Article Date: 6/1/2004

Practice Pulse
Tips, Trends & News You Can Use

Oklahoma Legislation Sparks Ban

The American Academy of Ophthalmology (AAO) has banned O.D.s from the education portions of its annual meeting in New Orleans. The AAO claims that O.D.s have attended the meeting "and then used their attendance as arguments to legislatures to expand their scope of practice."

The American Optometric Association (AOA) replied that "no state has ever predicated its expansion of scope efforts on the fact that some optometrists may have taken courses at an AAO meeting."

The AOA says that the ban appears to be part of a pattern of behavior by ophthalmology toward optometrists "that raises serious antitrust violation concerns." The AOA will continue to welcome ophthalmologists to its annual Congress.

The ban doesn't affect other allied healthcare professionals, says Allan Jensen, M.D., president of the AAO. "We let nurses take courses, but we would never expect them to perform surgery," he says.

The legislative battle

The ban is in response to H.B. 2321, recently passed in Oklahoma, which reaffirms O.D.s' rights to bill for surgical codes. (O.D.s in Oklahoma and other states have billed for surgical codes for 20 years.)

"In Oklahoma, optometrists are attempting to become ophthalmologists without going to medical school," says Dr. Jensen. "Legislation passed provides that the Optometry Board would be autonomous. Optometrists can decide what they want to do without direction from the medical board."

David Cockrell, O.D., F.A.A.O., president of the Oklahoma Board of Examiners in Optometry, says H.B. 2321 allows optometrists "to practice as we have for more than 20 years." Gov. Brad Henry signed the bill with the commentary that it neither expands nor contracts the scope of practice in Oklahoma.

In passing the legislation, Rep. Dale Wells (D), noted that the state has 600 registered O.D.s, but only 101 licensed M.D.s who practice in 18 of the state's 77 counties.

Oklahoma allows optometrists to correct and relieve ocular abnormalities through means such as contact lenses, eyeglasses, exercises or laser surgery. The law permits O.D.s to perform non-laser surgical procedures; however, optometrists are still forbidden to perform retina, LASIK or cosmetic lid surgery.

Dr. Jensen says that without a medical school education, O.D.s lack the qualifications to perform surgery. "Imagine someone who's assisting in brain surgery saying, 'I've seen it 25 times, so I can perform it now,' " he says.

Dr. Cockrell says that if any doctors, including optometrists, weren't performing procedures safely, then malpractice rates would skyrocket, which would give the doctors' governing board "just cause" to revoke their licenses.

Further accusations

The AAO says optometry "used Oklahoma" to expand its scope to include surgery within the Department of Veterans Affairs (VA) health system. The VA allows an O.D. to perform surgery provided he has received certification from his state board.

The AAO characterized the passage of the optometry provisions in H.B. 2321 as a "backdoor legislative effort." However, the bill's provisions were added in response to a state Attorney General's opinion, prompted by ophthalmology, which ruled that the Board of Examiners in Optometry had no authority to allow O.D.s to perform surgical procedures.

Cynthia Bradford, M.D., affiliated with the Dean A. McGee Eye Institute, requested that Sen. Mark Snyder ask for a review of the Oklahoma Optometry law. Ophthalmology sent the same request to the Attorneys General of nine other states. M.D.s made assertions that O.D.s in Oklahoma performed cataract surgery and cosmetic lid surgeries. A review found that Oklahoma O.D.s filed no claims for cataract surgery or blepharoplasty.

H.B. 2321 marks the latest round of battles between optometry and ophthalmology over refractive surgery in Oklahoma. The Oklahoma Optometry Board of Examiners allowed the state's optometrists to perform anterior segment laser procedures beginning in 1988. Optometrists performed over 15,000 procedures prior to 1995 without a compliant or lawsuit.

In 1995, when laser vision correction became an economic issue, ophthalmology filed a suit with in the Oklahoma state court system. The courts ruled that optometrists couldn't perform laser procedures until legislation outlined the parameters for laser surgeries. The House and Senate passed this legislation overwhelmingly.

Practice Management Services
Company Looks to Cut Practice Costs

Doctors Business Associates announced a new Web site, Founded in February, 2004, the company offers practitioners membership to its services. About 500 eyecare practitioners are currently members. The company claims it can reduce practitioners' costs on insurance plans, telecom services, cellular services, Internet services, credit card authorization and other products and services.

To become a member, log on to the Web site or call (888) 470-8744. Membership costs roughly $200 each year .

Evaluate Your Practice
Optical Internet portal Eyefinity has debuted Practice Trends, a new survey-based service that allows private practitioners to compare their practices to other practices nationwide.

Practitioners participate in surveys that cover finance and operations, staff management, marketing, customer care and product management. A Web site then collects all the data without identifying the respondent and benchmarks statistics. Each doctor receives a generated report.

Register for Practice Trends through the eLearn section of

On page two of the April 2004 supplement ("Contact Lens Care: Tomorrow's Technologies for Today's Comfort and Health"), Optometric Management presented the chart, "Key Components of Multipurpose Solutions." The chart incorrectly reported that ReNu MultiPlus contains the surfactant Tetronic 1304. ReNu MultiPlus does not contain this surfactant. Only Opti-Free Express contains Tetronic 1304. Optometric Management regrets the error and for your convenience, we have reprinted a corrected chart below.

Key Components of Multipurpose Solutions

Brand Name Manufacturer Ingredients
Complete MoisturePlus Advanced Medical Optics (AMO) Purified water, sodium chloride, polyhexamethylene biguanide, hydroxypropyl methylcellulose, propylene glycol, taurine, edetate disodium, potassium chloride, sodium phosphate, poloxamer 237.
Opti-Free Express
MPDS Lasting Comfort No Rub Formula
Alcon Laboratories, Inc. Sodium citrate, sodium chloride, edetate disodium 0.05%, polyquartenium-1 0.001% (Polyquad), myristamidopropyl dimethylamine (Aldox) 0.0005%, Tetronic 1304, boric acid, sorbitol, AMP-95.
ReNu MultiPlus Multi-Purpose Solution No Rub Formula Bausch & Lomb Hydroxyalkyl phosphonate, boric acid, edetate disodium, sodium borate, sodium chloride, polyaminopropyl biguanide (Dymed) 0.0001%, poloxamine
SOLO-care Plus CIBA Vision Sodium chloride, bis-tris propane, pluronic F127, Aqualube (cremophor), edetate disodium dihydrate 0.025%, polyhexanide 0.0001%


Think Outside the Office

If you benchmark your practice only against those of other optometrists, you're missing an opportunity, says Gary Gerber, O.D., president of The Power Practice (and a contributing editor of Optometric Management).

"If a patient has a great customer service encounter when buying a pair of shoes and then their optometrist takes too long to deliver their glasses, the patient's reference point is, 'Man, why can't my eye doctor do what the shoe store does!' " says Dr. Gerber. "The most successful practices are those who realize their business 'soul' is not compared to other optometrists, but to every other business transaction that their patients' experience."

Dr. Gerber recently had the opportunity to prove this point. At a national client meeting of The Power Practice, recognized business experts from outside the optometric community gave presentations. "Having a room full of like-minded O.D.s and these business thought leaders generates megawatts of creative electricity," he says.

Attendees agreed. "I took away four or five ideas and immediately put them to use in my practice," says John Burns, O.D. "It was great hearing from speakers outside optometry."

Kids' Prefer Photochromics

At the end of a 60-day study comparing regular, clear lenses with photochromics, 88% of children chose to keep the photochromics, Transitions Optical reported. The data comes from a company-funded study to assess children's visual experiences with different lens types. Twenty five girls and 24 boys participated. Initial results also show that children experience a "significant improvement" in their ability to see in bright sunlight outdoors with Transition lenses and that they had "virtually equivalent experiences with both types of lenses indoors."



Topographer drawing. Each time an eyecare professional purchases Boston Simplus, Boston Advance or a Boston Advanced Ortho-K Care System, the manufacturer will enter the ECP in a drawing to win $5,000 toward the purchase of a topographer. The promotion ends June 30, 2004.


Optos's thousandth customer. Optos announced its thousandth customer worldwide -- Spencer Quinton, O.D., of Henderson, Nev. -- to install its Optomap Retinal Exam.


Heidelberg gains new executive. Heidelberg USA appointed Travis Lindsay as its general manager and chief operating officer. Mr. Lindsay comes to Heidelberg from Carl Zeiss Meditech, where he served as global director of marketing.

Good News, Bad News

Approximately 2.6 million patients dropped out of wearing contact lenses last year, citing discomfort, too much fuss and insertion/removal difficulties as the top reasons, according to CIBA Vision. The company reported the figure at a recent national optometric meeting. However, other statistics for 2003 were more upbeat. Among them:

Challenging Conventional Wisdom

Many eyecare practitioners believe that eye patching with near visual activities in amblyopic children is ineffective beyond a certain age. However, a new study aims to prove that sentiment wrong. The Pediatric Eye Disease Investigator Group (PEDIG) conducted a study of occlusion therapy in 66 patients, ranging in age from 10 to 17, who have amblyopia and no other cause for decreased visual acuity. After two months of therapy, the authors reported that 18 of the patients (27%) showed at least a two-line improvement in amblyopic eye acuity. Three patients showed a one-line improvement at two months, with a subsequent improvement of at least two lines with continued treatment. They also found, and reported in the American Journal of Ophthalmology, that treatment effect wasn't significantly different between younger patients (10 to < 14 years) and older patients (14 to <18 years).

The need for prospective studies in childhood eye disorders led to the development of the PEDIG, which focuses on studies that it can conduct through simple protocols with limited data collection, implemented by both university-based and community-based practitioners as part of their routine practice. All completed and active PEDIG studies revolve around amblyopia.

Did You Know?

. . . that common household products caused an estimated 125,000 eye injuries treated at hospital emergency rooms in the United States in 2002, according to Prevent Blindness American (PBA)? Among the top items on the U.S. Consumer Product Safety Commission's list of items that cause eye injuries are: bleaches, general purpose cleaners, bathroom fixtures/products, paper/cardboard products, pens and pencils and yard and garden tools. Get PBA's Home Eye Safety Checklist at homecheck.html.

Adjusting Your Office to the Times
By Barbara Anan Kogan, O.D., Washington, D.C.

The 2002 Centers for Disease Control (CDC) National Center for Health Statistics' 1999-2000 National Health Examination Survey says that 60 million U.S. adults (30.5%) are obese with a body mass index (BMI) of greater than 30. An additional one in 50 Americans (4.7%) are clinically severely obese with a BMI of greater than 40. These figures have implications that can affect your optometry practice.

Here's how to take advantage of the opportunity to provide vision for new and existing pediatric and adult patients who are part of the obese population. These patients need eyeglasses, contact lenses and vision therapy, but also more frequent evaluation for diagnosing obesity-related chronic diseases and to monitor for progression of secondary ocular implications. This is especially so with diabetes and cardiovascular disease.

Making everyone comfortable

How do you get, for example, a 300- to 500-pound patient into your exam chair, or into any chair in your office? What special equipment is available for this care while making the patient, your staff and you feel comfortable while these patients are seeking your optometric care?

When preparing your corporate 1120 or 1040 federal income tax and state returns, contact your financial adviser about a 50% eligible access expenditure. It applies to practices with less than $1 million in gross income and less than 30 full-time employees. Buying $10,250 of equipment to provide care for obese patients reduces your taxable income by $5,000.

Many of today's exam chairs have a lift capacity of 500 pounds and some have wider seats, while others have retractable arm rests, says a nationwide ophthalmic equipment supplier. He recommends viewing the equipment at a conference or visiting a supplier for this purchase, as you most likely do when ready t replace an old exam chair, to accommodate any size patient. See booklet 9 "Setting up the Office Environment" in the American Medical Association's Assessment and Management of Adult Obesity Primer for Physicians.

Speaking from experience

Washington, D.C. solo practitioner, Stephen J. Feinberg, O.D., says: "Call your local medical supply store to order a transport chair, which has a larger seat that allows for improved mobility."

The front desk staffer can direct the patient to this chair, which Dr. Feinberg describes as one you can use in the reception area and in the contact lens and eyeglass dispensing areas. He points out that, "You need to have easily releasable arms on the chair in addition to the large seat so the patient can egress and ingress the chair to be examined." Additionally, Feinberg continues, "When the slit lamp is positioned in front of the patient, one needs a large size headrest for more precise evaluation of the ocular structures, taking Goldmann applanation tonometry and evaluating a contact lens fit."

For visual field testing, topography and retinal photographing, seat obese patients in a standard medical supply store oversized chair. However, he adds, "A motorized equipment table makes the exam smoother and provides a place for the patient to put his arm for sphygnomanetry with an oversize cuff." This same wide chair can optimize dispensing and training of low vision devices and equipment, and performing vision therapy activities at a higher table to allow the patient to pull the chair close to the table.

False Claims Act Helps Justice Dept. Zero in on Fraud

The Justice Department recovered $2.1 billion in fraud in 2003 under the False Claims Act, reports in a recent issue. Of that figure, $1.7 billion was recouped from healthcare companies and practitioners (anyone charging Medicare or Medicaid), a department representative said.

Credit for the increased recovery rate goes to False Claims Act amendments by Sen. Charles Grassley (R., Iowa), which strengthened "whistle-blower" provisions. Now private citizens who report fraud receive a portion of the recovered funds. According to Department figures, $1.48 billion of the monies recovered in 2003 came from whistle blowers' information.


Optometric Management, Issue: June 2004