Article Date: 4/1/2005

Practice Pulse
Tips, Trends & News You Can Use

Good Planning Requires You to Make Tough Decisions in Four Key Areas of Your Practice
By Bob Levoy, O.D.

Long-range strategic planning requires making hard decisions in four areas:

1. Decide what you and your team are going to do more of. What's working? What services and activities are generating the most practice growth? What products and services are the most profitable? If corneal pachymetry, for example, not only improves glaucoma diagnosis and co-management of refractive surgery, but also produces a good return on investment, then it pays to use this technology.

2. Decide what you and your team are going to do less of. What's not working? What contributes little to practice growth and profitability? What might you eliminate altogether? Are there services you love doing (for example, that are more enjoyable [and time-consuming] than remunerative) and if so, are you okay with that?

"Vision therapy" was the answer a Midwestern optometrist had to that question and after thinking about it, admitted that it no longer made economic sense. He now co-manages such patients with a vision therapy specialist.

3. What are you and your team going to start doing that you're not doing today? What new services, activities or products should you introduce to achieve additional practice growth and profitability? Would extended office hours, for example, make appointments more convenient for your target patients? Would in-house lab work result in better service as well as economic benefits? Would "networking" with primary care physicians, dentists and podiatrists about the care of diabetic patients result in mutual referrals?

4. What are you and your team going to stop doing altogether? Keep in mind that critical resources of time, money and space are always scarce. The only way you can improve results is by discontinuing certain activities altogether. You can then channel those resources into services, activities or products where they'll yield a higher return on investment. Is telephone directory advertising, for example, really worth the investment? Would the substantial dollars that you spend on a display ad be better spent on staff training or on new equipment?

Clarity is the key to long-range strategic planning. The more time you take to be absolutely clear about who you are and what you want to accomplish, the more profitable your practice will be.


CMS Reports the Good -- and Not-So-Good News

A recent report published in the journal Health Affairs indicates that while experts expect U.S. healthcare spending to continue to grow at a slower pace through 2014, it will represent a larger share of the gross domestic product (GDP). Written by economists and actuaries at the Centers for Medicare & Medicaid Services (CMS), the report concludes that healthcare spending should continue its decline, from 7.7% of GDP in 2003 to 7.5% in 2004, and should decline to 6.7% over the next 10 years.

The economists and actuaries claim that the trend is the result of diverging public- and private-sector spending, driven by such factors as the introduction of the new Medicare drug benefit in 2006; it will mean a large shift in funding from private payers and Medicaid to Medicare. The result, the authors claim, is that "over the 2003 to 2014 period, national health spending is forecast to continue growing faster than gross domestic product. The consequence is a projected increase in health's share of GDP from 15.3% in 2003 to 18.7% by 2014."

Laser Upgrade Compensates for Eye Movement

VISX last month announced that the U.S. Food and Drug Administration granted approval to its iris registration technology. The company describes it as the first iris-based, automated, non-contact method of aligning and registering wavefront corrections with the VISX CustomVue treatment.

Iris registration adjusts the laser ablation to compensate for any cyclotorsional movement and/or pupil migration that occurs when the patient goes from the upright to the supine position. This provides more individualized adjustments, according to Julian D. Stevens, M.D., of Moorfield's Eye Hospital in London, which makes for greater precision of laser vision correction.

Iris registration is a hardware product upgrade for the VISX Star laser system. Certification for iris registration will be available in the near future.


End-Stage Glaucoma Costs Decline in the Second Year

While there are substantial direct costs during the treatment of end-stage glaucoma patients, end-stage costs decreased from the first year to the second year of follow up, according to a poster presented at the annual meeting of the American Glaucoma Society (AGS).

The study, "Direct Costs of End Stage Glaucoma" (Spalding J.R., Varma R., Globe D., Walt J.G.), identified 47 patients in a low vision rehabilitation center who were diagnosed with glaucoma. Patients had visual acuities of 20/200 or worse. These patients were then cross-referenced as patients at an academic glaucoma clinic. The mean direct costs for the first and second year of follow up were $2,606 and $1,496 per patient, respectively. Low-vision costs decreased from 50.2% of total costs to 39.6% in year two. All other costs also decreased from the first year to the second except for drug costs, which remained relatively similar.

The study collected clinical, rehabilitation and billing data from the patients by chart review beginning no earlier than 1998 and extending for two years.


Essilor to Offer Various New Lenses in Coming Months

Essilor has introduced the first progressive addition lens (PAL) to account for each patient's unique head and eye movements. Mike Daley, president of Essilor Lenses, announced a "controlled" rollout of the Varilux Ipseo PAL at Vision Expo East last month.

Varilux Ipseo will require head and eye ratio and stability coefficient measurements, in addition to the patient's normal prescription. To generate the unique prescriptions necessary for the lenses, Essilor introduced the Vision Print System, an FDA-cleared diagnostic device.

A proprietary free-form lens cutting technology personalizes the lens surface design. These machines will develop Ipseo lenses only. The Ipseo received an award at the SILMO trade show in Paris as the most innovative lens in the last 10 years.

In other news for presbyopes, Essilor announced the first polycarbonate photochromic bifocal replacement lens, the Varilux Liberty Airwear Transitions V.

This month, Essilor is scheduled to launch LiteStyle Kids IQ lenses, an entry-level, anti-reflective lens with superior scratch resistance and a two-year warranty. The lens will "provide significant benefits for today's children who spend much time on the computer, in front of the television or in classroom fluorescent lighting conditions, says John Carrier, president of Essilor Laboratories.

This summer, Essilor plans to introduce the Thin & Lite 1.74, which will be the thinnest, flattest high-index material available, according to the company.

Did You Know?
May is Healthy Vision Month

Next month is the National Eye Institute's (NEI's) Healthy Vision Month and the focus is "Healthy People 2010 Vision Objective 28-10: Increase access to vision rehabilitation services and technologies for people who have vision impairment." Healthy Vision Month is paired with the American Optometric Association's Healthy Eyes Healthy People Program.


Use the Internet to Make Yourself Accessible

A California podiatrist has taken his practice worldwide. Jeffrey S. Hurless, D.P.M., uses the Internet to offer his patients online dispensing of products and to communicate with patients via e-mail. Through his Web site,, Dr. Hurless offers over-the-counter foot and ankle products that he recommends.

He provides patients with e-mail access as well. "It was very difficult during the day to accept patient phone calls," when they forgot his instructions or remembered a question for him, Dr. Hurless said. "I can see the e-mails come up and can usually answer them very quickly -- my patients love this." He says that he gets approximately 25 e-mails each week from all over the world. He says, "Do people e-mail me questions before seeing their doctor? Maybe, but I can offer them general information, locate a local podiatrist, and if they purchase products from my site, at least I know that they [the products] work."


Eye-Opening Exhibit

Transitions Optical says that approximately 8,000 people visited its "Eye Didn't Know That" traveling exhibit, which kicked off in Tampa last month. See page 19 for more information.


Transitions Announces Launch of Educational Program

At Vision Expo East last month, Transitions Optical announced that it's launching a multi-pronged program to educate the public about ocular health and coach optometrists in relating to their patients.

Following up on the "Eye Didn't Know That!" traveling exhibit and Web site, the company's "Back to School" program gives eyecare professionals (ECPs) the tools to educate middle school children about healthy vision and helps them gain visibility in their communities as well. Transitions will provide "healthy vision" lesson plans that are tied to national education standards to teachers and school administrators.

Outreach tool kits for ECPs include a customizable promotion letter that they can send to schools to offer their services in presenting the Eye Didn't Know That! lesson plan independently, or in conjunction with, the teacher; a lesson plan to follow if schools invite ECPs to speak to students, and a turnkey event plan for ECPs to host an Eye Didn't Know That! Eye safety event at schools. ECPs can download the toolkit free of charge at

Transitions' new Global Medical Director, Susan Stenson, M.D., F.A.C.S., presented a new philosophy of holistic eye care at Vision Expo East as well. Her "Healthy Sight Counseling" model represents a comprehensive approach to eye care that reaches beyond prescribing or dispensing eyeglasses to address preventive vision and eyecare concerns. It recommends that practitioners link eye health to overall well-being.

"General medical care relies on the history, physical examination, hereditary, social, environmental, occupational and recreational considerations to generate prescriptions to help treat and/or prevent disease," Stenson said. "'Healthy Sight Counseling' is based on the premise that this approach can be used in vision care."

In another effort to promote healthy sight, Transitions created three new advisory positions to provide leadership and guidance on the company's ocular health research and clinical initiatives. In addition to Dr. Stenson's position as the new global medical director, Transitions named Paula Newsome, O.D., M.S., F.A.A.O., and Madeline Romeu, O.D., optometric advisors. They will also act as Transitions' ambassadors to the larger worldwide medical community.


Optometric Management, Issue: April 2005