Article Date: 9/1/2006

Practice pulse

Web Sites Charged with Illegal Contact Lens Sales

An Internet-based contact lens seller will pay $40,000 in civil penalties under the Federal Trade Commission's first enforcement of the Fairness to Contact Lens Consumers Act of 2003 (FCLCA).

The FTC alleged that the defendants, Walsh Optical and owner Kevin Walsh, often failed to obtain or verify prescriptions when they sold contact lenses through their Web sites:,, and Under the FCLCA, prescription verification is required with all contact lens sales.

The Commission files a complaint when it has "reason to believe" that the law has been or is being violated. The FTC notes that the settlement is not an admission by defendants of a law violation.

David Cockrell, O.D., a trustee of the American Optometric Association, applauded the FTC's actions. He says he expects more cases "now that the FTC is actively investigating complaints" related to prescription verification.

Dr. Cockrell says this illustrates why legislation, such as Senate Bill 2480 (the "Contact Lens Consumer Protection Act," see OM May 2006, page 14), needs to further address prescription verification abuses "by making the FTC's enforcement job easier and more effective, instead of empowering Internet vendors to commit potential violations that may result in significant damage to patients' eye health."

The settlement also contains provisions that allow the FTC to monitor compliance. Is the settlement sufficient? "If it ultimately stops this type of behavior, then the answer is yes," says Dr. Cockrell. "but we will have to wait and see."

AREDS 2 Continues Study of AMD and Nutrition
By Barbara Anan Kogan, O.D.

Five years after the ground-breaking Age-Related Eye Disease Study (AREDS), the National Eye Institute is sponsoring the sequel.

AREDS 2 will investigate the effects of oral supplements of lutein, zeaxanthin and omega-3 fatty acids on the treatment of AMD. The study will also evaluate the role of the supplement on cataract progression prevention.

The randomized clinical study seeks to enroll 4,000 patients this summer at more than 40 clinical centers. The study will include patients from the ages of 55 through 80 who have either bilateral large drusen or advanced AMD in one eye only and the presence of large drusen in the fellow eye (AREDS AMD categories 3 and 4).

The study will conclude in July 2007 and follow participants for a minimum of five additional years. A secondary randomization will evaluate the effects of reducing zinc and eliminating beta-carotene from the AREDS formula.

Participants in the study will receive one of the following supple-ments: the AREDS supplements; the supplement with no beta-carotene; the supplement with a low dose of zinc; or the supplement with no beta-carotene and a low dose of zinc. (Beta-carotene was found to increase the incidence of lung cancer in patients who smoke.)

The study will use fundus photographs, taken annually, to evaluate participants for moderate vision loss, progression to AMD and cataract development.

The original AREDS study, which concluded in 2001, reported that an oral supplement of certain vitamins and minerals (vitamins C and E, beta-carotene, zinc, and copper) reduced a patient's risk of advanced age-related macular degeneration (AMD) by 25%. The advanced AMD participants had a 19% reduction in vision loss. Those participants without AMD did not benefit from the dietary supplementation.

AREDS cataract portion results showed the same nutrients did not have significant effects on either the development or progression of age-related cataracts.

Addressing The Cycle of Failure
By Bob Levoy, O.D.

In an effort to improve profitability, have you ever been tempted to skimp on payroll — by hiring fewer employees than needed and/or hiring as cheaply as possible? Leonard Schlesinger and James Heskett capture the implications of this strategy in their term "the cycle of failure" ("Breaking the Cycle of Failure in Services," Sloan Management Review, Spring, 1991).

The consequences of this strategy include stressed employees who lack the time and incentive to properly address patient care and/or disgruntled employees who feel underpaid and unappreciated. The inevitable result is low service quality and high employee turnover.

In a concurrent cycle, patients become dissatisfied with poor service, fail to develop loyalty and turnover as rapidly as the staff.

Management justifies the actions, say Mr. Schlesinger and Heskett, by claiming, "To get good people would cost too much and you can't pass on these cost increases to customers" or "High turnover is simply an inevitable part of our business. You've got to learn to live with it."

Part of the problem, say the authors, is failure to measure three cost variables: the cost of constant recruiting, hiring and training; the lower productivity of inexperienced new employees; and the time, effort and expense of constantly attracting new patients.

Also ignored are two revenue variables: future revenue streams that are lost when unhappy patients leave the practice; and potential income from prospective patients who are turned-off by negative word of mouth.

Reality check: Employees may stay on the job for a variety of reasons but if they feel overworked, unappreciated, and resentful about being exploited financially, they are unlikely to be highly productive or provide good service.

The 'Net is the Threat

When asked what is the greatest threat to the contact lens segment of a private practice, nearly 40% of the respondents to an OM Quick Poll replied "Internet and mail order sellers." Here are the totals based on 245 responses:
Competition from optical retail chains 1.7%
Contact lens-related legislation 16.2%
Competition from department stores 19.6%
Competition from discount superstores 23%
Competition from Internet and mail order sellers 39.6%
Go to the OM Website to answer the Quick Poll Question: How man hours do you work?









If you think it's difficult to keep your patients compliant with their eye medicines, consider that in the recent PRO-SELF study, cancer patients took only about 50% of their prescribed pain medications.

A study in the June 2006 issue of Ophthalmology reports corneal dryness affects the scan quality of optical coherence tomography (OCT) and measured nerve fiber layer thickness over a short period of time. The study recommends that patients blink often or use artificial tears when undergoing OCT imaging.

The American Journal of Ophthal-mology (Feb. 2006) found that more gatifloxacin-treated ulcers healed more completely when compared with those treated with ciprofloxacin. The conclusion suggests gatifloxacin as first-line monotherapy in bacterial keratitis.

Manufacturer Introduces Prototype "Flat" Contact Lens Package

Contact lens manufacturer ClearLab says it has seen the future and it's flat. But optometrists ask, will it fly?

The wholly-owned subsidiary of 1-800 CONTACTS, ClearLab, recently presented AquaSoft Singles, a single-use contact lens package that the company says will minimize or eliminate many challenges presented by today's contact lens systems including case contamination, lens inversion, solution compliance issues and left and right lens identification.

The AquaSoft Singles pack, which measures 1mm thick, compresses the lens so that it could be carried in a space as narrow as a credit card. The packaging is color-coded and clearly labeled for left and right. It's package labeling would include the prescribing doctor's name, thus resembling other prescription packages.

The prototype AquaSoft Singles package design.

Once opened, the lens presents with the outside surface face-up so wearers do not touch the inside of the lens or worry about inversion. The package could be used with any single-use soft lens. And because the package is designed for single-use lenses, solutions concerns are eliminated, claims ClearLab.

Optometrists agree that hygiene and compliance are important issues, as are lens inversion and identification, but the solution to these problems is not always cut-and-dried. Says Andrew Gurwood, O.D., "Single-use products are a good concept, however, some folks need rewetting drops or a mid-day break from lens wear. And if you remove the lenses for any reason, you need a case, which negates benefits gained from the packaging."

Alan N. Glazier, O.D., agrees that single-use lenses address solution compliance, but "a lens with fancy packaging would have to deliver more in terms of comfort or oxygen permeability to really make an inroad into the one-day market." 

Pamela Miller, O.D., says that her practice's solution to the compliance issue is education and appropriate follow-up. "We see our contact lens patients every six months," she says. "We ask basic questions concerning such areas as replacement, age of case, solutions [and] length of wear."

She admits however, that all practices may not be as steadfast in their approach to contact lenses. "In all fairness, I am fully aware that many offices do things differently than we do," she says.

ClearLab is convinced the packaging will score a big hit with con-sumers. Once patients experience the benefits of AquaSoft Singles, "we expect they will never want to return to the old days of lens mix-ups, fishing for lenses in a bowl, checking for inversion and cleaning with chemicals," says Graham Mullins, president and managing director of ClearLab.

While ClearLab holds patents in the United States and Japan for the AquaSoft singles pack, the product exists today only as a prototype. 1-800 CEO Jonathan Coon says that the company "needs a partner" to move forward and would consider a licensing agreement or a strategic or financial partnership. "We'd prefer the option that would allow AquaSoft to come to market most quickly," Mr. Coon says. ClearLab expects the product to come to market in no more than two years.

Ernest Bowling, O.D., notes that many eyecare professionals would have trouble recommending a product from 1-800 CONTACTS, a fact that Mr. Coon acknowledges could limit ClearLab's growth potential. As a solution, he says, the company is "evaluating a potential separation of ClearLab from 1-800 CONTACTS."


In our August issue ("Pulse," p. 14), we reported that 1•Day Acuvue Moist and 1•Day Acuvue are the only daily disposable contact lenses with UV blocking. Actually, CooperVision offers two daily disposables with UV blocking: Biomedics 1-Day and ClearSight 1-Day. We apologize for the error.


■ Optometrist Akio Kanai will recieve the United Nations 2006 Nansen Refugee Award for outstanding service to the cause of refugees. Dr. Kanai is active in both the World Council of Optometry and the World Optometry Foundation.

■ Optos recently formed a Primary Eye Care Advisory Council that includes David Nelson, O.D., Madison, Wis.; William Jones, O.D., F.A.A.O., Albuquerque, N.M.; Jerome Sherman, O.D., F.A.A.O., New York; Tom Lewis, O.D., Philadelphia; Gregg Ossip, O.D., Indianapolis; and Donald Digby, M.D., Greensboro, N.C.

Transitions Optical has joined Carl Zeiss Vision for a multi-city tour to teach eyecare professionals about premium products and healthy sight, while earning ABO or COPE credits. The cosponsored tour will continue through October. For information, call Transitions Optical at (800) 848-1506 or register online at

■ Vision Service Plan (VSP) announced President Rob Lynch's official transition to chief executive officer of the nationwide eyecare benefit company. Lynch was selected in late 2005 to succeed outgoing CEO Roger J. Valine.

The Association of Regulatory Boards of Optometry ( OE Tracker Web site now includes online continuing education certificates with unique serial numbers to guarantee authenticity. In addition, the Web site offers the ability to print a certificate online for any CE event that reported attendance to OE Tracker.

John Ingriselli has been appointed the new manager of customer service and applications for Gerber Coburn. Mr. Ingriselli's career at Gerber Coburn began in 1989. 

■ Transitions Optical named Brett Craig to the new position of chief operating officer, where he will provide global leadership and direction to Transitions Optical's commercial, marketing and operations organizations. Prior to joining Transitions, Mr. Craig held sales and sales/marketing management positions with PPG's industrial coatings business.

■ The Vision Council of America (VCA) and AARP have partnered to educate adults about the importance of regular vision care. The partnership will feature a public service advertisement (PSA) campaign about the need for regular eye exams for those over age 40. It will proclaim, "an eye doctor can see things you can't."

■ A new Web site,, free to consumers and providers, will allow users to compare prices of healthcare services. The site claims it has a database of over 700,000 physicians and it will create "transparency" in pricing.

Optometric Management, Issue: September 2006