Article Date: 11/1/2010

Practice pulse TIPS, TRENDS & NEWS YOU CAN USE

New Research Presented on Genetics, Diabetes, Cataract and More

AMERICAN ACADEMY OF OPHTHALMOLOGY ROUNDUP

■ This year's American Academy of Ophthalmology - Middle East-Africa Council of Ophthalmology Joint Meeting, held recently in Chicago, presented new research in a number of areas including genetics, diabetic retinopathy, cataract, retinitis pigmentosa and imaging. A sampling of the highlights follows.

Genetics

The field of pharmacogenetics — basing treatment on a patient's genetic profile — may tell retina specialists whether a patient who has "wet" age-related macular degeneration will respond to anti-vascular endothelial growth factor (anti-VEGF) drugs, reveals the Unifying Genetic Epidemiology of Macular Degeneration Study. Specifically, the study's researchers concluded that more responders than poor responders carried at least one risk allele (DNA sequence) for ARMS2, CFH, or for both genes," said Jaclyn L. Kovach, M.D., one of the study's investigators.

"Repeating this study in a larger population could bring us closer to a gene-guided therapy," she said.

In a presentation on glaucoma, Janey L. Wiggs, M.D., Ph.D., said genetic testing can indicate the presence of, or risk for, several types of glaucoma, so patients could be treated in time to save their sight.

"We can identify markers for congenital glaucoma, early onset (before age 35) primary open angle glaucoma and normal tension glaucoma, as well as several other conditions that increase glaucoma risk," said Dr. Wiggs.

Diabetic retinopathy

A study on diabetic retinopathy showed that 96 of 97 patients who developed proliferative diabetic retinopathy (PDR) developed the eye condition within the first two decades of being diagnosed with type 1 diabetes. If PDR did not develop during that period, however, retinopathy progressed slowly or stopped altogether. These findings confirmed an earlier study's finding that neither glycemic control nor duration of diabetes correlated with the severity or presence of diabetic retinopathy (DR) in patients who successfully survived 50 or more years with type 1 diabetes.

Retinitis pigmentosa

A presentation on the effect of 9-cis beta-carotene on retinitis pigmentosa patients (RP) showed that the vitamin may improve vision in some (RP) patients, said Ygal Rotensteich, M.D. Specifically, one-third of 29 subjects with RP showed improved visual function while taking the prescribed oral dose for 90 days. Meanwhile, the other two-thirds of subjects showed no effect. Dr. Rotensteich says he thinks the vitamin affected only some of the patients because its positive effect is associated with the retinoid cycle effect, which is involved in some but not all forms of RP. As a result, he recommended repeating the study with patients who have the genetic forms of RP that would most likely respond to 9-cis beta-carotene.

Cataract

A study revealed that cataract surgery reduced the frequency of car crashes by 12.6% in Australia after accounting for other potential factors, reported Jonathan Ng, M.D. Dr. Ng studied the accident rates for 27,827 Western Australian residents (age 60 and older) both one year prior- and post-cataract surgery on their first eye.

Imaging

Handheld devices, such as the iPhone, can be used to evaluate Internet-transmitted eye images.

"We found high consistency — more than 85% agreement — between evaluations based on the standard computer monitor and on the iPhone for all image sections tested," said Dr. Michael J. Pokabla. "There were no significant differences between evaluations and recommendations using the two systems, and the doctors rated the iPhone images as excellent."

Additional research from the Academy meeting has been included in the section "Drugs in the Pipeline" on this article.

Essilor to Obtain 50% of Shamir

AN AGREEMENT AND NEW LENSES ANNOUNCED

■ Essilor International signed an agreement to obtain 50% of Shamir Optical via a series of transactions. Under the terms of the agreements, Shamir Optical's existing management team will remain intact.

The transaction, which is subject to regulatory approvals, rulings and the approval of Shamir Optical's shareholders, is expected to close in mid 2011.

In other news, Essilor launched Varilux DRx, a back-side digital lens. Varilux lenses use the "Live Optics" design process, in which a real wearer is used at each lens design stage. The lenses are made with Essilor semi-finished single vision lenses using the company's proprietary Digital Surfacing Process Control. The company also announced:

► Eyecode lenses, which offer patients precise vision, regardless of where they look through the lens.
► Varilux Physio Enhanced Fit and Essilor Fit Single Vision lenses, which offer personalized measurements for pupillary distance, vertex distance, pantoscopic tilt, wrap angle and fitting height.
► Crizal Sapphire lenses with Scotchgard Protector and No-Glare anti-reflective technology.
► The Visioffice system, a device that provides eyecare professionals with a method of measuring patient fitting parameters.

O. D. NOTEBOOK
Alcon's board elected Daniel Vasella, M.D., as its chairman of the board, replacing Cary Rayment. Dr. Vasella is also chairman of the board of Novartis, which became Alcon's majority owner in August.
CIBA VISION Academy for Eyecare Excellence has made the 2010 Key Metrics of Optometric Practice publication available to eyecare practitioners at www.mbace.com. The comprehensive look at independent optometric practice performance benchmarks presents key benchmarks including gross revenue per complete exam, exam fees, frames turnover, gross revenue per O.D. hour, expense ratios ranges by category, staff hourly and annual salaries by position.
□ According to a letter published in the October 14, 2010 issue of the New England Journal of Medicine, alkyl nitrites, or "poppers" when used recreationally to induce intoxication, can cause vision problems and damage to the retina.
Wells Fargo and Matsco announced Wells Fargo Practice Finance, a resource for finance and support of healthcare professionals that aspire to start, grow or update a private practice. Visit http://practicefinance.wellsfargo.com.
VSP members who purchase an annual supply of Bausch + Lomb contact lenses from one of VSP's network providers will receive an additional rebate amount on top of the current national rebate program offered by Bausch + Lomb, both companies announced. See www.specialoffers.vsp.com/bausch for more information.
Bausch + Lomb announced that those patients who have the Crystalens intraocular lens implanted between November 1, 2010 and January 31, 2011 will be eligible for up to a $250 per-eye rebate from the manufacturer. For information, visit www.crystalens.com.
Integrity Digital Solutions, the electronic medical records company that developed Integrity EMR for Eyes, announced that Ronald A. Dunn is the company's president and CEO.
Marchon Eyewear has announced its new global headquarters, a 61,000-square-foot facility in Melville, N.Y.
□ Former U.S. President and Carter Center Founder, Jimmy Carter, received, on behalf of The Carter Center, two pledges — $500,000 toward the Guinea Worm Eradication Program and $500,000 toward the Onchocerciasis Elimination Program for the Americas — from the OPEC Fund for International Development.
□ The non-profit Prevent Blindness America announced that its Swing Fore Sight Golf Tournament, held in conjunction with Vision Expo West in Las Vegas, raised close to $140,000.
TearLab Corporation announced that the Centers for Medicare & Medicaid Services (CMS) has published their recommended payment determination for new test codes, including a proposed reimbursement rate for the TearLab Osmolarity Test, effective January 2011. The new Current Procedural Terminology (CPT) code that will apply to the TearLab Osmolarity test will be reimbursed by CMS at $24.01 per eye (national limit). The actual CPT code will be published by the American Medical Association in December.
The Power Practice, a practice management company, presented its "Practice of the Year" award to optometrist Steven Chander, Primary Eye Care Associates, Chicago, Ill., during the company's recent annual meeting in Las Vegas. According to Gary Gerber, O.D., president and founder of the Power Practice, Dr. Chander and his team have worked "diligently during the course of the year to position their practice as the premier optometry practice in their region."
□ Contact lens distributor ABB Concise acquired the soft contact lens distribution business of X-Cel Contacts, a Walman Company.
□ Early results of the OM Quick Poll (www.optometricmanagement.com) show that nearly 65% of practitioners have no plans to offer spectacle sales through their websites.

Oakley Donates Sunglasses to Miners

SPORTING GOODS COMPANY PROVIDES SUNWEAR FOR HISTORIC RESCUE IN CHILE

■ Oakley, Inc. donated its Radar with Black Iridium lenses in Path and Range lens shapes to 33 miners in Copiapó, Chile. The reason: to protect the miners' eyes from light exposure upon their rescue from a collapsed mine, in which they spent 68 days in almost total darkness.

"The requirements that were communicated to us [Oakley, Inc.] were: maximized peripheral vision coverage, 100% UVA, UVB protection, a dark lens that wouldn't impair normal activities and a secure fit," says Carlos Reyes, Oakley, Inc.'s vice president of Research and Development. "The additional features Radar provided were high definition optics, two lens shapes (e.g. Path and Range) to fit each miner's facial features, a neutral lens tint to help with natural color perception (as the miner's eyes returned to normal) and hydro/oleophoic coating to keep the lenses as clean as possible in all environments, which in turn helps keep vision unimpaired."

Why Oakley?

A few weeks prior to the October 13 rescue, journalist Jonathan Franklin, who was covering the emancipation efforts for www.addictvillage.com, recommended Oakley to the Chilean private health insurer Asociación Chilena de Seguridad (ACHS) for eyewear protection for the miners once they surfaced from their subterranean prison, according to Oakley, Inc. Apparently, Mr. Franklin had been through one of Oakley's High Definition Optics presentations, and when he heard that the ACHS was looking for eyewear protection for the miners, he thought of Oakley. He then contacted Oakley, Inc.'s PR team for help, along with the ACHS requirements, and Mr. Reyes then handpicked the eye-wear based on the ACHS' requirements.

Oakley donated 35 pairs of its Radar style sunglasses, which retail for $180 each. Chile's Minister of Mining, Laurence Golborne, who led the rescue efforts, wore one of the extra pairs as a symbol of solidarity with the miners.

This past August, 33 Chilean miners became trapped in a chamber of the San Jose' gold and copper mine roughly 2,300 feet below the surface after the mine caved in. On the early morning of October 13, however, a successful rescue mission commenced when the first of the 33 men made it safely out via a customized capsule. Most of the miners were found in surprisingly good health, said local reports.

U.S. SPACE ENTITY GIVES THUMBS UP FOR NEXT SPACE MISSION
NASA Clears Self-Correcting Spectacles for Flight
After months of evaluation, the National Aeronautics and Space Administration (NASA) has certified Superfocus glasses for space flight. The eyewear's inaugural mission: This month on the space shuttle Discovery to the International Space Station (ISS).

Superfocus glasses, formerly known as Trufocals, are self-correcting spectacles for presbyopic patients. Specifically, each lens is a set of two lenses — one flexible, one firm. The flexible lens — nearest to the eye — contains a transparent distensible membrane attached to a clear rigid surface. The pocket between the membrane and surface contains a small amount of crystal clear fluid. As the wearer pushes the slider on the frame's bridge, the fluid alters the flexible lens shape, changing the wearer's correction. As a result, the wearer can choose the correction that works best for him at any distance and under any lighting conditions without zones or lines.
"I read about these glasses in one of the optometry journals, and I thought they'd be a great alternative for our astronauts for several reasons. First, most astronauts are between age 46 and 48, making them presbyopic. Second, they're required to perform overhead work and see at different viewing angles and focal lengths in the ISS, U.S. Space Shuttle and Russian Soyuz spacecraft," explains optometrist C. Robert Gibson, senior vision consultant to NASA space medicine. "Third, during space flight — especially flights of long duration — some astronauts experience vision changes, which [NASA researchers ] attribute to the body's fluids redistributing to the brain and the eyes as a result of microgravity. Superfocus glasses enable the wearer to adjust for different focal lengths with undistorted vision over a wide field of view."
Dr. Gibson adds, however, that the spectacles won't completely replace the astronauts' current glasses. "Obviously, you can't adjust these when wearing a space suit," he says.

Management MEMO

Let The Golfer Select His Clubs

SOLICIT INPUT FROM STAFF PRIOR TO MAKING A PURCHASING DECISION
Bob Levoy

■ Do you want your staff to feel more engaged in their work? Would it benefit your practice's performance if the staff could leverage the experience they've gained on the job? Would you like staff to take initiative more often?

If you answered "yes" to any of these questions, you may be able to get your staff to do these things by soliciting input from these members of your team prior to making your next purchasing decision.�

The Reason

Here's why: Many optometrists alienate team members by making decisions without ever consulting the team. Examples include selecting new computers, office and/or lab equipment.

Yet ideally, everyone who will be affected by a particular decision you make should be involved in the decision-making process at some level — even if it means just asking for their opinions.

The benefits

Among the benefits:

Team members who use the equipment regularly know more about it than anyone else.
When people participate in decisions affecting the workplace, job satisfaction tends to increase.
Those "do as you're told" employees are not nearly as effective or as proud of their work as empowered employees.

Action steps

The next time you plan to purchase a piece of equipment, ask the staff member who uses it most often to recommend (or buy outright) what's needed. There are, of course, degrees of empowerment. Decide which is most appropriate based on the nature of the task and the abilities of the team member. For example, you can say any one of the following:

Investigate the situation. Report back to me. I'll decide.
Investigate. Make recommendations. I'll decide.
Investigate. Decide. Let me have final approval.
Take action. Let me know what you did.
Whatever you do is OK with me.

Reality check

Many team members are insulted when they aren't consulted on matters that affect their job. Their complaint? "I'm treated as if I don't have a brain in my head." Needless to say, this feeling is not conducive to on-the-job performance, morale, job satisfaction or retention.

Hard learned lesson: If the best golfers select their clubs, shouldn't your staff have input into selecting the equipment they operate?

Drugs in The Pipeline

ISTA Pharmaceuticals, Inc. has initiated a Phase III clinical program of its bromfenac ophthalmic solution (Remura) for alleviating dry eye syndrome signs and symptoms. The Phase III efficacy studies are being performed under the Food and Drug Administration's (FDA) Special Protocol Assessment. This is an expedited evaluation by the FDA of certain manufacturing, toxicology and clinical trial protocols to determine whether they are adequate to meet scientific and regulatory requirements. ISTA expects to reveal the results in mid 2011.�

AstraZeneca and the University College of London (UCL) Institute of Ophthalmology have joined forces to develop regenerative drugs for diabetic retinopathy (DR). Under the three-year agreement's terms, Astra-Zeneca and UCL Institute of Ophthalmology scientists will collaborate to identify new therapeutic tools that can modulate the regenerative capacity of stem cells. These tools could be used either to manufacture transplantable material or to directly stimulate new cell growth in the eye to help restore or improve vision in DR patients, a UCL researcher says.

Can-Fite BioPharma LTD, an Israeli biotechnology company, has opened an Investigational New Drug application with the FDA for a Phase III study of CF101, their oral drug designed for moderate-to-severe dry eye syndrome patients. Incidentally, the Phase II trial revealed a reduction in intraocular pressure, so the company has initiated a Phase II clinical study in glaucoma patients, which is currently ongoing.

Ocular Therapeutix, Inc. has completed a Proof of Principle clinical study on their moxifloxacin punctum plug. The single-site, single-armed, single-dose study revealed the plug achieved 100% retention in all 10 post-cataract surgery subjects and demonstrated sustained levels of moxifloxacin throughout the 10-day treatment period, the company says. The company says it plans on initiating Phase II clinical trials in 2011 for several indications, such as dry eye.

■ A Phase 11b trial suggests that fenretinide (RT-101) a small-molecule oral drug, from ReVision Therapeutics, which limits retinol delivery to the eye via reduction of serum retinol binding protein, slows lesion growth, stabilizes visual acuity and decreases the occurrence of choroidal neovascularization (CNV) in patients who have geographic atrophy (GA).

The double-masked, placebo-controlled, two-year multi-center study evaluated 246 GA subjects randomized into three groups (once daily doses of 100mg or 300mg of fenretinide, or placebo.) ReVision Therapeutics says it plans to start a Phase II trial after speaking with the FDA.

FDA News

■ Dexamethasone intravitreal implant 0.7 mg (Ozurdex, Allergan) has received FDA approval for the treatment of non-infectious ocular inflammation, or uveitis, affecting the eye's posterior segment. Allergan's Novadur solid polymer delivery system releases the biodegradable implant.
■ The FDA has approved Ista Pharmaceuticals, Inc.'s New Drug Application for bromfenac ophthalmic solution 0.09% (Bromday) as a once-daily prescription eye drop for the treatment of postoperative inflammation and decrease of ocular pain in post-cataract surgery patients. The company says it expects to discontinue its twice-daily bromfenac ophthalmic solution 0.09% (Xibrom) product in early 2011 as a result of this approval.
■ The Spectralis age-adjusted RNFL thickness normative database, from Heidelberg Engineering GmbH, has received FDA clearance. The new normative database enables you to assess glaucoma risk from a patient's first visit, the company says.
■ RevitaLens Ocutec multi-purpose disinfecting solution for silicone hydrogel and conventional soft contact lenses, from Abbott Medical Optics, has received FDA market clearance. The new solution effectively kills Acanthamoeba and Fusarium; removes proteins from the lens surface; reduces corneal staining and minimizes risk of eye complications, the company says.


Optometric Management, Issue: November 2010