Article Date: 9/1/2003

Practice Pulse
Tips, Trends & News You Can Use

Optometric Retina Society Strives to Expand Optometric Knowledge Base Rex Ballinger, O.D.; Jerry Cavallerano, O.D.; Tony Cavallerano, O.D.; Mark Dunbar, O.D.; Matt Garston, O.D.; Andrew Gurwood, O.D.; Bill Jones, O.D.; Maynard Pohl, O.D.; Leo Semes, O.D.; Jerry Sherman, O.D.; and Joe Sowka, O.D. recently created the Optometric Retina Society (ORS). The new organization's goals include organizing and producing an annual meeting; developing a fellowship between optometrists who have a high degree of interest in the retina or in retinal diseases; developing an educational symposium on the retina; and promoting research on the retina, its disorders and their treatments.

It also hopes to provide the leadership and support necessary for the advancement of retina as a primary care and a specialty care entity within optometry.

These founding members are now inviting all optometrists to participate in their educational efforts. ORS will offer two levels of membership for Optometrists:

1. General membership, which ORS will grant to any optometrist interested in furthering their knowledge of retina and retinal disease.

2. ORS fellowship status. Optometrists can attain this level of membership by meeting requirements set forth by the group.

(ORS will include details regarding membership on its Web site).

The first annual ORS meeting will take place April 16 to 18, 2004 in Boston. The program will include 13 hours of COPE-approved continuing education on common macula problems for the primary care optometrist. For more information, call (888) 239-4518. The group expects to complete its Web site, which is currently under construction, in the near future.

Study Warns That Years of Tight Neck Tie Wear Raises IOP

According to a study published in the August issue of the British Journal of Ophthalmology, wearing a tight necktie obstructs the flow of blood in the jugular vein, increasing intraocular pressure (IOP). Investigators measured IOP in 20 normal subjects and in 20 glaucoma patients with their shirt collars open, three minutes after their neckties had been tightly knotted, then three minutes after loosening the tie. Mean IOP in normal subjects increased by 2.6 mmHg and in glaucoma subjects by 1.0 mmHg. Pressures dropped once the subjects loosened their ties.

While it could take several years of wearing a tight tie to actually cause glaucoma, constantly elevated IOP is a risk factor for the disease, noted investigator Robert Ritch, M.D. "You can still wear a neckties, just don't wear it tight," he said.

Carl Zeiss Introduces Customized Progressive Lens without Distortions

Carl Zeiss Optical launched two new progressive lenses, the Gradal Individual and Gradal Short i, that deliver superior vision by better suiting the wearer's unique anatomy. The Gradal Individual eliminates the use of standard base curve technology by using new optical design software technology and CNC tri-axial free-form diamond surfacing to create custom-designed lenses for each patient. The result is "optimized wide-viewing areas with virtually no distortions," Zeiss says. The Gradal Individual features a minimum fitting height of 18 mm and allows the eyecare provider to specify many parameters. The Gradal Short i offers a fitting height of 15 mm, making it ideal for today's smaller frames.

In other business, Bill Dufort recently assumed the position of production manager for both Zeiss AR/Custom Coating and for Gradal Individual Surfacing labs.

Solution Aims to Prevent Dryness

Advanced Medical Optics (AMO) last month launched Complete MoisturePlus, a multipurpose contact lens solution designed to prevent the dryness associated with contact lens wear, in North American and European markets.

Complete MoisturePlus contains ingredients such as the dual lubricants hydroxypropyl methylcellulose and propylene glycol, electro lytes including potassium chloride and sodium phosphate, and the amino acid taurine to create a moisture shield in and around the lens. The moisture is time released to maintain comfort throughout the day, AMO says. Complete MoisturePlus is a no-rub formulation and requires only a four-hour soak time. It's now available in retail and drug stores nationwide.


FDA Clears Two CIBA Solutions for Use With Silicone Hydrogels

The U.S. Food & Drug Administration (FDA) has cleared CIBA Vision's AOSept Clear Care and SOLO-Care Plus contact lens solutions to add a specific indication for use with silicone hydrogel contact lenses. According to CIBA, Clear Care is the first and only no-rub peroxide-based formula in the United States to receive clearance for this indication.

UK Study Reveals British View on Eye Health

If Americans' attention to eye health is anything like that of the British, then U.S. patients are putting themselves and others at risk. According to a recent U.K. study of nearly 1,000 adults who hadn't had vision correction, many people put off wearing contact lenses or even eyeglasses even though they suspected they might need them.

More than 35% of those surveyed failed a basic eye test, but of these, 33% said they weren't surprised. Unfortunately for Britain, 65% of those who failed the test are car drivers. Now if the United States' statistics are anything like the United Kingdom's, then these facts should really drive home the message to eyecare practitioners that they need to keep educating their patients about the importance of eye health and hope that those patients pass the message on to others.

The study figures suggest that as many as 2.5 million Britons should be seeking eye care but aren't.

Gel Formulation May Improve Cataract Surgery

Dr. Arthur Ho and colleagues developed a polymer gel formulation, which they propose to use to improve cataract surgery in elderly patients. Rather than replacing the patient's natural lens with an intraocular lens, a surgeon would replace it with the gel -- in possibly only 15 minutes, says Dr. Ho. If scientists find the new treatment safe and effective, then they'll consider targeting a younger base of patients who are starting to need reading glasses.


l AMO adds to board of directors. Advanced Medical Optics, Inc. (AMO) has elected Deborah J. Neff to serve as a member of its board of directors.

l Transitions announces program award winners. Transitions Optical, Inc. has named the winners of its first grand prize drawing in the Transitions Optical Present & Earn Every Day Program. Optician Tammy Willing, sales executive Carol Miller and patient Marilynn Winship each won a $2,000 American Express "Your Choice" Cash Card through the program.

l Kelman receives Pisart award. Lighthouse International has selected Charles D. Kelman, M.D., as the winner of the 2003 Lighthouse International Pisart Vision Award. Dr. Kelman invented phacoemulsification surgery. He will receive a $30,000 award and a sculpture.

l Sowders receives VSP award. Jim Sowders, O.D., recently received Vision Service Plan's national People First Award.


l AR Council adds five new members. The AR Council recently added Central Optical, Eyecare Business, LOH Optical Machinery, Ozarks Optical Laboratories and Robertson Optical as its newest members.

l IntraLase signs distribution agreement. IntraLase Corp. has placed 22 femtosecond lasers in the second quarter of 2003, marking the company's strongest quarter since the commercialization of its IntraLase FS laser in early 2002.


l Paraoptometric recognition week. With the support of the American Optometric Association (AOA), the AOA Paraoptometric Section has designated September 14 through 20, 2003 as Paraoptometric Recognition Week. Paraoptometrics are honored for their dedication to the profession of optometry.

Transitions Offers Online Marketing Tool

Eyecare professionals now have easy access to customizable advertising and other marketing tools through Transition Optical's Transitions Online Marketing Tool. Optometrists can order various practice management tools and promotional items such as prescription pads, business cards, HIPAA compliance forms, coupons, patient registration and history forms, file jackets, comprehensive eye exam forms with contact lenses, pens, magnets and more. You can even customize most print materials. Just visit

According to Transitions, with just a few clicks of the mouse, eyecare professionals can easily create custom advertising materials, download on-hold messages and order the tools and promotional items. If you don't have access to the Internet, you can still order the materials via a toll-free number ([800] 848-1506). You can also request a brochure that shows all items and provides ordering instructions.

Cleaning and Polishing Gas Permeable Contact Lenses
By James W. Hartzell, O.D., F.A.A.O.

Cleaning and polishing gas permeable (GP) contact lenses need not be complicated. With a small bucket unit, a spinner tool, a suction cup, sponge tools and polish (all available from most contact lens laboratories) you can become an GP lens expert in a matter of hours.

What to look for

Before you do any modifying, examine the patient's lens. Evaluate the base curve, power, overall diameter, optic zone diameter and center thickness, especially if no past records are available. You can easily detect scratches, coatings and deposits by directing a 7X or a 10X contact lens loupe and lens up to a light source, which should be slightly to the side of the line of sight. As an alternative, use the "palm test," where you push the lens across the palm of your hand. If it doesn't glide, then you need to clean it.

What to do

If the patient's GP lens is coated but not scratched, then cleaning the lens manually with a lab cleaner may suffice. Lab cleaners are effective and manually cleaning lenses reduces staff time. Hyper-Dk materials can be more vulnerable, so try modifying the lens with a lab cleaner first.

Rejuvenating lenses with a heavy muco-protein coating or getting rid of surface scratches requires polishing. A variable speed modification unit with conical and edging sponge tools, various sized suction cups and a spinner tool is preferred. You can do the job right with a laboratory cleaner, one or two abrasive polishes and one mild polish. The key is being gentle and patient.

Although advances in manufacturing have reduced the need for edge polishing, it's helpful to contour the edge with an edge-polishing sponge tool and a suction cup, or with one of several other easy methods. I prefer an edge-projection device to ensure that the edge is optimally shaped, but the palm test should detect a sharp edge.

If in doubt . . .

If you're still not sure about what method is best for polishing and cleaning your patients' GP contact lenses, then consider viewing polishing methods demonstrated on video, available from the RGP Lens Institute (RGPLI). For more information, visit

Calvin Klein has launched a new ad campaign for Fall 2003. According to the company, the campaign exudes sex appeal and romance and the imagery is strong and provocative.

Do Your Patients Get It?
By Sheldon H. Kreda, O.D., F.A.A.O.

Eye drops are serious medicine -- and just as important as taking a pill, yet all too often O.D.s prescribe sight-saving drops without knowing a patient's ability to use them. Proper treatment extends beyond just writing a prescription -- you need to make sure your patients are using these prescriptions correctly.

So you did a great job diagnosing a patient's eye infection and prescribing the appropriate medications. This patient fills his prescription but can't instill the drops. I guarantee that both you and the patient will suffer. The patient's intraocular pressure doesn't go down and you blame the drug and alter the patient's treatment without questioning his ability to use the eye drop correctly, which can be the source of any treatment failure.

No doctor would send a first-time lens wearer home without instructions for the care and handling of contact lenses. So why would you send a patient away with a prescription for an eye drop without first making sure he can use it to achieve its desired effect? Use your contact lens training regimen as a model to set up eye drop instruction in your office. Here are some tips:

Don't just ask a patient if he can use the drops. When I prescribe drops, I hand the patient a bottle of artificial tears and ask him to instill one drop into each eye. (I often have them repeat this at follow-up visits). Any patient who fails to instill the drops correctly receives drop training.

Techs provide training. Pop the lid of a bottle of artificial tears and drop in the tip of a fluorescein strip (this will tint the solution yellow). Put the lid back on and shake the bottle. The yellow solution provides visible proof of whether the patient is getting the drops in his eye.

Use handouts. Clear instructions and diagrams greatly improve patient compliance in various areas.

Don't drop the ball. Just because you prescribe a medication doesn't mean a patient will use it properly. Patients must master self administration of topical ophthalmic drugs and it's your responsibility to make sure they accomplish this. Assess a patient's ability to instill drops and you could reduce unnecessary and costly changes to therapeutic regimens.

You can't go wrong

Eye drop training is an essential part of medical optometry. It applies to good practice management, patient care and protection from liability.

Squalamine Provides Hope for Battling AMD

Pennsylvania-based Genaera Corp. released results from a small, early-stage trial of squalamine for treating wet age-related macular degeneration (AMD). The drug, which is administered intravenously, demonstrated improvement or no deterioration of vision in 97% of the 40 patients. Squalamine is an anti-angiogenesis that works by cutting off nutrients to the abnormal blood vessels that grow beneath the retina.

Dr. William Li, president and medical director of the Angiogenesis Foundation, says that squalamine shows that anti-angiogenesis can not only preserve vision in AMD patients, but it can also restore their vision.


Optometric Management, Issue: September 2003