Article Date: 4/1/2009

Health Centers Lack Eyecare Services
Practice pulse TIPS, TRENDS & NEWS YOU CAN USE

Health Centers Lack Eyecare Services

RURAL AND POOR POPULATIONS LESS LIKELY TO RECEIVE VISION CARE

■ A total of 70% of federally funded community health centers don't offer on-site eyecare services, says a George Washington University School of Public Health and Health Services report. Federally funded community health centers are often the only option for rural and low-income populations to receive vision care.

The report, "Assessing The Need For On-Site Eye Care Professionals in Community Health Centers," also revealed only 11% of these health centers report having full-time eyecare professionals (those with paid eyecare professionals utilize optometrists to staff their centers); just 4% say they plan to expand or build capacity for on-site eye care in the next 12 months; 73% say they don't plan to purchase instruments or equipment to provide comprehensive eye care through the next year; and only 10% have on-site optical space.

The major barriers to offering comprehensive eyecare services are an inability to afford the necessary space and equipment; difficulties with Medicaid, Medicare and private insurance reimbursement; and discrepancies in Medicaid coverage and benefits.

The report was supported by the American Optometric Association (AOA), the National Association of Community Health Centers (NACHC), the New England Eye Institute (NEEI) and the Massachusetts League of Community Health Centers (MLCHC) — all of which formed a partnership in 2006 to develop strategies to increase access to high-quality, comprehensive and affordable vision care for all medically underserved populations in community health centers.

New Optometry Schools Prepare For Enrollment

ROUGHLY 50 STUDENTS EXPECTED AT NEW SCHOOLS

■ Midwestern University, in Glendale, Ariz. and the University of the Incarnate Word (UIW), in San Antonio, are gearing up for their first Optometry School classes.

The Arizona College of Optometry at Midwestern University will welcome 50 students in its inaugural class in August. Hector Santiago, O.D., Ph.D., is the dean of the new school. The program includes basic health sciences, optics, visual science, ocular dysfunction and disease, and on-campus and off-campus externship rotations. Construction is currently taking place on an Eye Institute, which the University expects to open spring 2010.

Meanwhile, the Accreditation Council on Optometric Education of the AOA granted the UIW School of Optometry pre-accreditation approval to start its doctoral professional program. This action allows the new institution to recruit, select and admit future O.D.s. H.S. Ghazi-Birry, O.D., M.D., the school's dean, says he expects between 50 to 60 students to comprise the inaugural class, which will present fall 2009.

This past January, UIW launched a Bachelor of Science program degree in Vision Science. Completion of the program satisfies the requirements for entrance into the School of Optometry and other health-related professional programs, such as medicine, offered through other colleges.



SynergEyes has launched www.sharingonevision.com for keratoconus patients. The site offers education about the condition and the SynergEyes KC hybrid contact lens; testimonials from keratoconus patients who've achieved success in the lens; and a doctor locator search tool, so the patient can find a practitioner in his area who's certified to fit the SynergEyes KC lens. In addition, the site offers educational videos on proper insertion, removal and cleaning of hybrid contact lenses.

Bausch & Lomb Makes Deals With Santen and Pfizer

IOL LICENSING AGREEMENT AND PRODUCT CO-PROMOTION IN THE WORKS

■ Bausch & Lomb (B&L) has established business relationships with Santen and Pfizer Inc.

The deal with Pfizer: A five-year co-promotion agreement, whereby both the B&L and Pfizer sales forces will promote five drugs: latanoprost ophthalmic solution (Xalatan, Pfizer); loteprednol etabonate ophthalmic suspension 0.2% (Alrex, B&L); loteprednol etabonate ophthalmic suspension 0.5% (Lotemax, B&L); loteprednol etabonate 0.5% and tobramycin 0.3% ophthalmic suspension (Zylet, B&L); and besifloxacin ophthalmic suspension 0.6%. B&L expects FDA approval on besifloxacin ophthalmic suspension 0.6% this year.

Bausch & Lomb signed a licensing agreement with Santen that allows B&L to develop, manufacture and market Santen's foldable, hydrophobic acrylic intraocular lens (IOL) material in all geographic regions, but Japan.

"Bausch & Lomb is enthusiastic about the potential that these polymers hold for developing next-generation IOLs to benefit patients and surgeons alike…" says John Sheets, Jr. Ph.D. and B&L's corporate vice president and chief technology officer.

Santen has marketed the IOL material in Japan since July 2008 as the Eternity IOL. The Food and Drug Administration (FDA) approved it in early February. The company says that several ophthalmologists have commented that the IOL aids in managing cataract patients who have retinal complications, such as diabetes mellitus.

B&L's IOL portfolio is currently comprised of the Akreos and SofPort AOV aspheric IOLs and the presbyopia-correcting Crystalens HD.

New Service Broadcasts Testimonials on The Web

TAKE WORD-OF-MOUTH REFERRALS TO A LARGER AUDIENCE

■ Most optometrists agree that the best form of marketing is word-of-mouth testimonials.

"There's nothing more convincing than patients' compliments," notes Kevin Gee, O.D., of Gee Eye Care, in Missouri City, Texas.

If there is one challenge with this form of marketing, it's that it reaches a very limited audience. But what if testimonials could reach the same audience tapped by YouTube.com and other Web-based broadcasting sites?

Smile Reminder, a patient messaging software system, has added a feature that does just that. Touted as a "patient acquisition tool," the vSling feature captures, manages and distributes video testimonials over the Internet.

With vSling, a practice can use a webcam, which is attached to a computer in the practice, to record patient testimonials. You, the eyecare practitioner, can then review, edit and approve the testimonials for distribution on Web sites. vSling posts testimonials on a search enginefriendly profile page. And, obviously, these testimonials are available for posting on your practice's Web site as well.

Dr. Gee says he approaches patients to use vSling either at the end of an appointment "when they have compliments," or after they've completed a post-appointment survey (which is also conducted through Smile Reminder).

"It helps if the practice is already using the Internet as a media outlet," says Dr. Gee. "We were a heavily Web-based practice (i.e. online appointments, patient information forms, etc.), even before the integration of Smile Reminder, and that made the transition easier. This [vSling], however, isn't burdensome for those who aren't Internet savvy."

The Smile Reminder system allows practices to directly communicate with patients by automatically sending personalized, real-time text messages to patients on their cell phones, e-mail addresses and pagers. For more information, visit www.smilereminder.com.

Understanding Efficiency and Effectiveness
Bob Levoy, O.D., Roslyn, N.Y.



■ When trying to maximize the operation of your practice during challenging times, two very different approaches exist. One is to focus on efficiency; the other is to focus on effectiveness. Both are important.
An efficient practice focuses on doing things in the right way to maximize productivity and profitability. An effective practice, on the other hand, focuses on doing the right things that maximize patient satisfaction and referrals. The first is an "inward" view. The latter is an "outward" view.
The four permutations:
1. Inefficient and ineffective. Nothing's going right in such a practice and the result is often turnover of both patients and employees.
2. Effective but inefficient. The practice is doing the right things, but not very well — such as dispensing that fails to offer patients premium lens options (i.e. AR coating, UV protection, high-index materials, PALs, polished edges and other add-ons that would greatly improve a patient's visual efficiency, comfort, safety or appearance).
3. Ineffective but efficient. The practice is doing the wrong things well, such as the costly and time-consuming use of letters and postcards to get patients to return for comprehensive eye exams.
4. Effective and efficient. In the high-performance optometric practice, the practice is doing the right things — and doing them well.
Optometrists focused on efficiency often look for ways to maximize profitability by working faster, delegating as much as possible, skimping on payroll expense and cutting corners to save time or money. And up to a point, these are sound management strategies.
That point of diminishing returns occurs when such cost-containment measures impinge on your effectiveness and patient satisfaction. For example: Does the emphasis on delegation and working faster require you to take less time with patients to properly explain findings, make recommendations and answer questions? Does skimping on payroll expenses result in being understaffed at times or worse, having a staff that's not as knowledgeable and experienced as the job requires? Does belt-tightening require a cut-back on continuing education or needed equipment updates?
Effectiveness, says management expert Peter Drucker, is the foundation of success. Efficiency is a minimum for survival after success has been achieved.

Just How Bad is Contact Lens Compliance?

CIBA INTRODUCES SURVEY RESULTS AND A NEW LENS

■ A Ciba Vision study of 1,654 contact lens wearers provides a glimpse into the severity of contact lens incompliance:

► A total of 59% of two-week silicone hydrogel (SH) lens wearers wore their lenses for longer than the manufacturer recommended replacement frequency (MRRF).

► A total of 29% of one-month SH wearers wore their lenses past the MRRF.

► A total of 15% daily disposable wearers wore their lenses past the MRRF.

Interestingly, when patients were asked to identify their eyecare practitioners recommended replacement schedule for their respective lenses, 2% of one-month replacement SH wearers, 10% of daily disposable wearers and 22% of two-week replacement SH wearers reported longer periods than the MRRF.

Patient reasons for overwearing lenses included "forgetting which day to replace lenses" (51%) and "to save money" (26%). In investigating hygiene-related behaviors, 18% of patients said it was only "somewhat important" to "not important" to clean lenses every day. Sixteen percent said they replaced their lens cases every year, while 14% said they never replaced their lens cases.

The distribution of lens types was 45% two-week replacement, 39% one-month replacement SH, and 16% daily disposable.

Air Optix Night & Day Aqua

In other contact lens news, CIBA Vision has launched Air Optix Night & Day Aqua, replacing the original CIBA Night & Day contact lens. The new lens, which is Food and Drug Administration (FDA)-approved for up to 30 nights of continuous wear, features the AQUA Moisture system. This system provides moisture for comfort on-contact, throughout the day and when worn overnight, the company says.

The lens offers a Dk/t of 175 @ -3.00D, base curves of 8.6mm and 8.4mm, a diameter of 13.8mm and power ranges of +6.00D to -8.00D in 0.25D steps and -8.50D to -10.00D in 0.50 steps.

CooperVision Online Tools Streamline Practices

WEB TECHNOLOGY ELIMINATES CONTACT LENS DISPENSING CHALLENGES

■ CooperVision.com, like other contact lens company Web sites, offers you and your staff tools that, when used in combination, save time and improve customer service. The CooperVision tools, however, are MyCooperVision, CooperDirect (online ordering and direct patient shipping via MyCooperVision) and an Online Learning Center. (Visit www.coopervision.com to access these tools.)

Through MyCooperVision, contact lens technician Cynthia Cosby, of First Eye Care in Plano, Texas, says she's not only able to quickly look up parameters, whether the lens is in stock and if its on backorder how long it'll take to arrive, but also place an order, leave it, and go back to it. Further, she says that because CooperDirect automatically saves orders as she goes along, she's able to place all orders at once, saving her and her fellow staff members a great deal of time.

So, what do they use this extra time for, exactly?

"We spend more time interacting with the patients, and we use the Online Learning Center, which provides education on lens fitting and free continuing education courses," she explains.

Business manager Diane Mamola, who manages a three-location practice for Primary Eye Care Centers in Crystal Lake, and Rockford Ill., adds that she appreciates the paperless attributes of MyCooperVision.

"[MyCooperVision] enables me to view invoices online… "As a result, I no longer have to juggle invoice and patient files to make sure the billing is correct."

Ms. Mamola says she believes MyCooperVision has also given Primary Eyecare Centers a competitive edge over contact lens retailers.

"The CooperDirect component allows us to directly ship lenses to patients… When we tell patients about this component, it makes them less likely to walk with their prescription…" she says. "Patients appreciate the convenience and fast delivery, and we appreciate not having to do phone orders, tray up the lenses, call the patient to let him or her know their lenses have arrived and then wait for the patient to pick them up."

Contact Lens Wear May Improve Children's Self-Perceptions

LENS-WEARING KIDS EXPERIENCE INCREASE IN CONFIDENCE

■ Contact lens wear in children might augment their physical appearance, athletic competence and social acceptance self-perceptions, says a study in March's Optometry and Vision Science.

"… There is considerable developmental research to support the importance of self-perceptions in areas such as peer relations, academic performance and the overall school experience," says Eugene Wong, professor of psychology at California State University, San Bernadino, who's written on the topic of children self-perceptions. "Thus, given that the results of this study suggest benefits for contact wearers, eyecare practitioners likely would benefit from considering these findings when working with children; always keep in mind, however, the individual differences from child to child."

The randomized, single-masked Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study revealed that self-perceptions of physical appearance, athletic competence and social acceptance in contact lens-wearing myopic children age eight to 11 was greater than in same-age myopic children who wore spectacles.

Also, the ACHIEVE study showed that contact lens wearers who initially disliked spectacle wear became more confident in their schoolwork than those satisfied with their glasses.

The three-year study, which took place at five U.S. clinical centers, was comprised of 484 children. A total of 237 children wore spectacles, and 247 wore either daily disposable or two-week disposable Vistakon contact lenses.

The purpose of the study was to determine whether children unhappy with spectacle wear would benefit more from contact lens wear than children who didn't mind wearing spectacles.

Researchers measured the results of the study using one global measure of self-worth and the Self-Perception Profile for Children Global Self-Worth scale. This scale consists of five domain-specific sub-scales. They are: scholastic competence, social acceptance, athletic competence, physical appearance and behavioral conduct.

Essilor Presents Annual Lab Awards

PROGRAM RECOGNIZES SALES AND MARKETING PERFORMANCE

■ Essilor of America recently announced the winners of its enhanced Independent Distribution Division (IDD) Advantage Plan Annual Laboratory Awards. The awards recognize independent lens distributors that have achieved top sales and marketing performance in specific Essilor product categories. The company recognized outstanding achievements, by company, in the following categories:

  • Varilux Award of Excellence: Central Optical, Youngstown, Ohio
  • Crizal Award of Excellence: Balester Optical Co., Wilkes Barre, Pa.
  • Premium Materials Award of Excellence: Balester Optical Co., Wilkes Barre, Pa.
  • Essilor Transitions Award of Excellence: Walman Optical, Minneapolis, Minn.
  • Essilor IDD Lab of the Year: Balester Optical Co., Wilkes Barre, Pa.
  • Essilor IDD Managed Care Lab of the Year: Davis Vision, Plainview, NY.

Essilor presented the awards at an annual ceremony held at the company's National Sales Meeting. Essilor provided each winning lab with a comprehensive rewards package.

The company determines the award winners based on a combination of key sales-related factors, including unit and percentage unit growth; marketing programs and events executed during the year; Advantage Plan programs and promotion results; and partnership with the Essilor Brand sales team.

Essilor's IDD Advantage Plan is a distributor program that provides laboratories services and support in the areas of marketing, education, sales, technical services and technology transfer and funding.

O.D. NOTEBOOK
Wal-Mart announced it will reduce prices for contact lenses and youth eyewear. Through its program with 1-800 CONTACTS, Wal-Mart will cut prices on annual supplies of contact lenses by 12% to 50%. Also, the retailer will offer frames and lens packages starting at $39 for those ages 18 and younger, including a one-year free replacement guarantee. The cost cutting is part of the retailer's initiative to make healthcare more accessible to customers, says John Agwunobi, M.D., vice president and president, Health and Wellness, Wal-Mart.

Bausch & Lomb has appointed Brian J. Harris as chief financial officer and corporate vice president. In addition, the company has launched a U.S. consumer initiative to increase presbyopia awareness and the availability of its multifocal contact lens designs. The consumer initiative is comprised of TV spots highlighting the lenses; advertising on an array of Web sites, such as HGTV; and www.goodbyereaders.com, a new Bausch & Lomb Web site, which features an online promotion that offers consumers the chance to win a personal lifestyle makeover and a year's supply of the company's multifocal lenses.

Transitions Optical named Scott Henning director of its eyecare professional (ECP) and professional development team. Mr. Henning will be in charge of developing and driving initiatives to support eyecare professionals through education and marketing programs. Other duties: to establish new communications strategies, as well as create and implement an ECP loyalty program.

Prevent Blindness America is offering tips on how to keep eyes safe when applying and make-up. You can find more information at www.preventblindness.org/resources/factsheets/FS15_cosmeticsPDF.

VSP Vision Care, Eyefinity/ Officemate and Transitions Optical will produce a series of complimentary webinars, highlighting the unique eye health and communication considerations for treating Hispanic patients. Visit the eLearn tab at www.eyefinity.com for more information.

Lesley L. Walls, O.D., M.D., D.OS., Tulsa, Okla., earned the Heart of America Contact Lens Society (HOACLS) 2009 Optometrist of the Year award for his "untiring service" to the profession. HOACLS also presented Jack Hartstein, O.D., M.D., with its Vision Service Award.

Carl Zeiss Vision has formed a partnership with Serengeti, a subsidiary of Bushnell Outdoor Products, to promote a national prescription sunglass program throughout the Carl Zeiss laboratory network.

VISION USA, a program of Optometry's Charity — the American Optometric Foundation, received a $100,000 grant from The Alcon Foundation to help meet the needs of a growing number of people who are unable to afford vision care.

Abb-Concise received the Contact Lens Manufacturers Association's (CLMA) Seal of Excellence Award. The award recognizes excellence in quality and expertise in the manufacturing of GP lenses.

HEALTH Notes
A laser burn to one retina may cause both eyes to lose immune privilege, says a study in February's American Journal of Pathology.

Environmental factors through a lifetime, such as poor nutrition, smoking and extreme exposure to sunlight, appear to influence the function of the rod cells, while genes affect the cone cells, says a classical twin study in February's Ophthalmology.

Paragon HDS HI 1.54 GP lens material (Paragon Vision Sciences) has received Food & Drug Administration (FDA) approval. The new material could deliver up to 1.00D of incremental add power; prove beneficial in increasing optical zone diameters; decrease the overall lens mass linked with high myopic prescriptions; and improve overall comfort and oxygen transmissibility, Paragon Vision Sciences says.

Transitions Optical, Inc. is increasing their focus in the sunwear business. Their SOLFX lenses — available in prescription and non-prescription — have an initial tint and self-adjust to the sun, automatically changing darkness level to provide vision in both sun and shade.

• Bimatoprost ophthalmic solution 0.03% (Latisse, Allergan) received FDA approval as a treatment for hypotrichosis of the eyelashes. Patients apply the once-daily prescription drug directly to the base of the upper eyelashes via a single-use-per-eye disposable applicator for long, full and dark lashes in eight to 16 weeks, according to a double-blind, placebo-controlled study of 278 patients. The drug is currently available.

"Eye Health & Allergies," a brochure that will help you educate your patients on allergy signs, symptoms and strategies for prevention and treatment, is available at no charge from the Asthma & Allergy Foundation of America. You can order the brochure, which is supported by 1-DAY ACUVUE MOIST Brand Contact Lenses, in bulk quantities (50 copies) by e-mailing eyeallergybrochure@rprny.com.

AMD Round-up:
ArcticDX Inc. now offers a saliva test called Macula Risk, which determines one's genetic risk for age-related macular degeneration (AMD). Analytical studies have revealed that the test is 100% accurate, according to a company press release.

• Daily supplementation with folic acid, vitamin B6 and vitamin B12 may reduce the risk of AMD in women age 40 and older at high risk of cardiovascular disease, says a study in The Feb 23 issue of Archives of Internal Medicine.

• Report 25 of the age-related eye disease (AREDS) study revealed that cataract surgery has no clear effect on the risk of progression to wet AMD, despite past large studies that revealed the contrary. Report 25 appears in February's Ophthalmology.

• The more you run, the less likely you are to develop cataracts and AMD regardless of your sex, say two separate studies in January's Investigative Ophthalmology & Visual Science.

AMD Alliance International (AMDAI) has developed a Macular Disease Patient Charter written by AMD patients to abate the severe depression and anxiety often associated with AMD. Visit www.amdalliance.org/documents/Patient_Charter.pdf.

• The changes noted in neural response in AMD patients are likely driven by the lack of input to a population of neurons and not by a change in the way in which the brain processes visual information, says a Massachusetts Institute of Technology (MIT) study.


Optometric Management, Issue: April 2009