Practice Pulse

AOA and VSP Clash Regarding Healthcare Reform; FDA News; Practice Tip: Bump Your Patients to “First Class;” Beware of Cultural Red Flags; EyeSite; In The Pipeline; Research Notes; Boomers Short-Sighted on Nutrition?

Practice pulse


VSP and AOA Clash Regarding Stand-Alone Vision Plans

■ In late November, Daniel L. Mannen, O.D., F.A.A.O., and vice president of VSP Global's optometric programs posted on his As Eye See It blog ( that the exclusion of stand-alone vision plans from selling in the Health Care Reform Act's (HCR) insurance exchanges has the potential to exclude O.D.s altogether and “impair current optometric access to patients.” Further, he criticized the American Optometric Association (AOA), which lobbied to block stand-alone vision plans from the exchanges, for failing to share its specific plans to ensure true integration into healthcare and the maintaining of professional independence and called for a reversal in the AOA's position.

“If the AOA leadership cannot articulate the exact steps by which they will accomplish true optometric integration and cannot describe how optometric access will be protected if stand-alone vision plans diminish, then their plan must be considered, at best, unrealistic and, at worst, downright harmful,” Dr. Mannen wrote.

A total of 90% of consumers have their visioncare plans through stand-alone vision plans, according to the National Association of Vision Care Plans.

“Speaking as a practice owner, the potential exclusion of standalone vision plans in the HCR package would be tenable or even desirable, so long as the benefit is for examination and medical treatment, leaving room for eyewear-only plans to be sold independently. The simplicity for patients and providers would save us all some sanity,” says Ben Gaddie, O.D., of LaGrange, Ky. “But I know this isn't likely, so our top priority should remain federal legislation that pierces the walls of discriminatory policies from insurance companies and gaining equal footing with other doctoral-level providers in the mainstream medical delivery realm.”

AOA President Dori Carlson, O.D., released a response letter to Dr. Mannen's blog, in which she wrote that she is committed to ensuring that neither medicine nor insurers gain the ability to define optometry. She also wrote that standalone vision plans can participate in the state health insurance exchanges by working with qualified health plans to ensure the delivery of the full range of essential eyecare services O.D.s provide to patients.

“We will not let medicine or insurance companies define us and limit our practices for their benefit,” she wrote. “Our members can be assured that the integration and independence of optometrists is and always will be at the forefront of my mind and the efforts of the AOA.”

For the full response letter, visit


Bump Your Patients to “First Class”

Justin Holt, O.D., West Point, Utah

■ When an airport check-in kiosk recently asked whether I wanted to upgrade to first class for $90, I thought, why not? It was on my bucket list, so I went ahead and upgraded.

After happily boarding, I sat in my oversized luxury seat, and a flight attendant promptly greeted me by name and asked for my beverage order. After take-off, I was quickly brought my Diet Coke and a package of mixed nuts. Another Diet Coke appeared whenever my glass was empty. The attendant took my lunch order, and that burger and cheesecake rivaled the best I've had. After lunch, the attendant brought a warm hand cloth to “refresh” myself. When we landed, each flight attendant thanked me as I left the aircraft.

A little upset that I had spent extra money, my wife asked whether I felt I got $90-worth of free stuff or pampering. I told her it was neither. It was $90-worth of not being disappointed. What I was trying to convey was that it was absolutely worth $90 for a better experience.

I walked into the airport and through security much the same as everyone else. I picked up my luggage at the same carousel as other passengers. The difference was my in-flight experience. It reminded me of the many experts who urge us to “separate our practice from the competition though service.”

If your lenses, frames, etc. are more or less the same as the competition's, why should patients visit you when they can get to “the same destination” through another practice or optical retailer? My answer is that I try to “bump” my patients to first class. I provide a better, more personable and an overall more pleasant experience than the patient can get elsewhere. Do my patients pay a premium for my services? Of course. But so do first class passengers.

There is a market for providing services that others are not willing to do. In other words, my office is not in competition with those practices that provide “coach” service.


Beware of “Cultural” Red Flags

Bob Levoy, O.D., Roslyn, N.Y.

■ Even with the best credentials, equipment, location, inventory and fees, if your employees aren't right for the culture of your practice, the reputation and growth of your practice will be the worse for it. Consider some of these often underestimated red flags:.

Doesn't smile: “We don't train people to smile. We hire people who smile,” said the late Vincent Stabile, former vice president of people at Jet-Blue Airways. “I look at people and try to ascertain their default position. If their natural default is friendly and smiling, that's likely to be a person who will provide the customer service we want.”

Shows a lack of courtesy: If common courtesy is expected of everyone in your practice at all times, how does a job applicant interact with your receptionist for example, when first calling or arriving at your office? Is he or she polite, respectful, appreciative of any assistance offered? Ask your receptionist about her reaction to the job applicant. You may be surprised by how rude some job applicants can be when not being interviewed.

Doesn't look the part: The “look” you prefer is part of the culture of your practice. For example, do you prefer conservative attire, hair style and accessories? If so, it's one that serious job seekers should have.

Optometrists often find themselves with a desperate and immediate need to fill a vacancy. This can lead to a common hiring mistake: settling. Lowering standards and hiring a bad fit for your practice's culture can lead to poor office morale, a loss of patients and a damaged reputation. Don't compromise your standards for the sake of expediency.

In The Pipeline


New Laser Surgery Makes Brown Eyes Blue

When Crystal Gayle sang, “Don't it Make Your Brown Eyes Blue,” she was lamenting a relationship gone south. Now, almost 35 years later, the song title can be used to describe a new form of laser surgery that permanently transforms one's brown or hazel eyes blue.

“I'm incredibly excited about it,” Gregg Homer, Ph.D., chairman of the board and chief medical officer of the company told MSNBC. “I have light eyes, and I think brown eyes are just as beautiful as blue eyes. But I started doing this because I thought it was a cool technology, and I thought it would be nice for people to have a choice … ”

The laser procedure disrupts the brown layer of pigment in the iris, causing the body to initiate a natural tissue-removal process. The procedure is then repeated on the opposite eye. A small ring around the edge of the pupil remains untreated, as the laser does not enter the pupil for safety reasons.

Because the Stroma laser treats the iris alone, the company says it should have no effect on vision, and thus far, this has indeed been the case. In addition, Stroma Medical says no adverse events have been reported to date.

However, several ophthalmologists voiced concerns that burning large amounts of brown pigment may cause inflammation, damage the cornea, cataracts or even glaucoma. Others called for long-term studies to assess the safety of the procedure.

The company says it expects the procedure to be available to the general public outside the United States in about 18 months and inside the United States in about three years with a retail price of around $5,000.


Researchers Creating At-Home Glaucoma Testing Device

A group of University of Arizona Researchers is developing what they call the tactile tonometer, a handheld device that may only have to be applied to an eyelid to assist in the monitoring of glaucoma at home, according to an article in the Arizona Daily Wildcat, the student newspaper of the University of Arizona.

“ … The key is to achieve a balance, to have something that's convenient but still produces the desired accuracy,” Gholam Peyman, professor of basic medical sciences at the Phoenix Biomedical Campus told the newspaper. “There's no technology that does both.”

The researchers received a $50,000 grant from the National Science Foundation's Innovation Corps program, which funds research it deems has commercial potential.


Boomers Short-Sighted on Nutrition?

■ While 55% of baby boomers worry about vision loss and 78% rank vision as the most important sense, almost half said they don't have an eye exam at least annually, and very few of the respondents were aware of the role that nutrients play in eye health. Those are the results of the recent Eye on the Boomer survey released by the Ocular Nutrition Society (ONS).

“If people are at risk for heart disease, they typically make lifestyle modifications,” says Jeffrey Anshel, O.D., F.A.A.O., president of ONS. “This survey found that people are as concerned about their eyes (as they are about heart disease) but do not know the simple steps they need to incorporate into their daily lives to take care of them.”

The study found that more than half the respondents take supplements to protect their joints, bones or heart health, yet only 18% said they take supplements to support eye health. Of those who said they do not take supplements, 31% said it was because they believe they receive enough nutrients from food.

Most surveyed were not aware of the importance of nutrition as it relates to eye health. For example, almost 60% reported that they were not aware of the role of omega 3 fatty acids, compared to 66% for lutein and 89% for zeaxanthin.

Sponsored by Bausch + Lomb, the study interviewed 1,001 men and women, ages 45 to 65. For further information about the survey, visit

FDA News
■ Aflibercept injection (Eylea, Regeneron Pharmaceuticals, Inc.), also known as VEGF Trap-Eye, has been approved for the treatment of neovascular (“wet”) age-related macular degeneration at a recommended dose of 2mg every four weeks (monthly) for the first 12 weeks (three months), followed by 2mg every eight weeks (2 months).
■ The FDA has denied Alimera Sciences' New Drug Application for fluocinolone acetonide (Iluvien), saying the risks of adverse reactions in the FAME study were not offset by the drug's benefits. Iluvien, an extended-release intravitreal insert, is designed to provide a therapeutic effect of up to 36 months for the treatment of diabetic macular edema (DME) associated with diabetic retinopathy.

eye site: ODLean Joins Facebook
The ODLean Facebook page ( is an extension of the consulting program from Vistakon's The Vision Care Institute. Specifically, the page provides commentary, education and industry trends from ODLean experts regarding productivity, marketing and patient experience. Also, the facebook page features weekly practice management and marketing tips and serves as a forum for discussion among eyecare practitioners and their staff.

• Mild-to-moderate AMD patients who took an 8mg zeaxanthin supplement daily for one year, improved their detailed high-contrast visual acuity by 1.5 lines, their shape discrimination increased, and they experienced a clearing of their kinetic visual fields scotomas, says November's Optometry.
• A post-hoc analysis of the Phase III VEGF Inhibition Study in Ocular Neovascularization (V.I.S.I.O.N.) study revealed pegaptanib sodium (Macugen, Eyetech Inc.) for neovascular AMD did not appear linked with the occurrence of sustained elevated IOP through a two-year period.
• Akebia Therapeutics, Inc., has announced it has initiated a Phase I study of the human protein Tyrosine Phosphatase beta (HPTPB) inhibitor AKB-9778 for diabetic macular edema and diabetic retinopathy. AKB-9778 is designed to stabilize vessels in the back of the eye, preventing the vascular leak and abnormal blood vessel growth linked with diabetic eye disease.
• Lower levels of physical activity were found associated with lower ocular perfusion pressure, says October's Investigative Opthalmology & Visual Science. As a result, the researchers say further research is needed to investigate the potential benefit of increased physical activity as a safe and simple method of modifying glaucoma risk.

Alcon launched the OPENINGS Patient Support Program ( for open angle glaucoma in the United States, which provides a range of support materials to help patients who have high IOP. The website includes a dedicated page where eyecare professionals can re-order support materials,
■ CooperVision announced it has expanded its recall on limited lots of its Avaira Toric lens to also include limited lots of Avaira Sphere lenses. The reason: CooperVision says it has identified certain lots of the Avaira Sphere lenses that didn't meet the company's updated quality requirements due to the level of silicone oil residue. CooperVision says it intends to replace the recalled product with available Avaira Sphere lens inventory.
■ New research published in October's Contact Lens and Anterior Eye showed that most contact lens wearers were not compliant with professional and manufacturer recommendations. The research also showed that compliance was slightly better in daily disposable lens wearers, although 85% were still not fully compliant. This web-based survey was conducted in 13 countries across Europe and Asia. Among the low compliance behaviors: rubbing and rinsing the lens, hand washing, correct lens replacement and case cleaning.
Eyemaginations announced its LUMA patient education and marketing software is now compatible with Smart System from M&S Technologies, MaximEyes from First Insight and NexTech Practice 2011. LUMA will now link seamlessly with one of the compatible systems. For more information, visit
Fatheadz Eyewear, which makes oversized sunglasses and optical eyewear for individuals who have large heads, as well as eyewear in standard and intermediate sizes, announced a new women's line, Dea, and 10 new styles of spectacles and sunglasses will be available in January 2012. Fatheadz and Dea eyewear are priced from $29.95 to $79.95. For more information, visit
■ The American Optometric Association Paraoptometric section seeks nominations for the Paraoptometric of the Year. For more information, call (800) 365-2219, ext. 4108, or e-mail The deadline for nominations is Feb. 1, 2012.
Carl Zeiss Vision reported it has licensed the VSP Optics Group to manufacture multifocal lenses under U.S. Patent No. 6,089,713, which describes the manufacture of back-surface progressive multifocal lenses whose front surface is rotationally symmetrical. The design is determined by the individual prescriptions alone or in combination with at least one of the following: individual frame choice, lifestyle, wearer behavioral patterns and/or other options.
No. 7 has been named the exclusive distributor in the United Kingdom for the Unilens' C-Vue Advanced HydraVUE family of custom silicone hydrogel contact lenses. No. 7 will also serve as a C-Vue Advanced HydraVUE distributor throughout the European Union Countries.
VSP Global announced Jim McGrann has been named president of VSP Vision Care, effective January 1. Mr. McGrann succeeds Gary Brooks, who is retiring after 33 years with the company. Mr. McGrann most recently served as VSP Global's chief technology officer, a role he'll continue in the interim, and chief executive officer for Eyefinity.
Transitions Optical introduced the Transitions Star Program, which will offer eyecare professionals resources to help practices attract and engage patients. Through the program, ECPs can promote the company's Certificate of Authenticity and earn rewards for vouchers for Transitions lenses to events, such as the Transitions Championship PGA tour and Transitions Academy. For more information, visit
Diversified Ophthalmics announced it has promoted Ronald Cooke, Jr. to vice president of manufactruing and distribution. In addition, David Isreal, a 30-year veteran of the optical industry, assumes the role of vice president of operations.