Article Date: 7/1/2011

Practice pulse TIPS, TRENDS & NEWS YOU CAN USE

OPTICAL DELIVERY CENTER HELPS “MEET THE NEEDS OF AN IMPORTANT CLIENT,” THE COMPANY SAYS

VSP Explains Partnership with Cisco

■ A relatively new optical delivery center at Cisco Systems Life Connections Center has several VSP member doctors questioning VSP's support of the private practitioner. The reason: The center's dispensary is owned and operated by Eyefinity, VSP's for-profit company, appearing to place it in direct competition with local VSP providers.

Daniel L. Mannen, a private O.D. in Oregon and VSP's vice president of Optometric Programs, recently addressed the Cisco Systems' dispensary via his blog “AsEyeSeeIt” on www.vspprovesit.com.

Specifically, Dr. Mannen posted that Cisco Systems—a 15-year client of VSP—approached the not-for-profit vision insurance company regarding the addition of an optical delivery center to Cisco Systems Life Connections Center, located in San Jose, Calif. (This wellness site offers primary medical care and fitness for Cisco employees). Cisco Systems made it clear it was going to add optometric services, including a dispensary, with or without VSP, read the post. Dr. Mannen further explained that during this time Cisco Systems' VSP contract was coming up for renewal. So, to keep the contract, VSP agreed to partner with the company to offer the optical delivery center.

“The intention was never to take patients away from neighboring VSP practices, but rather to help meet the needs of an important client,” Dr. Mannen posted. “Cisco employees are still encouraged to visit their current VSP doctor, as they have always been.”

Since the center opened last August, nearly 19,000 VSP claims have been filed from patients in the San Jose area vs. 1,000 claims filed by the center, and 24% of the 1,000 patients who used the center had seen a VSP member doctor within the past three years, according to VSP.

MOTION REGARDING CE INTRODUCED

AOA Motion Would Allow ACOE to Accredit CE Providers

■ A motion by the American Optometric Association (AOA) House of Delegates would expand the scope of the Accreditation Counsel on Optometric Education (ACOE) “to include accreditation of providers of continuing professional optometric education.”

“An essential characteristic of a profession is its ability and willingness to regulate itself. Unlike medicine, dentistry, podiatry and osteopathy, optometry has no profession-developed and representative organization that accredits continuing professional education,” explains Chris Quinn, O.D., AOA Board of Trustee member. “We do have a process developed by regulators (Council on Optometric Practitioner Education [COPE]) to review and approve CE, but it lacks transparency and representation of the profession itself.”

The AOA did not contact the Association of Regulatory Boards of Optometry (ARBO) regarding the motion, says ARBO President Michael W. Ohlson, O.D. (COPE is a committee of ARBO.) “Therefore, we do not feel we have enough information to form an opinion at this time,” he says.

Dr. Ohlson did say, however, that ARBO is open to collaboration with another continuing education accreditation body. He adds: “However, we feel that any additional bureaucracy, expense or confusion for the individual O.D. should be avoided.”

Craig Steinberg, O.D, J.D., general counsel of the American Optometric Society (AOS), cited three concerns with the motion.

“First, the ACOE isn't bound by COPE's rules regarding commercial influence on CE, and this provides a major financial incentive for commercial interests to get involved with lectures at AOA-sponsored meetings,” he says. “Second, if the ABO, which is controlled by the AOA, and other AOA-affiliated CE providers decide they will accept only ACOE-accredited CE, all O.D.s who are maintaining their certification with the ABO will naturally select only ACOE-accredited seminars, and this will lead to the demise of COPE. Also, it's highly possible the ACOE would refuse to accredit CE offered by organizations, like the AOS. Finally, the motion, if passed, may substantially increase CE costs, as the ACOE may become the only CE accreditation body in town.”

Dr. Quinn says the motion in no way creates a monopoly or otherwise restricts the delivery of CE. “Ultimately, it is each individual state board that makes its own decision about the acceptability of any CE in meeting the statutory requirements for re-licensure,” he says. “We assume these boards will continue to make these judgments in a manner they feel appropriate,” he says.

Dr. Quinn adds that the ACOE, in developing its standards for accreditation of providers of CE, will likely develop its own standards for commercial support of CE. “It is important that education be free of commercial influence or bias,” says Dr. Quinn.

LITTLE IMPACT ON OPTOMETRISTS

Generic Drug Manufacturers Not Required to Warn of New Risks

■ The Supreme Court, in a five-to-four ruling, recently declared the makers of generic drugs are not required to update their warning labels when new risks of taking the drugs come to light.

“I don't think that the ruling will have any significant effect on O.D. prescribing,” says Joseph W. Sowka, O.D., F.A.A.O., professor of optometry and chief of Advanced Care and Special Testing at Nova Southeastern University College of Optometry, in Fort Lauderdale, Fla. “Initially, O.D.s may request that patients demand brand name only. However, that won't last long. It is very unlikely that any significant untoward effects will occur from topical ophthalmic meds.”

“Additionally, if the patients have prescription drug coverage, demanding a brand name drug will likely be met with the claim being denied and the patient needing to pay full retail cost of the medication in order to obtain the brand name drug,” Dr. Sowka says. “When faced with the high cost of some medications, most patients will relent and accept the generic rather than pay full retail price, despite the O.D. admonition.”

He adds that the point may be moot, anyway, as many ophthalmic medications aren't produced in branded form once the patent expires.

The Supreme Court ruling was born out of two separate cases, in which two women sued separate generic drug manufacturers (Pliva, Inc. and Actavis, Inc.) for inadequate warning labels regarding metoclopramide, a drug used to treat heartburn and acid reflux.

LENS SOLUTION FINDINGS AND DAILY DISPOSABLE SAVINGS REVEALED

Bausch + Lomb Introduces Research and Program

■ At this year's Optometry's Meeting, held in Salt Lake City, Utah in mid-June, Bausch + Lomb introduced compelling findings on its latest contact lens solution and a new program to make daily disposable contact lenses more accessible to both parents and children throughout the United States.

To start, a recent study on the company's BioTrue solution showed that 97% of patients who tried it, and 99% of eyecare practitioners who recommended it were satisfied with the solution. (Their satisfaction was rated as “somewhat,” “very” or “extremely.”) Biotrue is a bio-inspired contact lens that works like the human eye to enable it to stay clean and moist throughout the day, Bausch + Lomb says. It accomplishes this via three characteristics: a lubricant called hyaluronan found naturally in the eyes, it matches the pH of healthy tears, and it maintains the activity of certain beneficial tear proteins.

To prepare kids for the 2011-2012 school year, Bausch + Lomb introduced the “The Daily Score.” This program will give eyecare practitioners the opportunity to offer their patients instant savings on the company's Soflens daily disposable. Specifically, it will allow patients to obtain Soflens at a cost of less than $1 a day.

“‘The Daily Score” will enable more kids to benefit from Bausch + Lomb SofLens daily disposable lenses so they can kick off the school year with the clear, crisp vision necessary to perform their best, in school and out,” says Lisa VanDeMark, VP North America Marketing, Bausch + Lomb.

ON-SITE MAINTENANCE

Haag-Streit Offers Slit Lamp Service

■ Haag-Streit now offers its slit lamp customers the “Haag-Streit On-Site Technician Program,” or HOST program, to ensure both the accuracy and quality of its slit lamps, the company says. Specifically, Haag-Streit sends technicians to eyecare practices to disassemble the slit lamps, clean and inspect all components and fix or replace worn parts.

The maintenance service costs $300 per slit lamp. After the first two slit lamps, there is a 5% discount for each additional instrument. Practices that upgrade to LED slit lamps receive the HOST service on that instrument free.

HOST is not currently included in the company's standard service contracts. Optometry practices can schedule online at http://haag-streit-usa.com/customer-support.aspx or by calling: (800) 787-5426.

MANAGEMENT MEMO

A Strategy for Long-Term Growth

By Bob Levoy, O.D.
Roslyn, N.Y.

■ Every optometric practice needs a strategy for long-term growth. The alternatives (guesswork, intuition, trial and error), often miss the mark. Long-range strategic planning however, can be daunting, full of economic theory and number crunching. However, in his book Winning (HarperBusiness 2005) Jack Welch, former GE chairman and CEO reduces the subject of “strategy” to three simple steps:

“Come up with a big aha for your business—a smart, realistic, relatively fast way to gain a sustainable competitive advantage.”

Start by identifying the strengths and weaknesses of your practice as well as others. What do you (and they) do best? Is there demand for a specialty practice such as dry eye therapy, hard-to-fit contact lenses, glaucoma treatment, etc.? Would technology such as electronic health records or a digital fundus camera give your practice that all-important competitive advantage? How about early morning hours? A team member with language fluency for patients with limited English proficiency? The possibilities are endless.

“Put the right people in the right jobs to drive the big aha forward.” The “high performance practice,” as defined in my book, 201 Secrets of a High Performance Optometric Practice, means having the right people in the right jobs doing the right things at the right time. “The fact is,” says Welch, “you get a lot more bang for your buck when strategy and skills fit.”

“Relentlessly seek out the best practices (i.e. tactics) to achieve your big aha, adapt them, and continually improve them.”

“Strategy is unleashed,” Welch says, “when you have a learning organization where people do everything better every day … without this learning culture in place, any sustainable competitive advantage will not last.” As a start, hire people who love to learn.

Strategy, Welch concludes, is simply finding the big aha and setting a broad direction, putting the right people behind it and then executing with an unyielding emphasis on continual improvement.

FDA News
Aflibercept ophthalmic solution (Eylea, Regeneron Pharmaceuticals, Inc.) has received a unanimous recommendation for approval from the FDA's Dermatologic and Ophthalmic Drugs Advisory Committee for the treatment of neovascular or “wet” AMD. The FDA will consider the recommendation in reviewing the Biologics License Application (BLA) for Eylea—submitted by Regeneron Pharmaceuticals, Inc. in February—though the drug's approval is not contingent on the recommendation. When asked historically how many drugs have received FDA approval after a unanimous or majority recommendation for approval by committee, an FDA spokesperson said the government agency doesn't track that data.
The Squalamine intravenous infusion (IV) (Evizon, Ohr Pharmaceutical Inc.), an anti-angiogenic drug created for the treatment of wet AMD, has been reformulated as an eye drop to enhance uptake to the back of the eye and reduce the potential for side effects. The Squalamine IV was awarded fast-track status and a Special Protocol Assessment by the FDA for a Phase III study in wet AMD patients.

Correction
In the June 2011 issue of Optometric Management, we incorrectly referred to optometrist Troy Bedinghaus of Lakewood Family Eye Care as Craig Bedinghouse (“Create the Dispensary of the Future Today”). We apologize for the error.

O.D. NOTEBOOK
Alcon recently launched its new contact lens solution, OPTI-FREE PureMoist Multi-Purpose Disinfecting Solution (MPDS) in the United States. According to the company, the MPDS contains HydraGlyde Moisture Matrix, which embeds itself on and within the lens surface and demonstrates the ability to provide 16 hours of lens wettability.
Vistakon announced the launch of Healthy Vision with Dr. Val Jones, a new radio program devoted to educating and improving the eye health of Americans. Dr. Jones is CEO of Better Health, LLC, a network of popular health bloggers. The show can be found at www.blogtalkradio.com/healthyvision. Free podcasts of the show can be downloaded at www.itunes.com.
Marchon announced Micha Siebenhandl as vice president, global house brands. Mr. Siebenhandl has been with Marchon since 1997 and has held several senior positions with the company in Europe.
■ As a part of its three-year ultraviolet (UV) campaign, “UV Been Missing Something,” The Vision Council launched a free suitcase-packing iPhone app and campaign website (www.uvbeenmissingsomething.com). The app, called PackLists, not only generates customized packing lists for travelers, it is also designed to help promote UV protection for consumers' eyes. PackLists is available through the App Store or can be downloaded directly from an iPhone.
VSP Optics Group has hired Dave Delle Donne as vice president of business development. Mr. Delle Donne will lead and manage business development strategy for multiple areas of VSP Optics Group.
Transitions Optical announced The Eyecare Practice of the Year awards program to formally acknowledge practice partners who are actively promoting healthy sight. The program will recognize up to three finalists, and one practice will be named the “2011 Eyecare Practice of the Year.” For complete information, visit www.Transitions.com/ECPoftheYear.
■ The Think About Your Eyes campaign, sponsored by the Foundation for Eye Health Awareness, has reached more than 22% of the U.S. population and has driven approximately 1.6 million comprehensive eye exams, resulting in eyecare professionals detecting more than 300,000 incremental cases of potentialy blinding eye disease, says the organization. For more information, visit www.thinkaboutyoureyes.com.
Optometry Giving Sight has named Amir Khoshnevis, O.D. Philanthropist of the Year. Dr. Khoshnevis, whose practice, Carolina Family Eye Care, has two locations in Charlotte, N.C., was chosen because of his desire to provide eye care and glasses to those in need. For information on giving to the global fund-raising initiative, visit www.givingsight.org.
Carl Zeiss Meditec now offers online training modules for its ATLAS Model 9000 corneal topographer and Visante omni system. The training modules are divided into categories of basic and advanced functions. The training modules are available to anyone by registering online at www.elearning.zeiss.com.
■ The Ocular Nutrition Society has announced its fall Nutrition Education Symposium, which will be held Oct. 11 in Boston (one day prior to the American Academy of Optometry meeting). For more information, visit www.ocularnutritionsociety.org.

RESEARCH Notes
• Patients who have celiac disease are at an increased risk of developing cataract, says May's American Journal of Epidemiology. These findings were culled from a population-based cohort study.
Santen Inc. has initiated a global Phase III study to evaluate its investigational immunosuppressive and anti-proliferative agent sirolimus (DE-109) for the treatment of non-infectious posterior uveitis. A total of 500 subjects who have active, non-infectious posterior, intermediate or panuveitis will be enrolled at 150 sites, where they will be randomized into three arms to receive different doses of the drug.
• Manipulating miR-23/27 levels may have important therapeutic implications in neovascular AMD, says June's The Proceedings of the National Academy of Sciences. Specifically, researchers found that the Inhibition of miR-23 and miR-27 function by locked nucleic acid-modified anti-miRNAs inhibits angiogenesis in vitro and postnatal retinal vascular development in vivo. Also, miR-23 and miR-27 have been shown to enhance angiogenesis by promoting angiogenic signaling through targeting Sprouty2 and Sema6A proteins, which exert antiangiogenic activity.
• The mean annual spending by individual patients on glaucoma drugs grew from $445 in 2001 to $557 in 2006 (roughly 25%), with “significant” expenditure increases noted in women, those with public-only insurance and those with less than a high school education, says June's Archives of Ophthalmology.


Optometric Management, Issue: July 2011