Article Date: 10/1/2011

Practice Pulse

THE AVASTIN-LUCENTIS DEBATE CONTINUES

Wet AMD Therapies: Cost, CATT and Contamination

■ If all wet AMD patients who received ranibizumab injections (Lucentis, Genentech) had instead received off-label bevacizumab (Avastin, Genentech) injections—FDAapproved for colorectal cancer in 2004—during 2008 and 2009, Medicare Part B would have saved approximately $1.1 billion, and beneficiaries would have saved about $275 million in copayments. Conversely, if all wet AMD patients who received bevacizumab injections had instead received ranibizumab injections through the same period, Medicare would have increased estimated spending by approximately $1.5 billion, and beneficiaries would have paid $370 million more in copayments.

These are some of the conclusions of the report, Review of Medicare Part B Avastin and Lucentis Treatments for Age-Related Macular Degeneration, published by the Department of Health and Human Services (HHS) (available at http://oig. hhs.gov). The purpose of the report: to determine if the exclusive use of either therapy would impact Medicare and beneficiary expenditures.

The report covered 936,382 treatments of bevacizumab and 696,927 treatments of ranibizumab during the two calendar years. Although HHS estimates there were approximately 239,000 more bevacizumab injections during this period, Medicare paid a total of only $40 million for all these treatments, vs. $1.1 billion for all ranibizumab injections.

The report comes on the heels of the report of the one-year results of the CATT trial, funded by the National Eye Institute, which reported that bevacizumab and ranibizumab had equivalent effects on visual acuity when administered according to the same schedule.

Writing in the July 2011 issue of Retinal Physician (a sister publication of OM), Pravin U. Dugel, M.D., said that although CATT provided “definitive” one-year results, definitive long-term results “are not yet available.”

In August, the FDA reported that at least 12 AMD patients had contracted Streptococcus endophthalmitis infections from a single lot of bevacizumab repackaged by a pharmacy in Hollywood, Fla. (Bevacizumab, is repackaged into smaller doses for wet AMD patients.) Some patients lost all remaining vision in the infected eye.

While the cause and extent of the outbreak is still under investigation, the FDA warned that repackaging without the proper aseptic techniques can “compromise product sterility, potentially putting patients at risk for microbial infections.”

ANNUAL EYE-Q SURVEY REVEALS GEN Y ADHERE THE MOST TO CL DIRECTIONS

Young Patients Most Compliant with CL Directions, Survey Says

■ Generation Y patients (those born between 1978 and 1994) are the most diligent about complying with their doctor's contact lens wear and care instructions, according to the American Optometric Association's (AOA) 2011 American Eye-Q survey.

Specifically, the survey shows that Gen Y-ers are the most likely to replace their daily disposable lenses on a daily basis as directed and appropriately store their lenses. With regard to the latter, the survey also reveals this patient demographic held the top spot for replacing their contact lens cases every one-to-three months as directed.

Meanwhile, baby boomer patients (those born between 1946 and 1964) were the greatest offenders with regards to replacing their lenses, with almost 70% divulging they wear their lenses longer than recommended. In addition, the “greatest generation” also came in last for lens case replacement, as just 28% said they replace their case every one-to-three months.

“With regards to replacement, baby boomers most likely were first fit in contact lenses when conventional wear (annual replacement) was the only soft contact lens option, so “stretching” lens wear might not be thought to be that big of an issue,” says Susan Kovacich, O.D., a contact lens practitioner and associate clinical professor at Indiana University's School of Optometry, in Bloomington, Ind. “This is in contrast to younger patients who may have never known anything different than one-day, two-week or onemonth replacement. So, a longer wearing schedule would not be considered the norm.”

In the case of contact lens cleaning, however, baby boomers came out on top. Specifically, only 8% of this patient demographic said they soaked or cleaned their contact lenses with water vs. 19% of Gen X-ers (those born between 1965 and 1977) and 22% of Gen Y-ers.

Other highlights from the survey:

► Young patients were less aware than older patients that glaucoma and diabetic eye disease can develop without early warning signs.

► Gen X-ers are most likely to select a pair of sunglasses based on the level of UV protection vs. other factors, such as cost or brand. Further, this patient demographic tends to spend the most on sunglasses vs. other age groups.

“[A total of] 64% of respondents reported that their optometrist had not prescribed or recommended sunglasses, which I found concerning, says Teri Geist, O.D., of Omaha Neb. “Patients need to be educated on the importance of UV protection as well as the symptoms that could result from not protecting eyes and vision from damaging UV rays.”

The AOA's American Eye-Q survey was comprised of 1,000 Americans age 18 and older, who embodied a nationally representative sample of the U.S. general population, the AOA says. (Margin of error at 95% confidence level.) The survey was conducted online between May 19 to May 23.

COMPANY SEEKS TO ASSESS REPETITIVE STRESS INJURIES AMONG EYECARE PROFESSIONALS

Haag-Streit to Launch Study

■ In an effort to identify best practices to minimize repetitive stress injuries caused by ophthalmic devices, Haag-Streit is partnering with University of Connecticut researchers to study different types and designs of equipment and exam techniques. Specifically, the researchers will incorporate field measurement and laboratory simulations to quantify the risk factors for ophthalmic work and postural stress.

Haag-Streit U.S.A. has donated current exam equipment as well as new models created with enhanced ergonomic designs. This is to enable researchers to measure the benefit to doctors. Heine has also provided equipment for the study, which is expected to be completed before the year's end.

Nicholas Warren, associate professor of medicine, ergonomics coordinator, at the University of Connecticut will be working with Dr. Martin Wand, M.D., Dr. Craig Mehidau, M.D., and University of Connecticut graduate student Matt Kozachek to structure and implement the study.

Dr. Wand is scheduled to present some of his findings during the Glaucoma conference at American Academy of Optometry meeting, which will take place in Boston between October 12 and 15th, according to a spokesperson for Haag-Streit.

TRANSITIONS AND CLMA MAKE A COMMITMENT

World Sight Day Arrives This Month

■ Optometry Giving Sight (OGS) has announced Oct. 13 as World Sight Day. The organization encourages optometrist to participate in one of three ways:

(1) by donating eye exam fees collected on any day in October.

(2) by making a personal or practice donation.

(3) by planning a practice event that invites patients to donate.

OGS also invites companies to make a tax-deductible donation on or before Oct. 13. Transitions Optical responded to the call by donating $25,000 in support of the “Company Challenge.” Meanwhile, the Contact Lens Manufacturers Association has endorsed OGS as its preferred charity. Further, AllAbout-Vision.com has gotten into the charitable spirit. Specifically, for each new “like” on its Facebook page through the end of November, the website, which provides consumers with an “independent source of trustworthy information on eye health and vision correction options” will donate $5 to OGS.

World Sight Day is designed to raise funds for projects that provide vision care, local training and infrastructure support for people who are blind or vision impaired due to uncorrected refractive error. A total of 85% of the donations go directly to support these projects.

For more information on how you can help, contact (888) OGSGIVE in the United States, or (800) 585-8265 ext. 4, in Canada, or visit the www.givingsight.org.

IN PARTNERSHIP WITH BLACK WOMEN'S ORGANIZATION

Transitions Raises Health Awareness

■ Transitions Optical, Inc. and the National Council of Negro Women (NCNW) have again partnered to raise eye health awareness among Blacks. To kick off this continued partnership, the ophthalmic lens company made its second appearance at the NCNW's 26th annual Black Family Reunion Celebration, held in mid-September in Washington, DC.

During the event, which attracted more than 250,000 attendees, Transitions Optical provided eye health education, including its What to Expect: African-American Eyes brochure. In addition, the company sponsored free vision screenings and an appearance by Bess the Book Bus, a non-profit mobile literacy outreach vehicle.

In the last quarter of 2011 and throughout 2012, Transitions Optical says it will continue to work with NCNW to raise eye health awareness among Blacks. The company says it plans to distribute eye health information during the NCNW's 55th Annual National Convention this November as well as to NCNW chapters throughout the country.

The Council is an historic civil rights organization committed to advancing opportunities and improving the quality of life for African American women.

FDA NEWS

■ The FDA has granted QLT two fast track designations for QLT091001, its oral synthetic retinoid for retinal diseases, for the treatment of leber congenital amaurosis due to mutations in LRAT and RPE65 genes and for the treatment of autosomal recessive retinitis pigmentosa, resulting from inherited mutations in LRAT and RPE65 genes. QLT091001 has received orphan drug designations for the treatment of the LRAT and RPE65 genetic mutations in both LCA and RP by the government agency already.

Eye site - Accutome Launches E-Commerce Site

Accutome has launch its new ecommerce website, www.accutome.com, which features over 2,500 ophthalmic products. The website offers diagnostic and therapeutic drops, including generic antibiotics, and features a variety of supplies including bulbs, batteries, eye charts and paper products. Also accessible by smartphone and tablet computers, the site allows customers to manage their account via the web and track shipments. The website also acts as a resource video complete with product instructions and videos.

RESEARCH Notes

• The prevalence of dry eye syndrome (DES) among a veteran population was found to be high, and several medical conditions, such as post-traumatic stress disorder, depression, thyroid disease and sleep apnea, were found to increase its risk, says September's American Journal of Ophthalmology. Further, the use of several systemic medications, such as anti-depressant, anti-anxiety and anti-benign prostatic hyperplasia medications were also linked with an increased risk of DES.

• The repeated use of ophthalmic antibiotics post-intraocular injection appears to foster the emergence of antimicrobial resistance (i.e. Coagulase-negative staphylococci), reveals September's Archives of Ophthalmology.

• Playing video games (both action and non-action games) for a short period of time (40h to 80h, 2 h/d) using the amblyopic eye appears to result in a significant improvement in visual acuity (33%), positional acuity (16%), spatial attention (37%), and stereopsis (54%), says August's PLoS Biology. The researchers say that this finding suggests that video-game play may provide important principles for treating amblyopia, and perhaps other cortical dysfunctions.

LASIK Patients who have pre-operative hyperosmolarity (greater than or equal to 308 mOsms/L) appear to show worse long-term uncorrected visual acuity (p=0.018) when compared with those treated pre-operatively with an ocular lubricant, says a study presented at the European Society of Cataract & Refractive Surgeons meeting.

O.D. NOTE BOOK

Jerry Hayes, O.D., CEO and founder of Prima Eye Group, announced that Neil Gailmard, O.D., M.B.A., has joined Prima as a founding partner and will serve as President and COO.

1-800 CONTACTS has named Joel Sodano vice president of merchandising in the company's Glasses. com division. An 18-year veteran of Luxottica, Mr. Sodano will lead the company's efforts to develop new eyeglass and sunglass assortments for consumers who shop online.

Bausch + Lomb announced its new femtosecond laser platform, the VICTUS system. The system combines cataract, refractive and therapeutic capabilities in one platform. VICTUS was unveiled at the Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) last month.

■ SECO President Neil Draisin, O.D., of Charleston, S.C., has been named Optometrist of the Year by the South Carolina Optometric Physicians Association.

The American Optometric Society (AOS) announced that Don Sipola, O.D., F.A.A.O., of Virginia, Minn., has been elected to fill a vacant seat on the AOS Board of Directors.

Menicon Group announced that all its companies outside Japan will be unified under one entity, Menicon Holdings, based in Emmen, the Netherlands, where the company will build a new headquarters, R&D center and manufacturing plant.

TearLab Corporation appointed Richard Lee as the company's EMEA Business Development Director. Mr. Lee will oversee sales, marketing, operations and customer service for Europe, the Middle East and Africa.

The World Council of Optometry says its next conference will take place June 2012 in conjunction with the American Optometric Association's “Optometry's Meeting,” in Chicago. More information is available at www.worldoptometry.org.

The Association of Schools and Colleges of Optometry (ASCO) is pleased to announce the completion of the first Future Faculty Program. The goal of the program, funded by Wal Mart, was “to provide graduate students with an opportunity to gain the knowledge and skills to enhance their success in an optometric academic environment as career-long, productive faculty,” according to ASCO.

■ The recent Physicians Partnering Against Pain (P3) Survey funded by Janssen Scientific Affairs, LLC, reported that 44% of U.S. patients in outpatient settings received potentially inadequate relief of moderate-to-severe acute pain.



Optometric Management, Issue: October 2011