Practice pulse
TIPS,
TRENDS & NEWS YOU CAN USE
B&L
RECALLS CONTACT LENS SOLUTION
Eye
Fungus Attributed to Solution Formulation and Non-Compliance
|
If You
Suspect Fusarium |
1.
Report the event o the FDA at 1-800-FDA-1088 (phone), 1-800-FDA-0178 (fax) or at
http://www.fda.gov/medwatch/report.htm.
2.
Scrape tissue for laboratory analysis — in initial presentation, clinicians
cannot differentiate between bacterial disease and most fungal keratitis.
3.
Do not initiate steroid treatment until fungal infection is ruled out. Fungal disease
"feeds" on the immuno-suppression produced by steroids.
RESOURCES FOR PREVENTION,
DIAGNOSIS AND TREATMENT
• The American Optometric Association:
www.aoa.org/x5119.xml
• The American Academy of Ophthalmology: www.aao.org
• The Centers for Disease Control and Prevention:
www.cdc.gov
|
In
response to the incidence of Fusarium keratitis among soft contact lens wearers,
eyecare professionals re-evaluated the management of contact lens patients, while
Bausch & Lomb announced it would permanently remove its MoistureLoc solution
from world markets.
B&L announced the voluntary recall on May 15, citing customer
safety as a top priority. An investigation by the U.S. Centers for Disease Control
and Prevention (CDC) reported that in cases of Fusarium infection among contact
lens wearers who could identify their solutions (118 persons), 64% reported using
MoistureLoc alone and another 12% reported using MoistureLoc with another product.
The CDC concluded that MoistureLoc was the only product with a
statistically significant association with reports of Fusarium. As testing by the
manufacturer and health authorities revealed "no evidence of product contamination,
tampering counterfeiting or sterility failure," B&L concluded some aspect of
the formulation was responsible.
Further tests by B&L found a disinfecting agent in MoistureLoc,
alexidine, was safe and effective when the solution was used properly. However,
evaporation of the solution can lead to a higher concentration of polymers that
may make the solution more likely to be contaminated with Fusarium.
Brian Levy, O.D., M.Sc., chief medical officer, B&L, noted
that the "extensive R&D effort" found that polymers in the MoistureLoc formulation
could create films under certain conditions of use, in particular evaporative conditions.
"This could occur in a number of instances — for example, when solution is
'topped off' in lens cases instead of changing solution daily, when bottles are
left open between uses and polymer forms around the tip or in the cap, or when cases
are not cleaned properly or changed regularly. The polymer film, which may form
on the bottle tip or in the case, reduced efficacy of the disinfectant and provided
an environment protective of Fusarium with the MoistureLoc formulation,"
said Dr. Levy. "Under similar test conditions, efficacy remained high for ReNu MultiPlus,
which does not contain the polymer content of MoistureLoc."
As of May 18, the CDC reported 130 confirmed cases of Fusarium
keratitis and of these 125 reported wearing contact lenses. "We advise patients
that infections are extremely rare, but they should report any incidents of red
or painful eyes to us immediately," says Sheldon Kreda, O.D.
Andrew S. Gurwood, O.D., provides strict instructions for lens
care including: clean contact lenses twice a day, keep lenses in a clean case, discard
lenses at the prescribed time, do not sleep in lenses, do not change solutions
"randomly" and remove lenses and call the practice ASAP in the case of discomfort
or red eyes.
Paul Karpecki, O.D., says he was "shocked" at how few patients
were honestly compliant when he brought up hygiene issues. "About 90% had taken
numerous shortcuts in contact lens care," he notes.
Dr. Karpecki says the incidence of poor contact lens compliance
"is up substantially from where it was before the 'no-rub' marketing."
"In my practice, I have taken steps to review patient compliance,
to dismantle the entire idea of no-rub, and to inform patients of the risks associated
with poor hygiene related to contact lens wear," says Dr. Karpecki.
WORK HARD
AND PLAY HARD
What to Do at Optometry's Meeting
If
the reasons you chose to attend the this year's American Optometric Association
meeting in Las Vegas (June 21-24) go beyond the purely educational, local optom-etrists
can give you tips for getting the most out of your down time. While you probably
already know about the casinos, you may need some suggestions when it comes to dining
and sightseeing. James A. Beckwith, O.D., of Vision Source, and Jeffrey Austin,
O.D., F.A.A.O., president of the Nevada Optometric Association, offer their homegrown
insights into the city's finest.
Dining on The Strip
|
OPTOMETRY'S MEETING
|
|
WHAT:
the 109th annual American Optometric
Association Congress and the 36th annual American
Optometric Student Association
WHEN: June 21-26
WHERE: Mandalay Bay Resort and Casino
(www.mandalaybay.com)
FOR MORE INFORMATION:
www.optometrysmeeting.com |
Andre's.
Simply "the best French food in town," according to Dr. Austin. Price
range: $35+. 3770 S. Las Vegas Blvd.; (702) 730-7955.
Cannaletto.
Located in the Venetian Hotel, this northern Italian-style restaurant offers outside
dining on the piazza ("Which in Las Vegas is really inside, but it seems like outside,"
says Dr. Beckwith) or more formal dining indoors. "The risotto is fabulous," says
Dr. Beckwith. Price range: $15-$25.
3355 S. Las Vegas Blvd; (702) 733-0070.
Capital Grille.
Specializing in steak and seafood, this restaurant offers plenty of Las Vegas ambiance,
with enormous paintings of quintessential "Vegas people" such as Sinatra and Liberace,
and a view of the Strip. It's located in the Fashion Show Mall. Price
range: $35+. 3200 S. Las Vegas Blvd.; (702) 932-6631.
Del Frisco's Double Edge Steakhouse.
This fine-dining restaurant "has the best steaks" in town, according to Dr. Austin.
Price range: $35+. 3925 Paradise
Rd.; (702) 796-0663.
Mon Ami Gabi.
Located in the Paris Las Vegas Hotel, this spot offers dining both indoors and outside
on the Strip. "Ask for a view of the Bellagio Fountains," Dr. Beckwith recommends.
"Very reasonable prices for outstanding food and view." Price
range: $25-$35. 3655 S. Las Vegas Blvd.; (702) 944-4224.
Must-see attractions
You'll find plenty of entertain- ment right there on the Strip:
The Venetian Hotel and Casino houses the Grand
Canal Shoppes,
which offer a real canal and gondola rides in addition to shopping, a branch of
Madame Tussaud's wax works museum and the Guggenheim Hermitage.
3355
S. Las Vegas Blvd.
The
fountain
show
at the Bellagio Hotel and Casino runs every half hour from 3p.m. till 8p.m., and
every 15 minutes from 8p.m. until midnight. 3600 S. Las Vegas Blvd. (at the intersection
of Flamingo Rd. and the Strip).
Dr. Austin recommends the avant-garde Blue
Man Group Theater,
which will appear at the Venetian from 6/15-6/25.
If you want to venture outside the city, Dr. Austin recommends
a visit to the Hoover Dam.
A National Historic Landmark, it's the highest concrete dam in the Western Hemi-
sphere and only 35 miles south of Las Vegas. For information on tours, go to shop.vegas.com.
SCREENING
IMPACTS 140,000 STUDENTS ANNUALLY
Oklahoma Passes Vision Screening Law
Oklahoma
recently enacted the Children's Vision for Excellence Act, which requires vision
screenings and follow-up eye exams for students who fail. The law goes into effect
in 2007 and will result in screenings for 140,000 students and an estimated 10,000
follow-up exams each year.
The law requires children entering kindergarten, first and third
grades receive a screening. Students who fail will be required to receive a comprehensive
eye exam.
Follow-up care for students who fail the screenings is a critical
issue. Vision Council of America noted of the 31 states that required vision screening
last year, 28 did not require a follow-up exams for those who failed.
KEEPING IT IN THE FAMILY
When it comes to referrals, the right specialist
may be closer than you think
When it comes to referring your
patient to a specialist, M.D.s are not your only option. Many optom-etrists are
qualified to handle complicated ocular conditions, from challenging contact lens
cases to eye disease. Whether you need to find an appropriate practitioner to refer
to, or get referrals yourself, here are the issues you'll need to consider.
Why go to another O.D.?
When optometrists think of making referrals to colleagues, they
typically think of M.D.s. (A complete list of conditions that are appropriate to
refer to M.D.s is included in the feature "A Complete Guide to Referrals," which
begins on page 76.) When the patient needs surgery or treatment for eye disease,
this makes sense. However, there are also many situations in which sending a patient
to another O.D. not only benefits that patient, but your practice as well.
Just like an M.D., another optometrist may have specialized knowledge
that you don't. Kenneth A. Lebow, O.D., F.A.A.O., of Virginia Beach, Va., points
out that visual training or developmental vision are specialties he will refer for.
Neuro-retinal cases, such as retinitis and optic neuropathy, and systemic issues
also qualify. "An excellent example of when to refer to another O.D. is when the
practitioner has limited experience with keratoconus or post-refractive surgery
contact lens fittings," Dr. Lebow says. Referrals for these situations should occur
more frequently than they do, he claims.
Another important reason to find other optometrists to whom you
can refer your patients is to get coverage for an emergency when you are out of
town or otherwise unavailable. This is critical, Dr. Lebow says. "It then becomes
a reciprocal relationship."
William L. Jones, O.D., of Albuquerque, on the other hand, covers
many of the problems M.D.s typically do. Nearly 12 patients are referred to his
office on a weekly basis. His referral-only practice treats patients with glaucoma
and performs retinal evaluations, such as age-related macular degeneration, diabetic
retinopathy and retinal breaks. He gets referrals for such cases because he has
made himself an expert. "I've been involved in cases such as these since my residency
in 1977," Dr. Jones says. "I decided to open a practice specializing in them to
help fellow O.D.s with eye-disease patients."
Building your network
How can you find qualified O.D.s like Dr. Jones to whom to refer
your patients? It's a more sociable experience than you might think. "It's as easy
as getting to know the practitioners in your area," says Dr. Lebow. Find out who
handles what, he advises, and be sure to ask what the practitioner feels most comfortable
doing.
Dr. Jones incorporated a more formal approach as well. He says
that shortly after opening his practice, he hosted an open house to answer questions.
Play fair
Getting your patient back after you've referred him or her to
a specialist has always been a major concern for practitioners. Dr. Jones says that
sending the patient back to the referring optometrist is always his policy. He provides
a detailed report back to his colleagues in the form of a written report and a PowerPoint
presentation with all of the tests he performed on the patient. He says he sends
these reports as soon as possible so the referring O.D. knows that the cases were
treated promptly and taken seriously. Dr. Jones also often calls the referring O.D.
with an update the same day he's seen the patient.
Rather than take that level of conscientiousness for granted,
Dr. Lebow recommends discussing the matter with the specialist prior to the referral.
Making it clear that you expect the patient back once the treatment is completed
is critical, he says.
As
a contact lens specialist, Dr. Lebow explains, "When a practitioner refers me a
contact lens fit due to its complexity, I typically return the patient to the referring
doctor to get glasses that can be interchanged with their contact lenses. The original
O.D. does the eye health exam and I evaluate the contact lenses." He warns, though,
that every once in a while, a patient does choose not to return to his or her original
doctor.
Get started
If you're ready to begin your referral network, there's no need
for lengthy preparation. Dr. Lebow advises simply picking up the phone and calling
the O.D. you're considering to handle your patient's care. Remember to have that
discussion about returning the patient to you once the treatment is completed. Find
an optometrist who makes you feel comfortable with the relationship.
If you want to receive referrals, then you do need to do some
preparation. Not only does this require extensive knowledge of a given specialty,
but, "Then you have to build a reputation upon your knowledge," Dr. Jones says.
He recommends publishing or lecturing on your area of specialization to boost your
image in the community.
For your referral network to succeed, be sure to keep it a two-way
proposition. "Too often it is a one-way street," says Dr. Lebow. "When this happens,
referrals fail and feelings get hurt." — René Luthe, Senior Associate Editor
O.D.
NOTEBOOK
►The
Senate rejected Bill S.1955, the Health Insurance Modernization and Affordability
Act, designed to establish small business health plans that would be exempt from
many state coverage requirements. The legislation would have allowed health plans
to discriminate against O.D.s, according to the American Optometric Association.
►The
Journal of the American Medical Association has published a National Institutes
of Health (NIH) study, which finds that 14 million Americans are visually impaired.
Of these, more than 11 million, many economically disadvantaged, would benefit from
eyeglasses or contact lenses.
►President
and CEO James V. Mazzo has been named Advanced Medical Optics' (AMO) chairman of
the board, following the retirement of William R. Grant, who will remain a member
of the company's board of directors.
►The
Allergan Foundation, the philanthropic arm of Allergan, presented the University
of California Irvine Department of Ophthalmology with $2 million, the largest donation
ever for ophthalmology.
►VSP (Vision Service Plan)
recently launched a video series to provide tools for young baseball players. The
Get Focused Sports Vision Video series (www.getfocusedamerica.org) helps children
sharpen their skills while learning about the overall importance of eyecare. The
drills require only inexpensive household products or sporting goods.
►Carl
Zeiss Vision International, and SOLA International have completed the
merger of the North American ZEISS and SOLA ophthalmic lens businesses into a single,
entity: Carl Zeiss Vision.
►Correction.
On page 60 of "The GP Industry Update" (OM, April 2006) the photos are transposed.
The photo on the right depicts a contact lens treated with a plasma coat.
GIVING THE
INCUMBENTS A RUN FOR THEIR MONEY
Optometrist Runs for South Dakota State
Senate
Dr.
Phil Sietstra has always been interested in politics. That's part of what drove
him to throw his hat into the ring for the state senate seat in South Dakota's tenth
district. No one has challenged the Republican senators in his district for six
years. "It just seemed like the right time," says Dr. Sietstra. In fact, timing
is everything. Dr. Sietstra's youngest son is just off to college, allowing him
more free time. And his group practice just hired two new associates, which provides
enough staff to cover his patient load without causing patients a problem. "That's
very important to me," he says.
Dr. Sietstra's career in optometry was part of his political inspiration.
"If you think about it, being an optometrist is a bit political," says Dr. Sietstra.
He was in optometry school when West Virginia passed the first diagnostic laws.
"In order to get there, and to sustain our profession, we are constrained to stay
active in politics. Otherwise, someone else will tell us what our profession is
and that won't be good," he says.
Dr. Sietstra believes in community and responsibility. He'd like
ade-quate funding for public education and a raise in the state's minimum wage.
"A living wage is a family value," he says, "It's very difficult to take care of
a family if you're working three jobs." He'd also like to address healthcare costs,
which he says are a burden for small businesses.
"It's imperative that we be active in politics at the local level.
We can make a huge difference in protecting our profession from all sorts of untoward
influences," says Dr. Sietstra.
BETTY
WHITE LAUNCHES CAMPAIGN
Aging Americans Need AMD Education
According
to Prevent Blindness America, a new survey shows that only 55% of those over age
65 are aware of wet AMD. In addition, only 10% of the same age group knew that vision
can deteriorate rapidly with wet AMD.
In response, Prevent Blindness America and the Macular Degeneration
Partnership have sponsored "My Eye Health: In the Wink of an Eye," a national campaign
to educate Americans about AMD. The campaign, which received funding from OSI Eyetech
and Pfizer Ophthalmics, features actress Betty White, who discusses the importance
of early detection and treatment.
About 15 million Americans — almost one
in four over the age of 50 — have AMD. More than half of adults aged 65 and
older did not know that there are treatment options available for wet AMD.
The
My Eye Health campaign will educate the public about signs and symptoms of wet AMD.
In addition, patients can receive free copies of the Amsler grid along with instructions
on how to use it through www.myeyehealth.org or by calling (866) 702-EYES (866-702-3937).
The study results and the campaign are both signs that optometrists
have a tremendous opportunity to educate patients in the area of AMD.
Optometric Management, Issue: June 2006