Article Date: 12/1/2009

Practice pulse TIPS, TRENDS & NEWS YOU CAN USE

The Challenge: Patients Don't Understand Age-Related Eye Disease

WHY PATIENT EDUCATION IS CRITICAL

Lou Mancinelli, contributing editor

■ There is a concerning lack of public knowledge and misunderstanding regarding age-related eye diseases and conditions, according to the American Optometric Association's (AOA) American Eye-Q survey, which assesses public knowledge and understanding of issues related to eye and visual health.

So, what can you do to increase this public knowledge and understanding? Educate yourself and your patients, your colleagues say.

Because these conditions (age-related macular degeneration [AMD], cataracts, glaucoma, dry eye) typically progress slowly and are often considered a part of aging, "doctors don't always tell their patients [about them]," says optometrist Shannon Steinhäuser, who practices at Prime Eye Care in Phoenix, Ariz. Dr. Steinhäuser, a member of the Optometric Glaucoma Society (OGS), spends the bulk of her day serving the 70-plus crowd.

Only 18% of Americans know AMD is the leading cause of blindness in adults ages 65 and older, according to the survey. The survey also revealed less than a quarter of Americans understand the affects of glaucoma, but perhaps scarier, 89% of Americans wrongly believe glaucoma is preventable.

"A big thing is always tell the patient when they have the beginnings of something," says Dr. Steinhäuser. "When you go over your exam findings, in addition to telling the patient what they have, tell them what they don't have," she says. "This way, as a patient ages, when you tell them they have cataracts, they are not going to be blindsided by the news."

"Education is key to having patients understand there are eye diseases with no symptoms," says optometrist Christopher Quinn, a member of the OGS who practices optometry at Omni Eye Specialists, in N.J. "In the context of all mainstream general health messages should be the discussion of eyes as part of the package."

Inform your patients lifestyle changes can contribute to maintaining healthier eyes longer, such as eating healthy foods and avoiding cigarette smoke, says Dr. Steinh�user. A patient should be aware of their family history as well, she says.

"We have to realize that we are not dealing with 18-year-olds," says optometrist Charles Aldridge Jr., who practices in Burnsville, North Carolina and is a member of the OGS.

Dr. Aldridge recently became a diplomat for the American Board of Anti-Aging Health Practitioners (A4M), which, according to its website is dedicated to the advancement of technology to detect, prevent, and treat age-related disease and to promote research into methods to retard and optimize the human aging process. The A4M is also dedicated to educating physicians, scientists, and members of the public on biomedical sciences, breaking technologies, and anti-aging issues.

"The reason the public is unaware (of the seriousness of age-related eye diseases) is because the physician is unaware," says Dr. Aldridge. "What we're doing now is broke. We wait until the patient is broke to fix him."

Dr. Aldridge says it's up to you after you receive your degree to continue your education. He says there is a need for a change in optometry curriculum.

"It's not that we're doing bad, but there is this deficit. We know this disease. We are trained to treat this disease, but we have no understanding of how to be more preventative," he says. "It's a whole lot easier to treat a disease early, but difficult to diagnose (it). It is easy to diagnose a disease late but harder to treat it."

This is reflective of the setup of how physicians presently deal with treating age-related eye diseases, according to Dr. Aldridge.

"—But if you can take a patient with minimal macular changes and tell them early, 'Why don't we jump in with both feet and take some supplements and try to slow it down or turn it around?' It could be more beneficial to the patient," Dr. Aldridge says.

Optical industry organizations review ways in which they can team up

OLA AND VISION COUNCIL TO CONSIDER COLLABORATION

Lou Mancinelli, contributing editor

■ The Optical Laboratories Association (OLA) and The Vision Council have announced they're currently in talks regarding ways in which the two organizations can combine their efforts and activities to benefit their respective members.

"Changes in the industry have altered the business interests of our memberships," says Jon Jacobs of Superior Optical Lab. "The definitions of 'supplier' and 'laboratory' are changing. As the industry moves forward, we need to re-align our organizations to mirror the structure and meet the needs of the industry and better serve all of our customers."'

OLA and The Vision Council have shared a positive working relationship for many years and have common goals. Both organizations share numerous members and their members have a similar customer base. With consolidation in the industry and all of the technology advancements, in addition to the fact that The Vision Council's Lens Processing Technology Division and the OLA member labs share many synergies, it just seemed natural for OLA and The Vision Council to talk together to further explore collaboration. As we go to press, OLA and The Vision Council's representatives are currently reviewing mutual synergies at an open forum during the General Session at the OLA 2009 Annual Meeting in Washington, D.C. On the agenda: a discussion of overlapping memberships and separate organization activities, such as research, training and networking events, the priorities of each organization and a proposal to combine the OLA Annual Meeting in Las Vegas with International Vision Expo.

"Combining the shows would bring additional clout and credibility to both the OLA and International Vision Expo," says R. Michael Daley, chairman of The Vision Council. OLA would have contact with eyecare professionals and the International Vision Expo would increase participation of exhibitors and attendees, says Mr. Daley.

Think Holiday Safety First

WATCH THOSE GIFTS

■ Each year, hospital emergency rooms treat hundreds of thousands of toy-related injuries. In response, Prevent Blindness America offers the following suggestions, which can make the holidays safer:

► Recommend for gifts you feel are safe for your children.
► Inspect toys for sharp edges and small parts. If a toy part can fit inside a toilet paper roll, it should not be given to a child under the age of three.
► Avoid toys that shoot objects.
► When giving sports equipment, include protective gear.
► Check www.cpsc.gov for product recalls.
► Inspect toys for sturdiness. Toys should withstand impact.

EYE site
Insights for Patient Care

Bausch & Lomb has launched the Center for Patient Insights (www.centerforpatientinsights.com). The site offers news and insights designed to help eyecare professionals better understand opportunities with patients and industry. The site includes articles, independent research and videos. Information is presented in "PatientPoints," short articles that include information on how to improve practices. Users can browse articles over a number of different categories, including patient behavior, patient outcomes and vision conditions.

How Will In-Office Edging Impact Your Bottom Line?

OPTIMUS OFFER PROFITABILITY CALCULATOR

■ Only 23% of independent optometrists edge spectacle lenses in their offices, even though 57% believe that using an onsite lab would be more profitable for their practices, according to a recent survey from Vision Practice Management, a practice management and marketing firm. To help quantify the profitability of an in-office operation, Optimus High Definition Optics offers eyecare practitioners (ECPs) an "in-office edging profit calculator."

ECPs can download the calculator from the company's website, www.Optimuslens.com. After ECPs answer seven questions, such as "what is (your office's) average number of eyeglass sales per day," the calculator estimates the profits per month. The calculator shows two numbers — one estimating the savings over the cost of using a wholesale lab, and the other showing profitability using strategies proposed by the company. The calculator takes into account an investment in edging equipment and stocking Optimus "UltraClear&Lite" oleophobic AR lenses. The company has scheduled the release of these lenses to coincide with Vision Expo East (March 18-21, 2010) in New York City.

The calculator was developed by Sam Singleton, O.D., who found his practice could realize an additional $200,000 in profits each year through in-office edging.

CIBA Vision says Monthly and Daily CLs Show Growth

REPORT FROM THE ACADEMY

■ While the contact lens market was mixed in 2009, the first half of the year showed growth in the monthly contact lens category (up 13% over the first half of 2008) and the daily disposable category (up 7.8%), said Francesco Balestrieri, CIBA Vision president, Americas Region. Mr. Balestrieri made the announcement during a CIBA Vision press conference at the annual meeting of the American Academy of Optometry.

At the conference, Ciba Vision announced that its Focus Dailies Toric contact lenses are now available in 20°, 70°, 110°� and 160° axes. According to the company, the new parameters will increase the range of patient coverage from 55%, compared to previously available Focus Dailies parameters, to 78%. The lenses now feature an inversion mark to aid patients in inserting the lenses.

In other news, CIBA Vision expanded its Academy for Eyecare Excellence with new online learning modules and an iPhone "app." Ciba Vision developed the academy to provide eyecare professionals with clinical, business and management education. For more information about the academy or the app, visit www.cibavisionacademy.com.

HEALTH Notes

• Contact lenses prescribed for two-week or monthly replacement may lead to over wear, according to a Vistakon study presented at the American Academy of Optometry meeting. Specifically, 85% of two-week replacement wearers reported replacing their lenses within four weeks, and 55% of monthly replacement wearers said they replaced their lenses at five weeks. The study was comprised of a random sample of 645 frequent replacement hydrogel or silicone hydrogel wearers who answered questions via an online sponsor-masked survey.

• When using a driving simulator, hemianopia patients without visual neglect or cognitive decline take about twice as long as normal-sighted individuals to detect pedestrians via their blind side, according to a study published in November's Investigative Opthalmology & Visual Science. This finding dispels previous on-the-road studies that reveal these patients are safe to drive. A total of 24 subjects comprised this study: 12 hemianopia patients and 12 normal-sighted subjects matched via age, sex and years of driving experience.

• A lack of diffusible VEGF growth factor (i.e. one that can reach other cells at a distance when secreted) can cause degeneration of the choriocapillaris a retinal defect similar to nonexudative, or "dry" age-related macular degeneration (AMD), according to a study in the November 3, 2009 print addition of Proceedings of the National Academy of Sciences. This means that the continuous blockage of VEGF may contribute to the development or worsening of the "dry" form of AMD.

• Visual symptoms (i.e. "trouble seeing" and "blurred vision") have a stronger correlation with poor mental health than the presence of ocular diseases, such as AMD, cataracts and glaucoma, according to a study in November's American Journal of Ophthalmology. The study consisted of 5,021 patients receiving care via a physician group practice association and who filled out the short form-36 version one healthrelated quality of life survey.

• Older adults (mean age 69) who take cholesterol-lowering statins and have low macular pigment optical density may decrease their "dry" AMD risk by eating two to four egg yolks qd for five weeks without raising their LDL cholesterol level, according to a study in November's American Journal of Clinical Nutrition.

• A high level of hemoglobin may predict the occurrence of proliferative diabetic retinopathy (PDR) in type 1 diabetes mellitus patients, though the link varies by sex, according to a study in November's Archives of Ophthalmology. Specifically, it's linear and positive in men and quadratic in women. The study consisted of 426 subjects (213 men, 213 women) from the Pittsburgh Epidemiology of Diabetes Complications Study, which was an 18-year prospective cohort study of childhood-onset type 1 diabetes. None of the subjects in the study had PDR at baseline.

• The Navilas Laser System, from OD-OS, recently received FDA 510k clearance. The device incorporates retinal imaging with laser photocoagulation. Specifically, it produces a live image of the fundus in true color, IR and redfree image as well as fluorescein angiography with a 50° field of view via monitor, among other features.

• People who tolerate blurry vision may lack self confidence and be more disorganized than those who don't tolerate it, according to an American Academy of Optometry presentation supported by Johnson & Johnson Vision Care Inc. This means personality may affect refractive error correction, among other choices, when you present a patient with an image that appears degraded.

O.D. NOTEBOOK
◻ Can holiday meals benefit your eyesight? Yes, says AMD Alliance International, if the foods are rich in such nutrients as vitamins A, C and E, selenium, Omega 3 fatty acids, zinc, copper, the carotenoids (lycopene, zeaxanthin and lutein). For additional information, visit www.amdalliance.org.

Reichert has named Rick Subel vice president and chief financial officer. In addition to his experience in Fortune 500 companies, Mr. Subel has been chief financial officer for several privately-held companies in business-to-business service industries, including facility maintenance, real estate development, property management and security.

The Center for Nonprofit Management in Dallas recognized The Essilor Vision Foundation with the Excellence in Mission Achievements Award for organizations with operating budgets of under $1 million. The Foundation is dedicated to eliminating poor vision and its lifelong consequences.

Transitions Optical announced that Leonard Bertoli, O.D., Melrose, Mass., was the grand prizewinner in the eyecare professional category of the "Live Your Vision" photo contest. Dr. Bertoli won $10,000 for his photo that showed a sunset through a pair of eyeglasses. As part of the program, Dr. Bertoli designated the Helen Keller foundation to receive an additional $10,000 from Transitions.

◻ In other news, Transitions announced that it will sponsor the American-based professional cycling team, Team Garmin-Slipstream. The team will become Team Garmin-Transitions and provide Transitions with an opportunity to create awareness of the company's adaptive eyewear.

Marco has announced that My Vision Express, which develops software for eyecare management and point-of-purchase activities, has become a Marco EMR certified partner. The certification means that all Marco products will integrate with My Vision Express software systems and continue to do so as technology from both companies evolves.

ABB Concise has received the Contact Lens Manufacturer Association's (CLMA) Seal of Excellence, recognizing the quality and consistency of ABB CONCISE gas permeable lenses. This is the 18th consecutive year the company has won the award.

The Healthy Eyes for Life Foundation named R. Michael Daley president of the organization. Mr. Daley will work with the marketing committee to develop a vision health care message and strategies to create public awareness for the need for vision care.

The Commission on Paraoptometric Certification (CPC) has moved its certification renewal date from July to November. CPC credential holders will receive a series of notices, which provide information and guidance, over the next several months.

Eye Care Associates, a leading multi-site practice offering comprehensive eye health care in North Carolina, announced that April Kwong, O.D., has joined the practice and will serve patients in their Raleigh and Cary locations.

TearScience has named Mike Judy vice president of sales. Mr. Judy will lead the sales team and be responsible for commercialization of the company's diagnostic and treatment system for evaporative dry eye.

Infinite Mind, a software company, has launched the online vision therapy program eyeQ, which is to be used in conjunction with existing in-office therapy methods. For information visit www.eyeqadvantage.com.

The American Optometric Association is accepting nominations for the 2010 National Optometry Hall of Fame, which recognizes those who have made a significant and long-lasting impact on the profession. The 2010 selection committee will be represented by the Association of Schools and Colleges of Optometry, the College of Optometrists in Vision Development, the National Optometric Association, the American Optometric Association and the American Academy of Optometry. Nomination deadline is December 31, 2009. E-mail letters of nomination and supporting documentation to Julie Mahoney at JMMahoney@aoa.org.



Optometric Management, Issue: December 2009