
FOcus On
5. Bamashmus MA, Al-salahim sA, tarish NA, saleh
MF, et al. Posterior vitreous detachment and retinal
detachment after implantation of the Visian phakic
implantable collamer lens. Middle East Afr J Ophthalmol.
2013 Oct-Dec;20(4):327-31.
6. Fernandes P, gonzalez-Meijome JM, Madrid-Costa D,
Ferrer-Blasco t, et al. Implantable collamer posterior
chamber intraocular lenses: a review of potential
complications. J Refract Surg. 2011 Oct;27(10):765-76.
Digital Photography
Solutions
for Slit Lamp
Imaging
Coming soon
Digital
SLR Camera
Patients in the U.S. will likely see
new phakic IOL options available
in the near future. In addition to a
toric version of Visian ICL, under
clinical investigation is a fenestrated version of the ICL that will
eliminate the need for peripheral
iridotomy prior to lens implantation.ODT
References
1. Parkhurst gD, Psolka M,
Kerzirian gM. Phakic intraocular
lens implantation in united
states military warfighters:
a retrospective analysis of
early clinical outcomes of the
Visian ICL. J Refract Surg. 2011
Jul:27(7):473-81.
2. Barnes s. Is the ICL Ready for
Service in the US Army. Kauai, HI:
Hawaiian Eye Meeting; February
2010.
3. Parkhurst gD, Psolka M. A
Retrospective Analysis of
Outcomes in Consecutive Eyes
Undergoing Implantable Collamer
Lens Refractive Surgery for the
Correction of Myopia. san Antonio,
tX: Fourth Annual International
Military Refractive surgery
symposium; January 11-13, 2010.
4. Igarashi A, shimizu K, Kamiva K.
Eight year follow up of posterior
chamber phakic intraocular lens
implantation for moderate to high
myopia. Am J Ophthalmol. 2014
Mar:157(3);532-9.
19
Digital Eyepiece
Camera
iPhone® Adaptor
Made in USA
TTI Medical
Transamerican Technologies International
Toll free: 800-322-7373
email: [email protected]
www.ttimedical.com
ES476038_OP0814_019.pgs 07.30.2014 22:45
ADV
20
Focus on
Technology
August 2014
|
How to handle a bad online review
The five Rs of replying incude recognizing the opportunity and responding
“You are the worst Yelper ever!” Have you ever wanted to
reply to a user review with those words? I’m sure you have.
Well, I do, and it feels great! It often is the most helpful and
appropriate response you could make.
help ensure that the people who are
Let’s face it, there are just some bad
best matched for your office end up in
apples in the bunch. If they were great
your exam chair.
Yelpers, they would have never selected
your office in the first place. In an age
where people are reviewing everything
Service breakdown or bad match?
from their liquor store to their eye docThere are basically on two types of
tor, people can (and
negative reviews:
should) research a
one in which you
By Justin Bazan, OD
spot ahead of time
had a ser vice
is a 2004 SUNY grad and the
to determine if that
breakdown, and
owner of Vision Source Park
place is what they
one in which the
Slope Eye in Brooklyn. Reach
are looking for.
reviewer is just a
him on his Facebook page.
Review sites are
bad match.
abundant, and they
These ser vice
are best used to find
brea kdow n rethe ideal spot you are looking for. They
views are easy to handle. Simply apolare worst used as a forum to post a rant
ogize, own up to it, rectify the situaabout a business the reviewer should
tion, make amends, and then do somehave not been to in the first place. We
thing extra and unexpected to make
have the opportunity to educate the
up for it. Everyone is largely in agreepublic about this, and we should do so
ment on how to handle those types of
when given the opportunity. This will
negative reviews. These also represent
User reviews are often
quality control. Sometimes
it takes an outsider to help
the insider learn what is
really going on. I would
have preferred to know
about the situation when it
happened because it would
have lead to a quicker
termination or remediation
of those employees. It’s
great to remind staff they
are always potentially
being reviewed and that
the boss is looking at
them! This situation was
a service breakdown,
so the response was
easy. I apologized, and
privately I e-mailed her a
gift certificate to a local
vendor.
magenta
cyan
yellow
black
only a very small percentage of negative reviews.
Where people often get things twisted
are the instances in which you are
providing the experience you want to
provide, but the person is expecting
something else. Here is where most
business owners try to apply the service-breakdown resolution—which is
not the way to go because it sets you
up for continued failure. The bulk of
the negative reviews are cases in which
the patient’s expectations were not in
alignment with the experience you provide. Most often, the person isn’t a good
match for the business. Let’s take a
closer look at how to handle this bad
apple-type of review.
Replying to a negative review
Consider sticking to the five Rs of replying to a negative review:
1
Recognize the opportunity. The
truth is there really isn’t such a thing
as a negative review. Every review you
get is merely an opportunity to let the
world know where you stand and how
you do things.
Often, this is just way more apparent
with the one-star reviews. The more
people sharing their experiences, the
better, and the more people reading
your replies, the better. In a world
where people are online doing their
research, you want to have a strong
presence, and you want people to be
able to know what experience you are
going to provide them. It’s a beautiful
thing when the person reads about the
experience you provide and thinks to
himself “Wow, I have to go there!” or
“Wow, I would never go there.” That
will keep those best matched for your
office coming in and those who are best
matched elsewhere out. It’s a beautiful
thing having a schedule full of people
who are there because they want to
experience what they read about. It’s
a beautiful thing having people who
are already in alignment with you on
how you do things. The reality is those
negative reviews may be the best thing
for you.
ES476058_OP0814_020.pgs 07.30.2014 22:55
ADV
Technology
| August 2014
5
Nearly every user review site allows the business owner
to reply. This is your chance to review the reviewer. This
is your chance to show you care. This is your chance to
set the record straight. This is your chance to let people
know what kind of experience you love to deliver.
Be rational. Most people get upset
and irrational. Business owners often
want to please everyone and ensure that,
no matter who you are, you have the
most awesome experience. It takes time
to learn that instead of trying to please
everyone, you should focus on doing
the things you love to do and do those
things the best.
Until that realization occurs, the emotional response to a person having a
bad experience often kicks in, and the
reply to the review reflects that. We
often reply when emotions are charged
and might just feel differently if we
had time to process. Negative energy
blocks creative thinking. Simply sleep
on your response. Even consider asking around. My best replies often start
in emotion but are reworked the next
day before posting.
3
magenta
cyan
yellow
black
Respond. You must reply. How do
you feel when you come across a
business with tons of people expressing
their displeasure, yet the business has
not made a single reply? Most people
are going to think the business couldn’t
care less. Not replying is one of the worst
things you can do. If you don’t, people
are going to think you don’t care or are
a pushover.
Both of those things are detrimental to any chance of continued success
and happiness. Nearly every user review site allows the business owner to
reply. This is your chance to review the
reviewer. This is your chance to show
you care. This is your chance to set the
record straight. This is your chance to
let people know what kind of experience you love to deliver.
4
21
in person. It’s important you do the same
because the authenticity needs to be there.
When you keep things real, you can never
go wrong.
I’ve found that the best experiences
come when there is a consistency between the online research and the realworld experience. The worst is when
there is a mismatch.
Getting people to pay up
is a huge headache for
nearly every business
owner I know. I considered
that people who read this
review would understand
he was a little special, so
keeping it simple worked
best. Remember, hundreds
of other reviews praise the
experience, so this clearly
is not the norm. We did
nothing wrong; he simply
neglected to pay fees he
was responsible for. The
message is clear that we
expect people to handle
their responsibilities and
resolve problems without
drama. That is how we roll,
and we expect our patients
to as well.
2
Focus on
Keep it real. For consistency, it’s
imperative that you use the same persona of your brand online as you have
offline. The style I write with is “Brooklyn,” and it is the same way I say things
Repost. If you have been paying attention, you know that all reviews
are awesome and should be broadcast on
blast (via Facebook, Twitter, e-newsletter,
etc.). It will be hard at first to pump the
negative reviews into your social media
channels, but now that you have your
best response attached to it, things will
be OK. In fact, they will turn out for the
best. You have an incredible network of
supporters out there.
I’ve seen that our most popular Facebook posts are often, “Check out our
latest 1 star review!” Why? Because it
rallies the troops. Your network of advocates snaps into action. It spreads the
word and gets your message out there.
People love to read the negative reviews.
They are your best opportunity to attract
like-minded individual and repel those
in opposition.
No doubt this represents a departure
from old-school standards. However,
times have changed, and the way in
which people interact is evolving, too.
Customer service is not customer butt
kissing. The day and age of “The customer is always right” is over. To be successful in this new era, we have to keep
the following points in mind:
The ability for people to conduct
research before patronizing a business has changed the game forever.
The ability for user reviews and
owner replies has helped to provide equality on all fronts and—
this allows for the best possible
matches between those two parties to
occur.ODT
For a recent example of how this all
comes together, visit: http://ow.ly/
zrAEh and http://ow.ly/zrAJd.
I know you have some comments—
please share them with me! E-mail
me at [email protected].
ES476057_OP0814_021.pgs 07.30.2014 22:55
ADV
Special Section: PEDIATRICS
22
AUGUST 2014
|
Vision therapy: A top 10 must-have list
Keep patients engaged and meet therapeutic needs
By Marc B. Taub, OD, MS, FAAO, FCOVD
M
Over my 10-plus years in practice I have developed a core set of equipment that I cannot
live without. While some would be considered basic, others are more complicated. It is
this mixture of high and low tech that keeps
patients interested and enables
the uploading and downloading
of activities to meet therapeutic
needs. I hope that my top 10
pieces of vision therapy equipment will quickly become yours.
y name is Marc, and I am a vision therapy graduate. I was your
typical kid, except that I could
not pay attention
in school and hated to read.
Luckily, my second grade
teacher requested that I get
an eye examination, and the
optometrist recognized that
I needed more than glasses.
1. Wolff wands
I was referred to an optomeWolff wands
trist who specialized in learnIt is amazing that a simple
2. Hart charts
ing-related vision problems,
design can be so powerful. Cre3. Brock string
including visual efficiency
ated by Bruce Wolff, the wands
4. Marsden ball
and processing disorders.
are two 1-foot-long metal rods
I immediately started a viwith either a gold or silver ball at
5. Vectographs
sion therapy program and
the end (Figure 1). These wands
6. Balance board
saw tremendous improvecan be used for activities related
7. Rotator
ment in my symptoms and
to tracking and convergence, but
success in school. When I
most importantly, they are cru8. Lenses and prism
entered optometry school,
cial for an activity known as eye
9. Rotator glasses
despite my background, I
control. In any successful pro10. Computer programs
did not instantly gravitate
gram of vision therapy, the patoward the vision therapy
tient must understand where his
department. It was during
eyes are pointing in relation to
my first job after graduation that the light his body. Eye control is performed early in
bulb went off; I realized my true calling. therapy and aimed at achieving this underVision therapy has the potential to help so standing. It is the reflective nature of the balls
many people, to change lives. on the wand that make them irreplaceable. If
the patient sees his reflection, he knows that
he is pointing his eyes at the intended target.
Dr. Taub’s
top 10
therapy tools
1
2
Figure 1.
Wolff wands
magenta
cyan
yellow
black
Hart charts
Hart charts can be used for accommodation, eye movements (saccades), and visual
attention. There are two charts of rows of
letters, one small and one large (Figure 2).
The patient typically stands 10 feet from the
distance chart and holds the smaller chart
in her hand. If working on accommodation,
there are three levels to be accomplished:
near chart at arm’s length, slowing moving
toward the patient while reading, and as close
as possible before becoming blurry. The patient alternates reading a line from the distance and near charts during the activity.
The activity can be made more challenging
by alternating charts every half of a line.
For saccadic work, only the distance chart
is used. The patient is instructed to read the
outside two columns, one letter at a time,
Figure 2.
Hart charts
Figure 3. Brock string
alternating between the two columns. As
she becomes more proficient, she begins to
read the columns in the same manner moving inward, eventually reading the two most
inner columns.
3
Brock string
No, despite what everyone says, using the
Brock sting cannot treat conjunctivitis, but it
is unbelievably useful on so many levels in the
therapy room. A key component to a therapy
program is the appreciation of physiological
diplopia. The different colored beads (red,
yellow, and green) can be placed anywhere
along the string (Figure 3), depending upon
the area of fusion. When focused on one of
the beads, the patient should appreciate two
of each of the other beads. Once physiological
diplopia is appreciated, the patient can jump
See Vision therapy on page 24
ES475976_OP0814_022.pgs 07.30.2014 22:27
ADV
FOR THE HEALTH OF YOUR PATIENTS,
FOR THE HEALTH OF YOUR PRACTICE
ARE YOU PRACTICING FULL
SCOPE OPTOMETRY?
CONTROL YOUR CURRICULUM
AND YOUR SCHEDULE.
Expand your knowledge base to practice
to the maximum extent your license allows.
Choose from 325 hours of accredited
Continuing Education for every role and
experience level.
With 12 flexible CE packages, only pay
for the hours you want and participate in
the events that interest you. The time and
money savings continue with shared event
hours for groups.
THE ONLY EYECARE
CONFERENCE TO FOCUS ON
BUSINESS SOLUTIONS.
ALL UNDER ONE ROOF.
Trends and technology are constantly
advancing. Find something new to
differentiate your practice with processes,
technology, efficiency, management tactics,
marketing, patient service and staffing.
By combining Continuing Education with
informal exchange between other exhibitors
and attendees, you’ll bring back solutions
that you can implement immediately.
EDUCATION: WEDNESDAY, SEPTEMBER 17–
SATURDAY, SEPTEMBER 20, 2014
EXHIBITION: THURSDAY, SEPTEMBER 18–
SATURDAY, SEPTEMBER 20, 2014
Las Vegas, NV | Sands Expo & Convention Center
REGISTER TODAY FOR THE MOST COMPREHENSIVE, RESPECTED
AND ANTICIPATED EYECARE EVENT IN THE UNITED STATES. VisionExpoWest.com/OD
#VisionExpo
magenta
cyan
yellow
black
ES471176_OP0814_023_FP.pgs 07.25.2014 01:40
ADV
24
Vision therapy
AUGUST 2014
Figure 4. Marsden ball
between the beads or do a controlled Bug on
a String. The position of the crossing of the
strings provides feedback for the patient, as
well as the therapist. Suppression is easily
detected if two strings do not enter and exit
the bead. Red/green glasses can also be used
because the red and green beads will cancel
and not be seen by both eyes.
4
Marsden ball
Activities that are performed with the
Marsden ball are fun and perhaps the most
desired in the therapy room. We have become experts at making our own balls using
a Pinky ball and a baseball glove repair kit.
Writing letters on the ball with a Sharpie allows for the activities to focus on visual attention. The ball is hung from the ceiling and
can be bunted with a dowel, and hit/caught
with the thumbs, palms, and fists (Figure 4).
|
quence of therapy. Whereas tranaglyphs are
red/green and are subject to lighting problems, the polarized vectographs are easily
visible and not as finicky. The different vectographs have differing visual demands and
target sizes. For example, the Quiot and Gem
(Figure 5) are great peripheral targets with no
central demand, while the Spirangle, Clown,
and Vortex (Figure 6) contain both peripheral and central demands (letters). All of the
vectographs enable the patient to appreciate
the SILO (small in/large out) phenomenon,
which is a key aspect of a successful therapy program.
6
5
Vectographs
There are many different vectographs,
which can be confusing for the novice therapist, but each one has a purpose in the se-
Balance board
The balance board addresses the concept
that while the eyes are part of the body, they
must move independently of the head and
the body. Eye movements are deemed inefficient if there is accompanying body and/
or head movement. The balance board is a
square wooden board with a base (Figure 7).
The base can be square or round, and there
SM
M
F
FRA
Wavefront Optimized RefraXion
Knowledge | Speed | Impact
Rapid Diagnostic Discernment – Far more usable and accurate data that
precisely defines each optical pathway, providing rapid, diagnostic
assessments in a fraction of the time.
Practice Productivity & Efficiency – Speed, without compromise,
maximizes patient flow and practice productivity. Increase daily
revenue with more patients each day and more Optical time per patient.
Optimized Patient Satisfaction – Greater understanding, validation of new
Rxs, superior outcomes, less time testing, and on-time visits result in
elevated patient satisfaction, loyalty, and referrals.
magenta
cyan
yellow
black
“The Xfraction Process greatly
simplifies and accelerates
refractions while delivering
more usable information about
each patient’s optical path – in
less time. It’s simply the next
generation of refractive care,
with levels of diagnostic
precision and patient satisfaction
never before achieved.”
David Marco
Jacksonville, FL
“Adding Wavefront, and
more information, is
imperative to our future
refractive capabilities.
Now, understanding all
aberrations in the visual
system we can optimize
refractions.”
“Efficiency is paramount
today; anytime I can save
time and be more accurate
– it’s the perfect solution.”
Ian Benjamin Gaddie
OD, FAAO
Louisville, KY
Paul Karpecki, OD
Lexington, KY
ES474996_OP0814_024.pgs 07.29.2014 23:58
ADV
| AUGUST 2014
25
7
Figure 5.
Vectographs
Figure 6.
Vectographs
Rotator
As discussed earlier, efficient eye movements are crucial to reading and the learning
process. The standing (Figure 8) or tabletop
rotator is used to address concerns related to
poor fixation, pursuits, and visual attention.
Numerous plates aimed at various purposes
can be used with the device. Some have more
peripheral vs. central targets, while others
have designs in red/green to address suppression. The speed of the rotator can be
controlled and the demand altered based on
speed and target location.
8
are several levels of difficulty. The patient
stands on the board and attempts to shift his
hips only from side to side. It is harder than
it seems, and some patients have to start at a
lower level and stand on the board or perform
the activity holding the therapist’s hands. Lenses and prism
Lenses and prisms are absolutely essential, and it confounds me that these items
might not be on someone’s top 10 list. While
lenses and prisms are used early on in the
therapy program with the introduction of a
single lens or prism, they are also used in
a facility-type manner later on. Lens blanks
are used to facilitate an understanding that
the patient, not the lens, controls her accom-
Figure 7. Balance boards
modation. She must clear a minus lens with
the lens in place and blur the image without
the lens in place. As the program progresses,
lenses are used in a bi-ocular and then binocular fashion in the form of flippers.
Prism is used to facilitate an understanding of the eye moving in a specific direction.
Strabismics often have difficulty with this
basic task. Teaching a patient with esotropia what it feels like when his eye is pointSee Vision therapy on page 26
Simply time for better
“The Xfraction Process
helps me rapidly discern
between patients that can
be corrected to 20/20 with
simple refinements or full
refractions...and who
I can’t correct to 20/20,
and exactly why not.”
April Jasper, OD
West Palm Beach, FL
magenta
cyan
yellow
black
“I’m amazed, daily, at how
much usable information
I get from this technology,
and how integrated it
is in the practice. The
efficiencies have increased
patient capacity daily.”
“With Xfraction, everything
is smoothly connected,
and with a single button
push, all test results from
all devices are immediately
uploaded to my cloudbased EHR system.”
John Warren, OD
Racine, WI
Dori M. Carlson, OD
Park River, ND
“The Xfraction WOW
factor with my patients is
huge! They really notice
and appreciate the new
high-tech and integrated
experience...making them
more likely to come back
in the future.”
Nathan Bonilla-Warford
OD, FAAO
Tampa, FL
“A great consumer experience
means a more efficient, hightech, and high-touch experience.
The Xfraction process has
impacted all aspects of our
practice– especially the ability
to instantly let the patient
compare their old Rx with how
well they could be seeing. I don’t
know how we lived without it.
Scot Morris, OD
Conifer, CO
800.874.5274
www.marco.com
ES474995_OP0814_025.pgs 07.29.2014 23:58
ADV
26
AUGUST 2014
|
Vision therapy
ing inward is a necessary step. Prism facility
flippers are used to increase flexibility in the
vergence system as the patient alternates between convergence and divergence demands.
9
Rotator glasses
These glasses come in powers ranging
from 2^ to 45^. The direction of the prism
can be rotated enabling either yoked (same
direction) or dissociated (different direction)
prism (Figure 9). Yoked prism is very useful when working with patients with special
needs, including autism and developmental
delay, as well as those who have suffered a
traumatic brain injury. When performing an
activity with yoked prism, the patient has to
reorient his visual system to coordinate successful completion. The ability to alter input
is a needed aspect of a therapy program.
10
Computer programs
It is amazing how far computer programs have come in the 30 years since I per-
Figure 9. Rotator glasses
sonally went through a therapy program.
Yes, many of the basic concepts are still
in place, but the intricacy and variety of
programs is outstanding. Computer-based
activities can be performed both in the office, at home to support office-based therapy, and as a stand-alone home-based program. The office-based approach to therapy
has been shown to be more successful, but
these programs allow greater access for patients who cannot attend weekly sessions.
Depending on the program selected, activities can stress vergence, accommodation,
eye movements, and visual information processing. Each program is unique, and each
practice should investigate which ones work
best for its model of vision care.
BONUS: Sanet Vision Integrator
I already covered my top 10, but the Sanet
Vision Integrator is knocking on the door
and is a hit with the patients. It is a 52-inch
touch screen (Figure 10) that can be used
with any variety of patients. Activities are
aimed at eye movements but with a twist:
the tactile aspect of the touch screen brings
in eye-hand coordination. The target size,
color, location, and contrast can all be controlled, which is an asset when working with
brain injury patients or those with amblyopia. This is quickly becoming one of the
most-used therapy activities in my repertoire.
Keeping vision therapy fun
Figure 8.
Rotator
Even though vision therapy is not just for
children, a high percentage of participants
are in fact young. On the surface, some of
these activities are more exciting than others and, unfortunately, that is just how it is
sometimes. That does not mean that the activities cannot be made fun by using incentives or creating a competition between the
therapist and the patient or even between
patients. I suggest trying to space the higher
energy, more fun activities throughout the
therapy session to keep the child’s attention.
Figure 10.
Sanet Vision Integrator
Also, keep in mind that younger children and
those with attention challenges will need
shorter-duration activities to keep them engaged. If needed, the activity can be broken
into two shorter parts. Vision therapy is all
about engaging the patient to enact meaningful and long-lasting change, so do not be
afraid to take off the white coat, get on the
floor, and have fun!ODT
Author Info
Dr. Taub is the chief of Vision
Therapy and Rehabilitation
as well as supervisor of
the residency program in
Pediatrics and Vision Therapy
at the Southern College of
Optometry in Memphis, TN.
| AUGUST 2014
27
Finding the right frame styles for children
How to keep the peace between children, parents when selecting youth eyewear
Take-Home Message
Maintaining both parents’ and children’s happiness
when choosing pediatric eyewear requires a balancing
act, supported by the physician and clinic staff.
By Rose Schneider
Content Specialist
W
hen the moment comes for a child
who requires eyeglasses to pick
out frames, the process can be
tricky if the child’s idea of what
she wants differs from that of the parents.
While the child may find a frame designed
with Mickey or Minnie Mouse as the perfect
fit, her parents may feel more comfortable
with a more conservative option.
The key is to find a balance between parent
and child so that everyone walks away happy.
“Our approach is not much different [from that]
with older children,” said Indianapolis OD Penn
Moody. It is a collaborative effort among the
doctor, staff, the parents, and the child—not
necessarily in that order. We have parents who
will let the children select their frames, we have
parents who totally dominate their children’s
choices, and we have everything in between.
Where to begin
The best starting point for the eyecare practitioner, Dr. Moody said, is to recommend the
prescription and explain why the child needs
magenta
cyan
yellow
black
it. The clinic’s staff should then find out which
style the child and/or the parents find most
suitable.
The most appropriate way to approach this
process is to find out the necessary information from the child and parents separately, said
Lisa Frye, ABOC, in Birmingham, AL. Then,
once everyone is together, the optician can relay
what was discussed.
“This can help direct the process, as the
communication is shared,” Frye said.
Approaching budget limitations should be
the next step. Having a discussion about financing the eyeglasses and insurance is important
because it creates a pathway to understand
what the parents are comfortable with, she said.
“This allows me to find out what the parents
are most concerned about, whether there is a
budget, and if the parents have worn eyewear
and understand the process,” Frye said. “In
the case that the child is getting a first pair of
glasses and no one in the family wears spectacles, then I take the time to education them
on lens materials, options, and performance.”
Dr. Moody usually approaches the topic of
frame cost while the parents and child are browsing. “We do not ask budget questions at first
because it focuses the conversation on ‘how
much’ vs. ‘what is best,’” he said.
Involving the child is a must
The most important aspect to keep in mind
while finding the correct frame is to keep the
child highly involved in the process.
“We always involve the child in all parts of
the eye-care process/experience,” Dr. Moody
said. “We believe children are more likely to
wear spectacles if they are involved, and we
also want them to start to get involved with
their health care at an early age.”
Frye said that at her office, she uses two approaches to engage the child in the frame process. “If the parent has indicated she is very
open to allow the child to have a lot of say in
the process, then I walk the child to our children’s area, and I have a tray that holds several
pairs of glasses,” she explained. “We have mirrors at appropriate heights for easy access by
A collection of children’s frames is displayed. (Images
courtesy of Lisa Frye, ABOC)
a child. I encourage the child to try on frames,
and we start the process of discovering her
tastes and preferences.
“As she tries on the frames, I will get feedback from parents as well,” she continued. “I
offer advice on the fit and make sure the finished product will service them well. Once we
have at least three fames in that tray, I walk
them back to the dispensing table, and we go
through the frames to eliminate choices until
there is only one frame left.”
As for her second approach, Frye said she
will take more control by listening to what the
parents and child are saying, and then finding
the frames herself.
“I leave the child and the parent at the dispensing table, listening to what the parent and
the child are sharing, and then and place frames
into my tray that will fit well, keeping in the
guidelines that were established through the
communication,” she said.
Handling the awkward times
Nevertheless, awkward moments in discussions
among family members are bound to happen.
“Even with the best of intentions, there can be
awkward moments,” said Frye. “If a parent and
a child differ over something, I usually afford
them some privacy and step away for them to
have a moment to concur.”
If there is a disagreement, Frye suggests that
the child return at a later date to give the family more discussion time.
The bottom line in keeping the child and parents happy during the decision-making phase,
Frye said, is to stay in charge.
“Staying in charge, as the expert, when walking through the frame-selection process allows
us to keep the child from being overwhelmed
and can help merge the required budget and
frame preferences to please both child and parents,” she said.ODT
ES474961_OP0814_027.pgs 07.29.2014 23:55
ADV
28
Practice Management
AUGUST 2014
|
Lowering your financial risk: Part IV
Diversifying your practice
Develop a strategy to give your practice a competitive edge
By Bryan Rogoff, OD, MBA, CPHM
A
s optometrists, we tend to be extremely
knowledgeable with the most current
standard of care, but this does not mean
practice owners should invest in all the bells
and whistles of the latest and greatest technology. A full analysis of your practice’s demographics, along with market and industry trends, will provide information to make
decisions on where to invest and grow your
practice. Knowing your most profitable products and services is key, and obtaining comprehensive data about your cost drivers will
lead to lowering your financial risk. It is important to do your homework and research
before investing and diversifying your practice.
How inflation affects your practice
Corporate entities have backing from banks and
investors, as well as cash reserves, which gives
a strong advantage with capital. For the individual practice, you must think like a businessperson by looking at how inflation affects your
practice, and hedging is a must in your strategic
planning. Inflation hedging is executing strategies
to minimize future losses because of increased
prices. Inflation affects the price of goods as well
as depreciates the value of money. Purchasing
extra inventory when prices are low can be effective when it will be used or sold quickly. Buying groups are helpful for smaller practices due
to the ability to negotiate long-term contracts
with suppliers that lock pricing and get bigger
discounts because of volume. This has a direct
effect to your bottom line, as well as cash flow,
and understanding your practice’s past sales history, cost drivers, and market trends will give your
more perspective to avoid counterproductivity.
Diversifying while remaining competitive
For several years, market trends have focused
on the aging baby-boomer demographic, reimbursement rates with managed vision care and
health insurance plans, and legislative changes,
including the impact of the Affordable Care Act
(ACA). There is a lot of information regarding
each of these areas, but not all may affect your
practice directly. The opportunity to engage with
these trends and manage ocular disease has
been embraced by many optometrists, but will
the reimbursements from Medicare, Medicaid,
magenta
cyan
yellow
black
and private insurance be profitable enough to
stray away from your primary business model?
Primary care and contact lenses have been the
bread and butter of most optometric practices,
and diversifying into other areas may not show
a profit for years to come. Historically, as optometry has diversified into other arenas of medical ophthalmic care, it created market voids for
certain services and products that have been
and continue to be filled by retail/corporate
and online entities. The challenge is how to
remain competitive and focused while hedging your loses as you diversify your practice.
Now that the ophthalmic industry, Centers
of Medicare and Medicaid Services (CMS), and
the insurance industry have outlined demographic and market trends, which ones will
affect your practice the most? What market
drivers will cause the most losses that you
should hedge against? Electronic health records
(EHR) and practice management/scheduling
software not only keeps your practice compliant for ACA changes for medical billing and
future ICD-10 compliance, but good programs
gives you insight about sales and diagnosis
history, seasonality trends, and your practice’s
demographics. Every other week there are
updates regarding Meaningful Use Stages 1
and 2, the switch to ICD-10, and discussions
of Accountable Care Organizations (ACOs).
Lawmakers and the insurance industry have
indicated that fee-for-service reimbursement is
unsustainable, and there is a push toward coordinated care. It is extremely important to stay
focused with your current billing while preparing
ICD-10 changes but also diversify your practice
to accommodate coordinated care. Optometry
has lagged behind other allied health professions in medical billing and just started to catch
up; therefore, it is important to hedge against as
insurers and other models move toward ACOs
and coordinated patient care. When it comes
to investing in EHR and practice management
software, it is important to research which system will be compliant with healthcare changes
and give your practice the most productivity
and efficiency.
Your practice strategy
Managerial accounting methods, such as activity-based cost accounting (ABC accounting),
give insight of which activities and services
CHECK OUT THE PREVIOUS
ARTICLES IN THE SERIES
Part I: Lower your financial risk
Better manage your practice cash flow
optometrytimes.com/loweryourfinancialrisk
Part II: Hire and manage key employees
Create a culture of teamwork and success
optometrytimes.com/hirekeyemployees
Part III: Managing risk avoidance
Recognize how to reduce and evaluate risk
optometrytimes.com/manageriskavoidance
your practice provides that creates a competitive edge, as well as assists making informed
decisions regarding strategy for diversification.
ABC accounting assigns specific costs to activities, and to end products and services, which
reveals critical information about your practice’s resources and activities, and in turn, assigns a cost to perform them. Allocating fewer
resources in your everyday operations can lead
to loss of patients, employee turnover, loss of or
less cash flow, increased chair time costs, and
lost revenue. Expanding your office hours and
hiring additional staff can hedge against the
loss of patients and profitable services while
your invest in other areas.
It is an exciting time for health care and
optometry, and the American Optometric Association and state boards are pushing lawmakers to expand different avenues for the
profession to grow while protecting our interests. Understanding what investments your
practice needs to make to minimize market
voids will be crucial to keep your losses low.
When diversifying into other products and
services, it is important to develop strategies
to maximize your practice’s cash flow and
profits.ODT
Author Info
Dr. Rogoff is an independent
corporate and private practice
consultant specializing in best
healthcare, business, and
clinical operations practices.
He also currently acts as the
partnerships and marketing
liaison for the Maryland Optometric Association.
E-mail him at [email protected].
ES474960_OP0814_028.pgs 07.29.2014 23:54
ADV
InDispensable
| AUGUST 2014
In Brief
Skechers presents kids summer
collection
SK
MEI launches
Shape Finder 2.0
1068
SK
Milan, Italy— MEI recently released the
Shape Finder 2.0, an optical scanning
device which aims to improve and
complete the functionality of the EzFit
edger. EzFit can now be equipped
with Shape Finder 2.0 to prepare the edging process of
sport and special lenses.
Shape Finder 2.0 is designed to be integrated into
the MEI Tecnocam programming platform, which is
installed in every MEI edger,
and to avoid all standard
camera-based units’ common
errors. The camera lens set
and the lighting system is designed to emphasize the edge
profile in any kind of lens—
clear or dark mirrored—and to
eliminate the perspective effects and field distortions. The
Tecnocam software installed
in the EzFit machine interacts
directly with the Shape Finder
2.0 interface to align the
lens and extract the different
shapes starting from the outer
main shape and converting them into
a standard TRX file.
Santinelli expands
optical tools, supplies
with new supplement
Hauppauge, NY—Santinelli International is introducing more than 20 new
products, featured in its new catalog
supplement, augmenting its line of finishing supplies, precision tools, frame
parts, and working aids.
Highlights include an “anvil-style”
bench block, a spring-hinge tool kit,
a screw-extractor set, and replacement temples, bridges, and nose pads
for today’s popular frame styles. The
new catalog supplement is available
upon request and is also accessible in
an e-mag version via the company’s
website.
magenta
cyan
yellow
black
29
1078
SK
1556
SK
1154
Manhattan Beach, CA—Skechers recently
introduced its Summer 2014 eyewear
collection for kids with six styles for
boys and six styles for girls.
Epoxy-filled panels highlight the
temples of SK 1078 and SK 1079, two
key styles from the eyewear collection
for boys. The temple design features
a Skechers SKX logo in corresponding
colors, including orange, green, and red,
along with rubber temple tips. SK 1078
features a front handcrafted in multilayered acetate, while the front of SK
1079 is available in metal.
A robot-inspired laser-etched circuit
board pattern defines the metal temples
of SK 1062 and SK 1063 in contrasting
colorations. The softened rectangular
front of SK 1062 has a double-plated
metal construction, while the modified
rectangle front of SK 1062 is handcrafted in two-color acetate.
A striped pattern details the handmade acetate temples of SK 1067 and
SK 1068 in contrasting colorations, in-
cluding navy/white; black/green; black/
grey; and tortoise/orange on select
styles. SK 1067 features a modified
rectangle front, while SK 1067 boasts a
rectangular metal front with a foil SKX
logo appearing on each temple.
The new optical collection for girls, including SK 1554 and SK 1556, features
temples in handmade acetate adorned
with leopard print in pink, purple, blue,
and black. SK 1554 features a softened
cat-eye acetate front shape, available in
crystal combinations of pink and purple,
as well as solid black, while the modified oval metal front shape of SK 1556
is available in satin finishes of pink,
blue, and black.
Epoxy heart, flower, and peace sign
shapes in contrasting color combinations decorate the combination temples
of SK 1537 and SK 1538. These accents
are available in either a satin metal
front, as seen in style SK 1537, or a
candy-colored acetate front, as seen in
style SK 1538.
ES476213_OP0814_029.pgs 07.31.2014 00:08
ADV
30
InDispensable
AUGUST 2014
|
Cole Haan releases new summer line
COLE HAAN
251
COLE HAAN
1025
COLE HAAN
252
COLE HAAN
1025
COLE HAAN
1028
Hauppauge, NY— Cole Haan eyewear
recently introduced new styles for
men and women. Men’s styles feature
confident masculine shapes and rich
materials. Women’s styles blend materials in several color options with subtle
finishes.
Cole Haan 251 features laminate materials, pin dot metal accents, pops of
magenta
cyan
yellow
black
color, and Cole Haan’s new wordmark
logo. This style comes in black laminate,
seen above, and tortoise laminate.
Cole Haan 252 is an acetate frame
that features sharp angles, wide temples,
pin dot accents, and a deep rectangle
eye shape. It is available in smoke and
tortoise, seen above.
Cole Haan 1025 features an uplifting
eye shape and a metal trim on the temporal corners.
It is available in blue laminate, seen
above, black multi, and brown horn fade,
also seen above.
Cole Haan 1028 features a cat eye
shape and flat metal finishes on its
temporal edges. It is available in black,
brown, and wine, seen above.
ES476214_OP0814_030.pgs 07.31.2014 00:08
ADV
Want more? We’ve got it.
Just go mobile.
Our mobile app for iPad® brings you
expanded content for a tablet-optimized
reading experience. Enhanced
video viewing, interactive data, easy
navigation—this app is its own thing.
And you’re going to love it.
get it at optometrytimes.com/gomobile
Bringing Eye Health into Focus
iPad is a registered trademark of Apple Inc.
magenta
cyan
yellow
black
ES471178_OP0814_031_FP.pgs 07.25.2014 01:40
ADV
32
InDispensable
AUGUST 2014
|
Marc by Marc Jacobs launches Fall/
Winter 2014/15 collection
MMJ
435S
MMJ
610
MMJ
436S
MMJ
613
Marc by Marc Jacobs recently debuted its
Fall/Winter 2014/2015 eyewear collection, featuring new sunglasses and optical frames.
MMJ 435/S features a metal grid front
and matching acetate colored temples.
The sunglass style is complimented by
mirrored lenses. The color palette is inspired by the fall/winter fashion show:
matte red, matte black, mud, and smart
gold.
magenta
cyan
yellow
black
MMJ 436/S is a men’s sunglass style
in slim metal, highlighted by a metal grid
on the front and matching acetate colored temples.
The rectangular shape is offered in
dark colors such as ruthenium with grey;
shiny black with matte black; and ruthenium with black, enhanced by flash
lenses.
MMJ 613 is a unisex square-shaped
metal optical frame featuring a metal
grid on the front and acetate temples in
matching colors, such as red with opal
burgundy; matte black with shiny black;
and ruthenium with black.
MMJ 610 is a unisex acetate optical
frame, featuring a clean design, emphasized by the cut on the profiles, the
metal rivets on the front, and the keyhole bridge. The style is available in Havana/crystal; black/crystal; black/green;
and black/blue.ODT
ES476215_OP0814_032.pgs 07.31.2014 00:08
ADV
AUGUST 2014 / OptometryTimes.com
Go to:
33
products.modernmedicine.com
Products & Services
ShowcaSe
Dispensary
Search for the company name you see in each of the ads in this section for FREE INFORMATION!
magenta
cyan
yellow
black
ES474207_OP0814_033_CL.pgs 07.29.2014 20:13
ADV
AUGUST 2014 / Optometry Times
34
Products & Services
ShowcaSe
Go to:
conferences
EastWest
Eye Conference
October
9-11
2014
s
Visit www.eastwesteye.org for more information.
Wonder what these are?
COMPANY NAME
Go to products.modernmedicine.com and enter names of
companies with products and services you need.
marketers, fnd out more at: advanstar.info/searchbar
Bringing Eye Health into Focus
magenta
cyan
yellow
black
ES474206_OP0814_034_CL.pgs 07.29.2014 20:13
ADV
Go to:
35
Products & Services
ShowcaSe
proDucts
magenta
cyan
yellow
black
ES474213_OP0814_035_CL.pgs 07.29.2014 20:14
ADV
36
Marketplace
AUGUST 2014 / Optometry Times
proDucts & services
Dispensary
magenta
cyan
yellow
black
ES474214_OP0814_036_CL.pgs 07.29.2014 20:14
ADV
Marketplace
37
proDucts & services
software
QUIKEYES ONLINE
WEB-BASED OPTOMETRY EHR
• $99 per month after low cost set-up fee
• Quick Set-Up and Easy to Use
• No Server Needed
• Corporate and Private OD practices
• 14 Day Free Demo Trial
• Users Eligible for 44K incentives
Content Licensing for Every
Marketing Strategy
www.quikeyes.com
Advertisers Index
Advertiser
Alcon Laboratories Inc
Tel: 800-862-5266
Web: www.alcon.com
Marketing solutions fit for:
Outdoor | Direct Mail
Print Advertising
Tradeshow/POP Displays
Social Media | Radio & TV
Page
CVTIP, CV3, CV4
Cooper vision
Web: www.coopervision.com
CV2
Heidelberg Engineering
Tel: 800-931-2230
Fax: 760-598-3060
Web: www.heidelbergengineering.com
Live Oak Bank
Tel: 877-890-5867
Web: www.liveoakbank.com
Leverage branded content from Optometry Times to
create a more powerful and sophisticated statement
about your product, service, or company in your
next marketing campaign. Contact Wright’s Media
to fnd out more about how we can customize your
acknowledgements and recognitions to enhance your
marketing strategies.
Marco
Tel: 800-874-5274
Web: www.marco.com
7
15
24-25
Transitions Optical
Tel: 800-533-2081
Web: www.transitions.com
17
TTI Medical
Tel: 800-322-7373
Web: www.ttimedical.com
19
Vision Expo
Web: www.visionexpoeast.com
23
Vistakon
Web: www.acuvueprofessional.com
For information, call
Wright’s Media at 877.652.5295
or visit our website at
www.wrightsmedia.com
magenta
cyan
yellow
black
9
This index is provided as an additional service.
The publisher does not assume any liability for
errors or omissions.
Call Karen Gerome to place your
Products & Services ad at
800-225-4569, ext. 2670
[email protected]
ES474212_OP0814_037_CL.pgs 07.29.2014 20:14
ADV
OD Q&A
38
AUGUST 2014
|
Whitney Hauser, OD
Clinic development consultant for the Southern College of Optometry’s TearWell Advanced Dry Eye Center
Dry eye, skeet shooting, driving to Vegas
Q
How has technology improved
dry eye diagnosis and treatment?
I’ve been in practice for close to 15
years, and the technology we offer is really impressive. Years ago you’d say,
“Oh, your eyes look dry.” You do some
Schirmer strips or tear break-up time
and consider cyclosporine or artificial
tears. Now we have meibography—we
get down to the root
of what’s troubling the patient. Our patients say,
“I’ve been
told I have
dry eye, but
no one tells
me why.
No one tells me what kind of dry eye I
have.” The technology offers us an opportunity to educate.
Q
What do you say to patients when
they react to LipiFlow’s price tag?
It’s not been a big issue. Patients who
come to us have been everywhere, seen
everyone, and tried everything. They’re
to a point where price is not the biggest
stumbling block. What’s really driving
them is that their activities of daily living have been so profoundly affected by
their condition that the price tag isn’t
that shocking, honestly.
Q
What alternative treatments
does TearWell offer?
We don’t want to offer just one thing
to patients. We may prescribe medications, but we’ve also found that some of
our patients come in suffering from dry
eye with other conditions at play. We’ve
performed a lot of Sjögren’s blood testing here in office—and some of those
patients didn’t know they had a chronic
condition beyond the dryness.
Q
Do you see increasing interest in ocular
nutrition among your dry eye patients?
I do. Nutrition’s a funny thing in America—a lot of people are interested but
don’t always want to follow through.
Luckily for dry eye patients, there’s a
capsule for that. A lot of them are already taking omega 3 and using flaxseed oil. At TearWell, we really want to
tap into wellness and not just be a doctor’s office. We want to participate in
our patients’ overall well-being. So, part
of what we’re offering to them is nutritional counseling as well.
Q
What’s something your colleagues
don’t know about you?
My original career aspiration was to be
a broadcast journalist. I worked for an
ABC affiliate in Oklahoma before college. Then I realized there are a lot of
people out there wanting that same job,
and to rise to the level that I’d want to
was going to be too big of a challenge.
I still have a letter from Jane Pauley
on Today Show stationery encouraging
my career aspirations. A cousin who’s
magenta
cyan
yellow
black
an optometrist fit me in my first pair
of contact lenses when I was 12 years
old—I am very, very myopic—so it was
a life-changer. While broadcast journalism sounded exciting, that really made
a huge difference in my life. That’s how
I progressed on to optometry.
Q
What do you do for down time?
I’m into fitness and running, I run halfmarathons. Something that people
wouldn’t necessarily know about me is
that I’m also a sport shooting enthusiast. Surprising, right? I shoot pistols, rifles, and I’m a trap and skeet shooter. I
like to go to the range and shoot handguns typically but, being outside is really nice, too. I just don’t get as many
opportunities for that.
Q
If you could change anything,
what would you do differently?
I almost feel like I already made the
change. When I graduated and I went
into practice as an associate for one
year, I realized I didn’t like what I was
doing. I wanted more from my career.
So, I went back and completed a residency. My motivation was not only to
learn more, grow more, and give myself
more opportunity, but I wanted to teach
at SCO. That was in 2003. I didn’t come
here until a year ago, so there’s a 10year lapse. I went on to work in private
practice for 10 years, and that gave me a
different perspective than if I spent my
entire career in an academic institution.
Not better, not worse, just different. I’m
really glad that I’ve come back around
to working here with students.
Q
What’s the craziest thing
you’ve ever done?
I gotta tell you, I’m not really crazy.
When I was in optometry school, a
friend and I decided to drive to Las
Vegas over spring break. We left Memphis and drove 20 hours. We were there
for two days, then we drove back. We
had more fun on the road than we could
ever have in Vegas.ODT
—Vernon Trollinger
LISTEN TO FULL INTERVIEW
OPTOMETRYTIMES.COM/WHITNEYHAUSER
ES476065_OP0814_038.pgs 07.30.2014 22:56
Photo courtesy Whitney Hauser, OD
Q
How did TearWell come to be?
It started before I came to SCO. I’ve
been at the college for a little over a
year. Our chief of staff started developing the idea, then he started bringing on different faculty members. I was
recruited to work here and so was Dr.
Alan Kabat, and the pieces started coming into place with staff.
ADV
THIS IS WHY patients can
enjoy refreshing comfort with every blink—no matter
what the day may bring.
BLINK-ACTIVATED
MOISTURIZING AGENTS
DAILIES® AquaComfort Plus® contact lenses
are the only daily disposable contact lenses
with blink-activated moisture,* which helps result
in a stable tear film with refreshing comfort
throughout the day—every day.1
Visit myalcon.com
MOISTURIZING AGENTS
PVA, PEG and HPMC
help deliver comfort
from insertion to the
end of the day.
BLINK-ACTIVATED
MOISTURE
Moisture is released with
every blink, which helps
result in a stable tear film.
TEAR FILM STABILITY
Tear film stability helps
support clear vision.
PERFORMANCE DRIVEN BY SCIENCE™
*Based on DAILIES ® AquaComfort Plus ® sphere contact lenses.
Reference: 1. Wolffsohn J, Hunt O, Chowdhury A. Objective clinical performance of ‘comfort-enhanced’ daily disposable soft contact lenses.
Cont Lens Anterior Eye. 2010;33(2):88-92.
See product instructions for complete wear, care, and safety information.
© 2013 Novartis 11/13 DAF14004JAD
magenta
cyan
yellow
black
ES471188_OP0814_CV3_FP.pgs 07.25.2014 01:41
ADV
THIS IS WHY our new daily disposable toric
contact lens is designed for stable vision and refreshes
with every blink—no matter what the day may bring.
D UA
L T H I N ZO N E
S
PRECISION CURVE™ Lens Design
OPTIC ZONE
EDG
E
WITH BLINK-ACTIVATED MOISTURE
ATH
IN
NEW DAILIES® AquaComfort Plus® Toric
DU
PRECISION CURVE™
LENS DESIGN
Stable design helps
deliver ≤ 5° oscillation
with blink.1*
Visit myalcon.com
BLINK-ACTIVATED
MOISTURE
Moisture is released with
every blink, which helps
result in a stable tear flm.
UL
TR
contact lenses are designed to deliver
outstanding visual performance and comfort.
AL TH
ES
I N ZO N
SUCCESSFUL WEAR
Clear vision and
comfort throughout
the day.
NEW
Over 800 more parameters
with the same great design
as FOCUS® DAILIES® Toric
contact lenses
PERFORMANCE DRIVEN BY SCIENCE™
*Based on investigator assessment of lens rotation, at one week (n=181 lenses); using investigational lenses with -0.75D, -1.50D cylinder powers.
References: 1. In a subject-masked clinical trial (n=93); Alcon data on fle, 2010.
See product instructions for complete wear, care, and safety information.
© 2013 Novartis 11/13 DAT13016JAD
magenta
cyan
yellow
black
ES471189_OP0814_CV4_FP.pgs 07.25.2014 01:41
ADV

Comanaging phakic IOLs

Transcription

Similar documents

The author has no financial interest to disclose. How Many of your

The Architecture of the Model

Essilor - Mr. Blue

acuvue oasys® brand contact lenses 1

The Newsletter

CLEVELAND CAVALIERS: NBA CHAMPIONS

In the Lands of the Giants - Twelve

lenses - gyes.eu

ASCRS welcomes ODs

Ortho-K - Center for Unlimited Vision