Practice Pulse

ASCRS Establishes Integrated Eyecare Model Task Force; Ranibizumab and Bevacizumab Effects Similar After Two Years; Management Memo; Research Notes; Sixty-Nine Year-Old Graduates Optometry School.

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ASCRS Establishes Integrated Eyecare Model Task Force

M.D. Association Seeks Relationship with O.D.S

■ The American Society of Cataract and Refractive Surgery (ASCRS) has formed an Integrated Ophthalmic-Managed Eyecare Delivery (IOMED) Task Force to research and suggest ways in which ASCRS and its members can advance an eyecare delivery model that includes optometrists, says EyeWorld magazine, published by the ASCRS. So, although it’s been reported the organization will offer a new category of membership that enables optometrists employed by an ASCRS member — a board-certified ophthalmologist — to be eligible for membership in the organization, this is not a done deal.

“The Task Force will be charged with designing a mechanism to encourage greater efficiency as ophthalmologists and optometrists work together to meet the needs of the 77 million American baby boomers nearing the age of 65,” IOMED Task Force Chair and ASCRS Governing Board Member Stephen S. Lane, told the magazine. “We will be working to find ways to support an ophthalmologist-led integrated eyecare model in which ophthalmologists, optometrists, technicians, opticians and managers work together to deliver patient-centric care.”

The Task Force, which is comprised of ophthalmology and optometry representatives, is looking into options, such as ASCRS Annual Meeting educational tracks, new classes of membership and a separate society created to provide education to integrated eyecare practitioners.

It is expected the Task Force will make a formal recommendation to the ASCRS leadership in the coming months.


Ranibizumab and Bevacizumab Effects Similar After Two Years

■ Ranibizumab (Lucentis, Genentech), an FDA-approved AMD drug, and Bevacizumab, (Avastin, Genentech) a cancer drug used off-label to treat AMD, had similar effects on the visual acuity (VA) of neovascular AMD patients, according to year two of the Comparison of AMD Treatments Trial (CATT), published in May’s Ophthalmology.

Specifically, the mean gain in VA was similar for both drugs among patients who followed the same treatment regimen for two years (Avastin-Lucentis difference, -1.4 letters; 95% confidence interval [CI], -3.7 to 0.8; P = 0.21). In addition, the mean VA gain was greater for monthly vs. as-needed treatment (Avastin-Lucentis difference, -2.4 letters; 95% [CI], -4.8 to -0.1; P = 0.046). Also, the proportion of patients sans fluid ranged from 13.9% in the Avastin-as-needed group to 45.5% in the Lucentis-monthly group (drug, P = 0.0003; regimen, P < 0.0001). Further, the outcome of switching from monthly to as-needed treatment was a greater mean decrease in VA during the second year (-2.2 letters; P = 0.03) and a lower proportion of patients sans fluid (-19%; P < 0.0001). The rates of death and arteriothrombotic events were similar for both drugs (P > 0.60). Finally, the proportion of patients who had one or more systemic serious adverse events was higher with Avastin than Lucentis (39.9% vs. 31.7%; adjusted risk ratio, 1.30; 95% CI, 1.07-1.57; P = 0.009), although most of the excess events have not been linked with systemic therapy that targets vascular endothelial growth factor (VEGF).

The multicenter, randomized clinical trial was comprised of 1,107 neovascular AMD patients who were assigned to four treatment groups: (1) Lucentis monthly, (2) Lucentis as needed, (3) Avastin monthly (4) Avastin as needed. At one year, patients in the monthly treatment groups were reassigned randomly to a monthly or as-needed group without changing their initial drug assignment.

The study’s objective was to determine the effects of both drugs when taken monthly or as needed for two years and to describe the outcome of switching to the asneeded treatment after one year of monthly treatment.

Rehiring Former Employees Offers Many Benefits
Bob Levoy, O.D., Roslyn, N.Y.
■ One method of combating the high costs of staff turnover is to focus on bringing back boomerang employees — top performing people who used to work for you, departed on good terms and may be interested in returning to your practice.
Narrowing your focus
The former top performing employees who might be of special interest include:
• Those who voluntarily left.
• Those who were in key positions.
• Those with critical skills, such as coding or computer adroitness.
• Retirees who may have found retirement less satisfying than they thought it would be.
“Boomerang” benefits
Among the many benefits of boomerang employees:
Huge savings. They eliminate the considerable time and costs involved with recruiting, hiring and training new employees.
Short learning curve. They know the practice and its culture and are more likely to get up to speed faster than traditional hires.
Greater loyalty. Having learned that the “grass is not really greener elsewhere,” they’re not likely to leave again.
Strengthened retention efforts. Employees thinking about leaving may have second thoughts when learning the reasons former employees have returned.
Self-promotion. It speaks well of you (to current employees and patients) when former employees want to return to your practice.
Action steps
To encourage boomerang employees to someday return, you need to plant the seed during their resignation meeting. Take the advice of John B. Izzo, co-author of Values-Shift: The New Work Ethic and What It Means for Business (FairWinds Press, 2001): “When a valued employee says they are leaving, there are two things an employer should do. First, ask if there is anything you could change that might cause them to reconsider. Second, tell them, in no uncertain terms, ‘If you ever want to come back for any reason, I will try to find a job for you, so call me. Pride,” he adds, “can keep people from calling unless you make it clear that the call is welcomed.”

• Chronic cytomegalovirus (CMV) infection of the eye appears to be a new risk factor in the pathogenesis of wet age-related macular degeneration (AMD), says April’s PLoS Pathogens. One mechanism by which chronic CMV infection might promote the increased severity of choroidal neovascularization is through the stimulation of macrophages to make pro-angiogenic factors (VEGF), a result that requires active virus replication, the study’s researchers say.
• Ocular Therapeutix, Inc. will start a sustained release travoprost-loaded punctum plug feasibility study for glaucoma treatment. A total of 20 patients who have documented ocular hypertension or open-angle glaucoma are eligible for study enrollment, which will occur at the Singapore National Eye Center and the National University Hospital in Singapore. Primary endpoints: intraocular pressure reduction from baseline and 30-day plug retention.
• Micro-invasive glaucoma surgery procedures, such as micro-bypass stents and a phacotrabectome, offer a decrease in intraocular pressure, a reduction in glaucoma drug dependence and an excellent safety profile, says March’s Current Opinion in Ophthalmology.
• Those who have AMD are at an increased risk of developing both cerebral infarction and intracerebral hemorrhage, says the April 24 edition of Stroke.
• First-time users of topiramate (Topomax, Janssen Pharmaceuticals) are at an increased risk of developing acute-onset glaucoma, says May’s American Journal of Ophthalmology. Topiramate is a seizure and migraine prevention medication.
DR. Smith Hopes To Help Geriatric Patients

Sixty-Nine Year-Old Graduates Optometry School

■ Norman Smith, age 69, says he’s had success in life by sticking with one philosophy: “Follow Your Bliss.” This bliss has included gillnetting salmon on the Columbia River, assembling a fire alarm company’s control panels and starting and selling a variety of businesses — most recently a medical product manufacturing company. Now, the Oak Harbor, Wash. resident’s bliss is optometry. Specifically, he graduated from the College of Optometry at Pacific University in Forest Grove, Ore. last month.

“If I wake up and find a job monotonous, I move on. I’ve lived my entire life this way, and it’s worked out really well for me. Overseeing the medical product manufacturing company was no longer fun … ” he explains. “… I began doing research on small businesses, and the characteristics of optometry seemed perfect for a middle-aged or older individual.”

These characteristics: the requirement of a professional license (high bar to entry); its array of opportunities (if he ever becomes physically unable to conduct exams, he can shift his focus); the ability to make a comfortable living working two-tothree days a week; and the facts that optometrists tend to be happy and can work into their 80s and 90s.

Having taken a slew of college courses for fun, though never actually obtaining an undergraduate degree, Dr. Smith says he returned to college and then applied to all U.S. colleges of optometry.

“I applied to all the schools because although I knew I would make a good optometrist, I also knew that age discrimination might be an issue with acceptance,” he explains. “Only two schools acknowledged receipt of and accepted my application, but every one of them cashed the application check.”

Dr. Smith says he chose the College of Optometry at Pacific University because of its proximity to his home and the college culture, which he describes as “close-knit.”

While he waits for his O.D. license, which takes several months to receive in Washington state, Dr. Smith says he’s looking into either working for an established practice or opening a practice with someone else, where he can focus on the geriatric population.

“I find that when people reach a certain age, all the pretenses are gone, and I had the pleasure of meeting some real characters when doing the clinical portion of my degree at both the Mayo Clinic in Minnesota and at a VA hospital,” he explains. “In addition, this is the population where most ocular pathology exists.”

He adds that he thinks his age is beneficial in attracting and retaining this patient population because older patients tend to display hesitancy in being treated by young doctors.

Asked whether he thinks he’ll ever retire, he laughs:
“Retirement doesn’t work for me,” Dr. Smith says. “One of the times I tried to retire, I ended up building a 100-foot albacore boat and fishing in the North and South Pacific.”