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RAVISHING RED EYEWEAR & SUNWEAR — 2012 EQUIPMENT SUPPLEMENT INSIDE November 2012 • Volume 6, Issue 59 • www.ECPmag.com


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NOVEMBER 2012

EYECAREPROFESSIONAL

Vol. 6 Issue 59

Features 6

Courtesy of LINDBERG

Contents

Magazine

RAVISHING RED FRAMES Spice up your frame boards and offer the latest in red eyewear and sunwear. by ECP Staff

14

ECP INNOVATION Develop your “I-Skills” and make yourself indispensable to your practice.

8

by Anthony Record, RDO

22

OPTOMETRIC INTERNS Optometric professionals share their positive experiences working with interns. by Corrie Pelc

24

FREE FORM PROGRESSIVES Make progressive non-adapts a thing of the past with the latest in Free Form technology. by Renee Jacobs, OD, M.A.

32

18

FAMILY FOCUS Offering family discounts is a great way to increase sales to both parents and their kids. by Lindsey Getz

36

MY CATARACT SURGERY Chronicling the expectations, concerns, and eventual outcome I experienced during cataract surgery. by Elmer Friedman, OD

38

On The Cover: ic! berlin www.ic-berlin.de

Departments EDITOR/VIEW .....................................................................................................4 DISPENSING OPTICIAN .................................................................................14 MOVERS AND SHAKERS.................................................................................22 MOBILE OPTICIAN .........................................................................................28 OPTICAL SCI-FI................................................................................................36 OD PERSPECTIVE ............................................................................................38 INDUSTRY QUICK ACCESS............................................................................42 ADVERTISER INDEX .......................................................................................44 LAST LOOK .......................................................................................................46


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Transitions and the swirl are registered trademarks and Transitions Adaptive Lenses and Vantage are trademarks of Transitions Optical, Inc. ©2012 Transitions Optical, Inc. Photochromic and polarization performance are influenced by temperature, UV exposure and lens material.


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EDITOR VIEW Jeff Smith

EYECAREPROFESSIONAL

Magazine

Digital Discipline wareness of the effects of computer vision syndrome (CVS) – which is the vision-related problems resulting from prolonged computer use – are nothing new to most eye care professionals. But a thought provoking new study details the toll that modern digital media has been taking on our eyes.

A

According to a new report from The Vision Council, 70 percent of the U.S. population experiences some form of digital eye strain, and only half of them are doing anything about it. The consumer media report, titled “Keeping Your Eyes Safe in a Digital Age,” covers the growing trend toward digital eye strain resulting from people spending more and more time on digital devices, whether they are smartphones, tablets, laptops, etc.

Publisher/Editor . . . . . . . . . . . . . . . . . . . . . . . Jeff Smith Production/Graphics Manager. . . . . . . . . . . Bruce S. Drob Director, Advertising Sales . . . . . . . . . . . . Lynnette Grande Contributing Writers . . . . . . . . . . . . . . . . . . . Judy Canty, John Dick, Paul DiGiovanni, Elmer Friedman, Lindsey Getz, Renee Jacobs, Ginny Johnson, Jim Magay, Warren McDonald, Corrie Pelc, Anthony Record, Jason Smith Technical Editor . . . . . . . . Brian A. Thomas, P.h.D, ABOM Internet Coordinator . . . . . . . . . . . . . . . . . . . . Terry Adler Opinions expressed in editorial submissions contributed to EyeCare Professional Magazine, ECP™ are those of the individual writers exclusively and do not necessarily reflect the opinions of EyeCare Professional Magazine, ECP™ its staff, its advertisers, or its readership. EyeCare Professional Magazine, ECP™ assume no responsibility toward independently contributed editorial submissions or any typographical errors, mistakes, misprints, or missing information within advertising copy.

ADVERTISING & SALES

It was only a few years ago that the only electronic screens we looked at were in the workplace or in the home. Nowadays you only have to look around in any public place to see how ubiquitous these digital screens are. In a 2012 VisionWatch survey conducted by The Vision Council, more than one third of U.S. adults spend four to six hours a day on electronic devices; fourteen percent report daily use at 10 to 12 hours. Devices include televisions, desktop and laptop computers, smartphones, e-readers and tablets, and gaming systems. As high as 10 to 12 hours a day sounds, I’m sure we all know people who spend even more time than that. And realistically, these alarming statistics are only going to increase, especially among younger generations. Helpfully, The Vision Council report did offer some suggestions that you can give to your patients to help alleviate digital eye strain. Many of these solutions are similar to what you might have recommended in the past to prevent CVS, but they are still applicable today. Reduce glare by adjusting the brightness of your screen. Consider changing your background color from bright white to a cooler gray. Glare reduction filters are also available and can easily attach to computer screens. Remember to frequently dust and wipe digital screens to help reduce glare. Also dim your surrounding lighting to lessen the amount of overhead and surrounding light that is competing with your device’s screen. Try to avoid outside areas of intense brightness to help reduce glare and strain.

(215) 355-6444 • (800) 914-4322 lgrande@ECPmag.com

EDITORIAL OFFICES 111 E. Pennsylvania Blvd. Feasterville, PA 19053 (215) 355-6444 • Fax (215) 355-7618 www.ECPmag.com editor@ECPmag.com EyeCare Professional Magazine, ECP™ is published monthly by OptiCourier, Ltd. Delivered by Third Class Mail Volume 6 Number 59 TrademarkSM 1994 by OptiCourier, Ltd. All Rights Reserved. No part of this magazine may be used or reproduced in any form or by any means without prior written permission of the publisher.

OptiCourier, Ltd. makes no warranty of any kind, either expressed, or implied, with regard to the material contained herein. OptiCourier, Ltd. is not responsible for any errors and omissions, typographical, clerical and otherwise. The possibility of errors does exist with respect to anything printed herein. It shall not be construed that OptiCourier, Ltd. endorses, promotes, subsidizes, advocates or is an agent or representative for any of the products, services or individuals in this publication.

For Back Issues and Reprints contact Jeff Smith, Publisher at 800-914-4322 or by Email: jeff@ECPmag.com Copyright © 2012 by OptiCourier Ltd. All Rights Reserved For Subscription Changes, email: admin@ecpmag.com Scan this barcode with your smartphone to go to our website.

Don’t forget the age-old 20-20-20 rule: Every 20 minutes, take a 20 second break from your screen and focus on something 20 feet away. Also remember the importance of “eye-gonomics” and be sure your patients know how to properly position themselves in front of a computer or any device while seated. And last but not least, next time you “swipe” your beloved new iPhone, don’t forget to blink! 6 | EYECAREPROFESSIONAL | NOVEMBER 2012


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As seen on

ABC’s SHARK TANK The View Good Morning America • Patented stainless steel magnetic eyeglass holder • Back-plate embedded with magnets gets hidden under clothes • Front clip automatically self-centers on back-plate • Powerful magnet-to-magnet contact won’t poke holes in your clothing • Glasses are always within reach and can’t fall out

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2. adidas Eyewear from Silhouette Featuring a contemporary, streamlined design, the Lite Fit collection is perfect for eyeglass wearers looking to express their passion for sports. Custom fit features like the adjustable nose area and Traction Grip™ ensure a perfect fit while Performance Steel™ inlay in the temples provides for easy adjustment if needed. www.adidas.com/eyewear

2 1

1. LINDBERG LINDBERG’s successful fashion frame takes functionality, technology and fashion to new heights with its unique combinations of titanium and acetate. The color layers on the fronts interact beautifully with the clean look of the titanium temples. The new Acetanium products are inspired by the flared outer edges of 1950s eyewear. www.lindberg.com

3. Alain Mikli The Al11140006 is a red acetate mixed with a Walnut brown color that just screams fall fashion. It’s from our “Sassoun” collection, referencing a famous French children’s book about a prince. Chiseled and cut with high precision, just like pieces of jewelry, these colorful frames are fit for the princesses of the 21st century. www.mikli.com

3


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4

4. Kaenon Hard Kore: The result of innovative materials and a “function first” focus, KORE™ is the ultimate performance sunglass. This fresh design is lightweight, incredibly durable and intuitively integrates with the natural form of the wearer’s head shape while accommodating different facial features. www.kaenon.com

5. KLiiK KLiiK 478 is a combination ladies model that highlights the many shades of red. From the rich burgundy of the stainless steel front, to the Bordeaux and tomato red shades found on the textured TR-90 temple. www.kliik.com

5

6. Monoqool by Studio Optyx 6

Monoqool’s hottest color this season is Red. The NXT material is so lightweight it makes this frame only 4 grams in weight. www.monoqool.com


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Zyloware

Eyebobs

Randy Jackson Limited Edition X104 is a bold, retroinspired full rim zyl frame in a square shape. The frame’s front features small diamond-shaped metal rivets, giving it added design interest. The RJ X104 accommodates progressive lenses. Available in Colors: Olive, Red and Black, in Size: 54-17-145. www.zyloware.com

Ciao!: Say arrividerci to boring! You’ll be living la dolce vita in these stylish reading glasses. Eyebobs reading glasses are handmade with Italian plastics. Each pair comes with a protective case and a one year manufacturer’s warranty. www.eyebobs.com

Plan B Eyewear

Morel

On the Glacé model 6606 C2 Dark Red hues are married with a thin layer of demi-tortoise to add depth and dimension to this modified Cat Eye. You will see red, and you will be seen. www.planbeyewear.com

Koali’s Coral collection imitates the waving branches of the anemone. Frame fronts and temples are given both volume and movement through triple-layered acetate. The deliberately visible metal core inside the temple evokes the structure of a coral reef. www.morel-france.com

Rudy Project The Sunflower Diamonds Raspberry taps into the hottest fashion trends by borrowing inspiration from retro and classic looks from decades past. It’s molded to have a slight “wrap” quality to its fit and designed with a dazzling brand nameplate along the temples. The frame is RXable and available with their flagship prescription eyewear technology, ImpactRX™ FreeForm TEK™. www.rudyprojectusa.com


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A clear solution for unique vision Purchase any KODAK Uniqueâ&#x201E;˘ Lens from FEA and receive free KODAK CleARâ&#x201E;˘ Anti-ReďŹ&#x201A;ective Lens Coating*

$BMMFEA at 800.327.2002PSPSEFSBUwww.feaind.com First independent lab to produce in-house FEA Industries, Inc. 1 North Morton Avenue, Morton, PA 19070 tXXXGFBJOEDPN

.VTUTQFDJGZBEEJUJPOPG,0%",$MF"3XIFOQMBDJOHPSEFS 0GGFSWBMJE/PWFNCFS UISPVHI+BOVBSZ  Kodak and the Kodak trade dress are trademarks of Kodak, used under license by Signet Armorlite, Inc. CleAR is a trademark of Signet Armorlite, Inc. Š2012 Signet Armorlite, Inc.


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Smith Optics

Variety: Slightly oversized and rounded lens profile pairs easily with many women's facial features. Create all day comfort by easily adjusting the wire core temples to fine tune the fit to your unique beauty. Seamlessly integrated spring hinges provide flexibility. The Variety allows you to take a soft and subtle approach or claim the headlines. www.smithoptics.com

ic! berlin

MORE & MORE

MORE & MORE provides a perfect look for young, active and self-confident women. The collection combines a modern, fresh attitude to life with high product quality. In many ways the collection represents desirable eyeglasses for the fashion aware woman of today. www.mosaiceyewear.com

Mondottica

Shown is jfk terminal 1, from the just red rough (unpolished plastic) collection. Untouched, inviting, raw, naked...the provocative beauty of raw acetate. Pure elegance coupled with a rough and raw spirit. It was designed by Jeremy Tarian, who won the Silmo Dâ&#x20AC;&#x2122;Or in the sunglasses category this year, and whose concept for the collection is international airports. www.ic-berlin.de

Revolution Eyewear This fun design in red is simple yet with a little spice of flowery imagery to the zyl temples. The Rev717 is also available in Latte, Matte Black and Periwinkle. All Revolution Magnetic Clip-Ons can be special ordered for 3D Viewing and now custom lenses for specific sports as well. www.revolutioneyewear.com

Pepe Jeans Eyewear is a stunning eyewear collection filled with fresh styles and bold color combinations. Much like the internationally known Pepe Jeans clothing collections, the eyewear designs are stylish, affordable, and easy to wear. Featured here is style PJ3107 Molly in Red, and also comes in Brown, Black, and Purple in Size: 52/16-140. www.mondotticausa.com


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Hilco

Hilco’s stylish Lucky Collection reader in fierce Red, features an elegant rose pattern in a flattering low rectangular shape. Readers are a desirable fashion accessory for all your patients. Available in 5 powers and packaged with a coordinating soft, neoprene pouch. www.hilco.com

Charmant

TR 12511: The thoroughly chic Trussardi frame draws all eyes to the centre piece; high-definition brow bar which spreads smoothly into the elegantly crafted temples. The distinguished acetate brow is beautifully offset by light, rimless lenses keeping this style charmingly original. www.charmant.com

J.F. Rey Eyewear

FLEUR: Nostalgic about the flower used in their initial creations, Boz designers return to these legendary frames, this time using a different material. It features a minimalist metal pattern, true to the original, enhanced by polka dot and striped patterns to accentuate the color contrasts on the front on the frames. www.jfreyusa.com

J.F. Rey Eyewear Opened Eyes to Breast Cancer Awareness

On October 5, 2012 J.F. Rey Eyewear unveiled its long awaited PINK Breast Cancer Awareness eyewear frame at the Glam-A-Thon “Lipstick Lounge” event. This event featured some of the most influential women of South Florida coming together for a great cause to help find a cure for breast cancer. “We were proud to be involved in such a wonderful event for such a worthy cause,” says Travis Chivers, Sales Manager of J.F. Rey Eyewear USA. The frames were unveiled through a fashion show preceding the event alongside the newest products by J.F. Rey and Boz. “The ladies watched with amazement as we continued to send one model after another wearing our unique handmade frames. The climax at the end was to have two breast cancer survivors wearing our Limited Edition PINK Breast Cancer Awareness frames,” says Travis Chivers. The PINK frames are limited to only 200 pieces WORLWIDE and are almost completely sold out. The frame features the Breast Cancer Awareness ribbons along side a lace backing in the well known PINK color. J.F. Rey is giving 100% of the proceeds of the sale of the 200 frames to the Glam-A-Thon, a 501©3 organization. “It is a pleasure for me to be associated with a company that looks beyond profit and produces something to help make a difference in this world. Although this is only a small dent to help find a cure for this horrible cancer we hope that us producing this frame will open more companies eyes to do the same and give back to those that helped make them a success,” adds Travis Chivers.


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DISPENSING OPTICIAN Judy Canty, LDO

How Business?

That’s usually the second or third question during every office visit I make. The answer depends on: • What day it is • The last conversation, either in person or on the phone • What came in the mail or on the delivery • What didn’t come in the mail or on the delivery • The weather • How close or far off the next vacation is. I probably shouldn’t be asking that question. But I do, because I’m interested in the answer. I’m interested in the answer because I believe that somewhere in my brain or my bag is a solution or an idea that may help. As a dispensing optician, I often felt that I was one part fashion consultant, one part technical advisor and one part therapist...or bartender. My clients patronized my shop because they valued one or all of those roles. As a Territory Sales Manager (my official title), I still wear those hats and a few more...business advisor, industrial spy, deal maker, magician plus acceptor of all blame. It’s hard out here for a rep. So let’s talk about some of the questions I’m asked most frequently.

14 | EYECAREPROFESSIONAL | NOVEMBER 2012

“What are other places charging for...?” In a sentence, I don’t know. Really, I don’t want to know. How you choose to market your goods and services to your patients is not my concern. My concern is that you get what you pay for from my lab. My concern is that you understand what a fair price for services is and that you trust my lab to provide those goods and services in a way that makes you confident in our work. I might be able to give you “ballpark” numbers, but I’ve got a pretty big ballpark to work with and very few, if any, accounts are willing to share that information. If they do, I treat it as a “confidence”. I don’t kiss and tell. Once upon a time, at a Vision Expo East, a friend of mine showed off some orders he had placed for his shop. He had ordered several hundred of some inexpensive frames in a couple of popular styles and colors. I think he paid in the neighborhood of $10 or less per frame. His plan was to mark them up 10X, retailing them for $100. His logic was that if the frame broke, he could replace it at no charge and look like a hero. My thought was that “if ” was probably more like “when” and that the whole thing sounded pretty inconvenient for his patients. But he insisted that he “looked like a hero”. You control your markup, however, determining that percentage is no easy task. You might want to visit www.retailowner.com and take a look at their page of benchmarks. It has an entire page devoted to optical goods. Simply sending an employee out to price shop the competition is not enough anymore because the competition is not just the local brick and mortar. It’s a mass marketer or it’s an online marketer. If you can’t justify your pricing structure, then you may need to make some changes. Like it or not, you are running a business, not a non-profit organization. So, what are others charging for...? They are charging what they need to charge to remain a healthy business. It’s not a one size fits all marketplace anymore. What is the best progressive lens? That is the very definition of a loaded question. If I say A, you might have had a negative experience with that brand. If I say B, you might use that answer to forgo gathering information about other options. I don’t know what the best progressive lens is for your practice. There are hundreds of choices out there. What are your preferences for design, material availability, treatment compatibility and price? Give me some information and I can help you find your best matches. In all honesty, in the 30-some years I’ve been


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wearing PALs, there have only been a couple that I haven’t been able to tolerate. However, there have been quite a few that have not lived up to their marketing. Neither of us have anything to lose by being honest with each other. What is the best progressive lens? It’s the one you can count on to satisfy your patients’ needs, wants, and wallets. “Why aren’t you as fast as....? Or “Why aren’t you as cheap as...?” Most of the time, this question comes up because a patient asked you the same thing and you didn’t have a good answer or a plausible explanation. The temptation is to answer with the same old saw, “You can get them fast, good or cheap. Pick two.” But that’s not really an answer; it’s more of an excuse. We live in a world that demands immediate gratification. We want what we want, and we want it now. Our lives are controlled by instant messages, cellphones, Skype, Google and Twitter. Information overload is killing our ability to positively and rationally interact with each other. We are literally losing our patience and it’s costing us patients. No matter how you slice it, eyewear is a fully customized product, just like that bespoke suit you ordered and waited so patiently for. Eyewear may be the most affordable customized product your patients will ever own, but in our zeal to be the fastest, cheapest, most-expensive, so-far-ahead-of-the-pack-everything’s-a-blur practice we’ve lost sight of our primary task. You provide eye CARE, and more often than not, that care takes time, patience and some money.

Back in the day, I worked for a large corporate optical we’ll call P. We were being challenged in the marketplace by a young upstart we’ll call L. L was making glasses faster than P was set up to do. At P, our mantra became “Quality can’t be rushed” and when the marketing departments upped the pressure, we were cautioned that “you cannot make yourself look better by trashing the other guy.” I believed it then and I believe it now. Your patients need to understand that you and your practice have the highest standards of care, not just for their visual needs but for their eyewear as well. Well-made eyewear doesn’t have to take forever and cost an arm and a leg, but it does take time and it is not cheap. That’s what I’ll tell you and what you should be telling your patients. Why aren’t you as cheap as...or as fast as...? Because you and your patients deserve better. You may be asking yourself what, on earth, started this little rant? Well, I just re-read my copy of Ralph Drew’s Professional Ophthalmic Dispensing. Published in 1970, it is still relevant in today’s marketplace. The language and lens information may be dated (he insists on referring to us all as men), but the theory and application of his advice has stood the test of time, especially his chapters on communication and selling. So, how’s business? It’s ok, but there’s always time to curl up with a good book! ■


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MANAGING OPTICIAN Anthony Record, ABO/NCLE, RDO

Innovation IS an ECP’s Business IT IS RARE that I use my monthly message to simply recommend some outside resource to you. Every once in awhile though, I am impressed with a product, a website, a video, or in this case a book – enough that I want to share it with you.

Such is the case with the book Innovation is Everybody’s Business by Robert B. Tucker (Wiley Press, 2011). I use many of the concepts written about in the book when I facilitate the seminar “Building Strategic Business Skills.” I found most of the ideas fresh, insightful, and strangely applicable to the life of an eye care professional, and maybe you will too. If nothing else, the subtitle of Tucker’s book should make an ECP pay attention: “How to Make Yourself Indispensable in Today’s Hypercompetitive World.” Just like the world at large, the optical world has experienced slowdowns and cutbacks, and no optical professional’s future or security is guaranteed. I’m convinced that is why I have recently seen professionals in all walks of life more willing to invest in their own personal development. Whether that means attending seminars, listening to audio CDs, or reading a book (imagine that!), they realize the more skilled and proficient they become, the more indispensable they become to their employer, or if they are self-employed, to their clients, the more permanently successful they become. In the interest of full disclosure, I have absolutely no affiliation with the author or publisher, and have no real interest in whether you plunk down the $21.95 that is the publisher’s list price. (Newsflash: I just looked on amazon.com and they are selling the hardcover for $15.00 and the Kindle version for only $12.07.) Tucker calls the skills he writes about “I-Skills” (think I for innovation). There was one particular example in one of the I-Skills that really resonated with me, and it is that particular one that I want to delve into. First, let me give you an overview of some of the other benefits of the book, as outlined in the introduction. By developing I-Skills you will be better able to: • Do your job more effectively and transform your work to accomplish more with less stress and boredom. 16 | EYECAREPROFESSIONAL | NOVEMBER 2012

• Transform yourself from simply a competent employee, manager, or optician into a sought after, well-paid, difficult-to-replace eye care professional. Too often we look for job security and complain that our practice does not provide certain security. On the other hand, an innovative optician will seek to become indispensable in that the owner could not even imagine the practice without you. • Discover hidden opportunities to grow, get promoted, make more money, and achieve “internal fame” in your organization. • Help your practice survive and prosper, despite these ever-changing and turbulent economic times. • Master new ways of working to overcome obstacles and produce new, exciting results. • Improve the value-adding contribution of your team, work group, or department. • Bring yourself to the attention to upper management. • Live a richer and deeper life as you begin to actually look forward to going to work and start to have fun in your profession. • Become indispensable to your organization. Tucker then goes on to share seven I-Skills designed to achieve all of those things. They include embracing the opportunity mindset, becoming an assumption assaulter, cultivating a passion for the end customer, thinking ahead of the curve, becoming an idea factory, becoming a standout collaborator, and building the buy-in for all your new ideas. Believe it or not, it was the very first I-Skill that really resonated with me: Embrace the Opportunity Mindset. As with all of his other six I-Skills, he gives several detailed ways to actually accomplish the skill. For this one he teaches you the benefits of


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learning to consciously shift your perspective, thinking small, listening for “there’s got to be a better way” mutterings, paying attention to happy accidents, looking for problems that customers have that aren’t being solved, looking for opportunities to eliminate non-value-adding work (I especially appreciated this one too), and thinking big. Consciously Shifting Your Perspective is the one! He shares how he first learned the value of consciously shifting your perspective from his friend Mark Sanborn, the author of the bestselling book, The Fred Factor. Sanborn travels more than 150,000 miles every year, and when he was briefly home between trips he said he started to feel frustrated and angry at colleagues, fans, and other associates who would request favors, autographed photos, advice, etc...especially over the phone. “Every time the phone would ring...he would start to get in a huff. Then one day he thought, ‘What if I [consciously] shifted my perspective?’ So he put the words ‘Obligation or Opportunity?’ on a sticky note beside his phone. That helped him pick up the phone with an attitude of service, gratitude, and positive expectancy. When Mark wrote those words...he was consciously shifting his perspective. When the phone rings and he glances at the note, he is reinforcing the choice he has before him. When you and I choose to shift from obligation to opportunity, all kinds of positive things start happening. Possibilities suddenly arise out of thin air...You develop a reputation for opportunity creation.”

Wow! Now I don’t usually go in for the typical motivational stuff, but again...wow. As goofy as it sounds I did it...and it’s had a surprisingly positive effect on my life. So I’m going to ask you to do it too. Go ahead, doubt a little of your own infallibility...risk looking or feeling a little silly in front of your team.. Get a Post-It or sticky note, and boldly write those words (Obligation or Opportunity) on it. Now place it where you will benefit most from a conscious shift in your perspective. Maybe next to the phone is the most strategic place for you too. Maybe the best place for you to “stick it” is surreptitiously somewhere near the doctor’s exam room. Maybe shifting your perspective about interacting with him or her will help to improve your working relationship. Maybe it needs to be placed at the dispensing table where you can see it but your patients cannot. Now those “special” patients won’t be viewed by you as an obligation, rather you embrace the challenge as an opportunity to create a customer for life. Without getting into details, I can tell you that sticking mine near my landline phone (I even created a wallpaper for my iPhone too) HAS almost forced me to shift my perspective, and in the few short months since I have done so, many little benefits have been realized. One time, my perspective shift resulted in over $800 in sales before my shop even opened one morning. Thanks, Robert Tucker. And thank you, my fellow eye care professional. After all, it has been a life-long goal of mine to help others...just by telling them to stick it! ■


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PRACTICE MANAGEMENT Corrie Pelc

Optometric Interns Are They Right For Your Practice? FOR THE PAST SIX YEARS, Dr. Beryl Bechtold, chief optometrist and practice administrator for Michael J. Schermer, MD, Inc. in Sacramento, CA, has been overseeing optometric interns in the practice. What originally started with a local optometric student looking for an internship opportunity close to home has now evolved into the practice bringing in a new intern from the Southern California College of Optometry (SCCO) every three months. Dr. Bechtold says the intern works right alongside the doctors in the practice and is involved in the patient exam as much as possible. “They work up patients and then we of course review their work and review the case with them,” she explains. “Some things are straight-forward and other things are something they haven’t experienced, which is obviously what we want to broaden their knowledge base.” The interns also have the opportunity to see what it’s like to work in a private practice, including one with both an ophthalmologist and optometrist. “They’re having real life primary care experience,” Dr. Bechtold adds.

Intern 101 Dr. Harue Marsden, Associate Dean for Clinical Education at SCCO, says an optometric intern is an optometry student in the clinical training portion of their curriculum. “They are providing direct patient care or dealing with patients in a clinical situation,” she says. At SCCO, fourth-year students go on four clinical rotations – one at the school’s on-campus clinic, and the other three outside of the school, which are called externships. Dr. Marsden says SCCO has externship sites in a variety of opportunities, including hospitals, community-based health clinics and private practice, from as close as Southern California to as far away as Japan. “We definitely have a nice balance of what the students have the opportunity to get exposed to,” she adds. Another example of an optometric externship program is at SUNY College of Optometry in New York, NY, where all fourth-year optometry students are required to rotate out in an externship, says Dr. Patricia Modica, Assistant Professor who oversees the school’s optometric externship program. She says their students also take part in four rotations during their fourth year – two inside the school and two externships outside the school, and sites include military, hospital, outpatient clinic, and private practice settings. Getting Ready If an ECP is considering bringing an optometric intern into their practice for the first time, there are a few things they need to initially think about. For instance, Dr. Marsden says the ECP needs to ensure they can provide an encounter that offers the intern an opportunity for independent patient care, and that the intern will not just be used as a pre-tester or Continued on page 20


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Although vision care providers are often placed in a primary role of advising older patients about their ability to drive safely or legally, a new study found that the most frequent tests they use fail to capture the complexities of visual function that contribute to safe driving. In addition, the driving tasks about which they usually inquire include some, but not all, tasks commonly associated with crash risk. The study, which was conducted by the University of Michigan and published in current issue of Archives of Ophthalmology, found that common situations that prompted ECPs to ask patients about driving included poor visual function, inquiries from the patient or family and requests from the state. Visual acuity and peripheral vision testing were frequently relied on and

For example, questioning about night driving, reading road signs, and experiencing glare were frequent, but inquiries about driving tasks such as making left turns were infrequent. The likelihood of asking about specific driving tasks was significantly greater with more time in practice and with a higher percentage of older patients in their practice, and the likelihood was significantly less for ophthalmologists that it was for optometrists. The authors of the study concluded that ECPs need more education about useful resources, tests and questions.

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technician at the practice, but will be “challenged with the decision making and technical skills involved in an eye examination.” At the same time, Dr. Marsden says, the ECP needs to be ready to take responsibility so there is direct oversight. Dr. Bechtold agrees, saying ECPs should prepare to take more time with the intern – such as if there’s an interesting patient case you want to take the time to show them – which can interfere with your schedule a bit. “I’m delighted to spend the time (with them) because I know it’s contributing to the profession,” she adds. Additionally, Dr. Bechtold says to plan on taking the first week to orient the intern to the flow of your system. However, she says that the interns are so well-trained; they already come with a very good knowledge base. “I don’t feel like I have to really teach them the basics – it’s more reviewing things case-be-case, building on the basic knowledge they have and the real life experiences,” she says. Add to the Team Just like when bringing on any new member to the team, staff needs to be introduced to the optometric intern and understand why they are there. Dr. Modica says for private practices that bring on an intern, many times the intern will be interacting with the staff quite a bit as it will often be the staff handling the intern’s scheduling. “I always tell the staff you have to treat that extern as a member of your staff as well, and if there are any problems or concerns you express them to the student and then you certainly express them to me,” Dr. Modica explains. Dr. Marsden says that many times they have found staff to be very helpful in creating a learning experience for the intern, such as teaching them the ins and outs of the front desk. However, she says it’s also important for staff to understand while the intern is not just there to passively shadow the doctor, they still have limitations. “They’re not the doctor, so they don’t have the ultimate say.” Dr. Bechtold says in her experiences with interns, they rarely had issues with personalities not meshing, which she says is important when you are trying to build a team that works well together. “Most of the time it’s been a really wonderful thing ... and we consider them part of our family,” she adds. Preparing Patients Once staff is on board with the idea of an intern, it’s time to introduce the new teammate to your patient base. Dr. Marsden says one of their externship sites announces each intern to their patient base just like they would a new employee. “It’s like 20 | EYECAREPROFESSIONAL | NOVEMBER 2012

bringing in any new equipment or employee on staff – you want to introduce your patients to them and that helps make them a little more comfortable with the transition,” she adds. Dr. Modica suggests letting patients know about the strengths the optometric intern will bring to the practice, such as their knowledge of recent, cutting-edge technologies. “(The extern) can bring something that the supervisor may not have, or they can bring an area of expertise the supervisor may not have,” she explains. For her interns, Dr. Bechtold places an 8 by 11 sign on the front desk with the intern’s name and photo, which lets patients know there’s a chance they may be seen by the intern. Although she says patients have the right to refuse to be seen by the intern, most of the time she receives very positive comments from her patient base. “Patients enjoy being part of the learning experience,” she explains. “When I ask a patient their permission if an intern can come and see something in their eye, they’re more than happy to. It’s rare a person who doesn’t see this as an opportunity for an intern to learn.” Is It For Me? So, is bringing on an optometric intern for you? While Dr. Marsden says bringing on an intern is not for every practice, those that do may find their patients have a great respect for them as a practitioner that teaches and has an affiliation with an academic institution. “It certainly has some value to the practice and value to the public well-being,” she says. And Dr. Modica says private practice externships can help open the door for students to potential employment opportunities, and even help practice owners find a new graduate to take over their practice if they’re near retirement. “Sometimes it’s a great way for them to see if a certain person is a good fit for their practice,” she says. Overall, Dr. Bechtold says her experience with optometric interns has been really positive. She says although it does take more time to work with an intern, it’s a good learning experience for them. And she says working with interns has challenged her to continue to grow and keep up with the latest technologies. “I’ve learned just as much from interns as they’ve learned from me because there are always new things that we’re not exposed to,” she says. “In private practice you don’t have time to read about and stay on top of everything – they’ve brought new ideas and suggestions.” ■


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MOVERS AND SHAKERS CooperVision

Essilor Acquires Hirsch Optical

CooperVision, Inc has appointed Mark Harty as a new president leading the company’s European efforts. Harty has extensive experience as a general manager working in numerous international roles. Most recently, he Mark Harty served as the general manager, Medical and Surgical Division of United Drug (UK) Holdings Ltd. He also held the positions of VP and general manager at Boston Scientific, UK, president of Masimo PLC, UK, and VP and general manager—Global Critical Care, Edwards LifeSciences in the U.S.

Essilor has also acquired Hirsch Optical, a major wholesale laboratory. The company, which had been owned by Roz Rothstein, Michael Rothstein and Ken Mittel was founded in 1978. Hirsch Optical generates annual sales of $8.3 million. It serves customers in New York, New Jersey, Pennsylvania and Connecticut. The current management team, headed by CEO Michael Rothstein and senior VP Ken Mittel, will remain in place. Essilor also owns another lab in Farmingdale, Tri-Supreme Optical, which includes a stock lens distributor, The Lens Connection.

American Optical Services Marchon Marchon Eyewear, Inc. has announced the appointment of Erwan Le Guennec as the new international travel retail director, a new position within the company. Le Guennec will be based out of Marchon Europe BV in Erwan Amsterdam, reporting directly to Nicola Zotta, Le Guennec managing director of Marchon Europe BV. Le Guennec brings over 10 years of experience in the luxury sector and strong international expertise. Previously, he was with the LVMH Group working as the travel retail director of Europe and Africa for fragrance brands.

OD Excellence OD Excellence (ODX) has appointed Al Gleek to the new role of director of vendor relations. Gleek brings over 30 years of optical industry experience to ODX, including working with a diverse customer base of leading sport and Al Gleek fashion brands in the sunwear product arena. Gleek’s experience includes wholesale lab ownership and contact lens distributorship, and he was the manager of Sola Optical Technical Service Department and served as national sales manager for Bausch and Lomb Sunwear.

Essilor Acquires Balester Optical Essilor has acquired Balester Optical, a major independent wholesale laboratory based in Wilkes Barre, PA. The purchase price was not disclosed. The lab has been controlled by the Balester family since it was founded in 1934. Dale Parmenteri Balester Optical’s management team, including Heather Balester and Dale Parmenteri, will continue to manage the lab’s day-to-day operations. The lab, which has 75 employees and produces about 830 Rx jobs per day, will generate Rx sales of about $13.3 million in 2012.

22 | EYECAREPROFESSIONAL | NOVEMBER 2012

American Optical Services (AOS) is continuing its steady expansion pace in the vision care market with the acquisition of South Florida Eye Associates (SFEA), a prominent ophthalmology practice based in Miami, Fla. SFEA has been serving South Florida’s eyecare needs for the past three decades with 10 locations and an additional 11 affiliates throughout Dade, Broward and Palm Beach counties. The acquisition brings AOS’ current total location count in the U.S. to 95. AOS also acquired the 5-unit Eyear Optical in McAllen, Texas a week before the SFEA purchase.

European Sunglass Association and The Vision Council Merge The European Sunglass Association (ESA) and The Vision Council announced last month their intent to merge. Both parties signed a comprehensive Joint Operating Agreement— effective immediately—with the goal of fully merging the ESA into The Vision Council within 12 months. To ensure a seamless transition, the ESA, its leadership and related committees will remain in place for one year. ESA members are entitled to select from six operating divisions within The Vision Council that provide guidance, education programs, marketing materials, research and advocacy outreach to address common interests among members. Each member is also eligible to serve on the various committees, subcommittees and task forces under The Vision Council structure.

VisionWeb Names Labs of the Year VisionWeb has selected Luzerne Optical in Wilkes Barre, Pa., Milroy Optical in Tampa, Fla. and Vision Craft in Walled Lake, Mich as their 2012 Lab of the Year honorees. The VisionWeb Lab of the Year program was created seven years ago as a way to reward spectacle lens laboratories that have shown exemplary results growing and maintaining customer loyalty using VisionWeb.


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Aflac Launches “Vision Now” Individual Insurance Plan Insurance provider, Aflac has launched a new insurance plan for individuals known as Aflac Vision Now. In addition to a benefit of $45 for one eye examination per covered person per policy year, Aflac Vision Now also offers coverage for serious eye conditions, including $750 to $10,000 for permanent visual impairment, $50 to $1,500 for miscellaneous eye surgeries, and $1,000 for specific eye diseases and disorders. “While most vision care plans are limited to eye exams and vision correction materials, Aflac’s Vision Now product offers true vision insurance, paying benefits for eye diseases or disorders, eye surgeries and even permanent visual impairment,” said John Harmeling, senior vice president of worksite marketing at Aflac. Aflac offers three different vision correction benefits—Option One: $80 for prescribed vision correction materials (such as prescription glasses or contacts) or $130 for refractive error corrections

surgery (such as RK, Lasik, etc.). There is no waiting period, and the benefit is payable once per covered person, per policy year. Option Two: $175 for prescribed vision correction materials or $295 for refractive error corrections surgery. There is a 12-month waiting period, and the benefit is payable once per covered person during each successive 24-month period. Option Three: $270 for prescribed vision correction materials or $480 for refractive error corrections surgery. There is a 24-month waiting period, and the benefit is payable once per covered person during each successive 36-month period. Aflac Vision Now coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. Policies may not be available in all states, and benefits may vary by state.


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THROUGH THE LENS Renee Jacobs, OD, M.A.

Deliver the Free Form Progressive “WOW” Remember Common Sense + Degrees of Freedom Before the days of Free Form, we applied Old Time Common Sense to prevent the consequences of the progressive non-adapt. Remakes cost time and money. Remakes can even damage customer loyalty. With all of the new Free Form technology advances, one might think that progressive non-adapts would go the way of the dinosaur. Yet from experience, we know that some patients report they see better with their conventional progressives than with their new Free Form lenses! This can be exasperating, especially if the optician overpromised a “WOW”.

clarity when the progressive blend zone was compressed into smaller regions of each lens surface along with a reduced intermediate corridor. The science of optics has not changed. Opticians can still apply Old Time Common Sense to preventing the Modern Problem of Free Form Progressive Non Adapt. 3. After adapting to progressive lenses, patients often favor what they are most accustomed to wearing. This means that a “long corridor patient” might not readily adapt to a short corridor lens, and vice versa.

Old Time Common Sense

Degrees of Freedom

Remember, back in the day, when we had “that patient”. You know the one. She had successfully worn progressives in the past, but then seemed unable to adapt to her new prescription. When we had “that patient”, we knew what to do. We’d review the change in prescription. We’d research the progressive brand our patient enjoyed in the past. Then we applied common sense using what we know about optics:

Free Form technologies offer tremendous visual benefits, provided we remember to apply what we know from the past.

1. Higher Add powers have more “swim”, peripheral blur and aberrations. Knowing this, wise opticians warned their patients that increasing add power will improve reading. However, increasing add power requires an adaptation period because the peripheral vision experience changes too. 2. Short corridor progressives have more “distortion” than long corridor progressives. In the old days, when a patient selected a small frame, such that the distance from the ‘center of the pupil’ to the ‘bottom of the eye wire bevel’ was shorter than the ‘minimum fitting height’, it became necessary to order the ‘short corridor’ option. Most conventional progressives came with two choices: a long corridor (about 18 mm), or a short corridor (about 15 mm). Back in the day, when we needed the short corridor, we warned patients to anticipate a period of adaptation. We knew that patients would experience a reduced width of 24 | EYECAREPROFESSIONAL | NOVEMBER 2012

Exercise caution, because in modern days, some vendors are presenting free form technology as magic rather than science. They hold back proprietary design secrets while promoting the amazing: • Robotics enabled labs can turn virtually any single vision lens into a Free Form Progressive. For eye care providers, this means greater material availability, greater antireflective treatment compatibility, and fewer backorders. • Patients receive the prescribed Rx, accurate to 1/100th of a diopter. • The power progression from the center of the pupil to the full prescription add power is no longer limited to only two “minimum fitting heights”. Some brands offer multiple corridor lengths. • Lens topography can be “Customized” and “Personalized” so that the patient’s visual experience is more “Natural”. Vision through Free Form lenses is more like vision through contact lenses or vision before the patient needed eye wear. Advanced Free Form optical design software allows lens engineers to control the optics of individual points over an


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entire lens surface. Complex design recipes include merit functions for Degrees of Freedom, variables that are free to vary within design calculations. For example, given a prescription, an add power, a corridor length, and a reading width, the lens design software can be programmed to reduce the aberrations of oblique astigmatism, power error, spherical aberration, coma, and/or distortion. Prioritizing these variables might have the unintended consequence of creating an exceptionally thick lens. For this reason, the lens engineer will specify point spread functions, on the progressive lens surface, where weight and thickness take priority over reducing aberrations. In brief, free form lens design is complicated, proprietary, and patent protected. In some instances certain variables cannot be altered within the program. Eye care providers may never fully understand all design parameters, yet we know enough to discern that free form progressives have the potential to provide better optics than conventional progressives. Applied Science With this in mind, remember that optical math is not new. In 1924 we had calculations for Corrected Curve lenses. The big advancement of today is lathe technology that can cut a unique lens shape, calculated to provide best possible optics for an individual prescription, at a cost some patients can afford. Free form is not magic, but the technology is pretty amazing! The advantages of Free Form technology are truly remarkable. However, free form technology is science not magic. As with most optics, the free form advantage is minimal for small prescriptions. It becomes increasingly more significant for high spheres, cylinders, and add powers. Some would argue there is very little advantage for prescriptions close to plano. This is why opticians who promise “High Definition Edge to Edge Clarity” are overstating the truth. Remember math, apply both common sense and experience. Always read the fine print too!

high cylinder, or high add powers. Utilizing Free Form technology, we can provide “wider zones of best possible optics” and “thinner and lighter” lenses. At best, the improvement may be 20% to 30% better than the identical Rx in conventional progressives. Even with free form technology, it is scientifically impossible to remove all distortion and aberration due to the progressive blend zone. This means that the distance between ‘the center of the pupil’ and ‘the full reading add power’, is just as important today as it was in the past. Old Time Common Sense Prevents Modern Free Form Non-Adapt If your patient has been generally pleased with their conventional progressive lens, then study the appropriate fitting chart and order a new free form progressive with similar parameters. If your patient was successfully wearing a short corridor conventional progressive, fit a free form short corridor lens. If instead, your patient was happiest with a long corridor lens, then make certain the new frame will fit a long corridor free form progressive. Corridor length is one part of a custom design, one significant Degree of Freedom opticians can control to improve their success moving patients from conventional lens designs to free form lens designs. Continued on page 26

Progressive Layout Guide

Fitting Cross

At best, most manufacturer websites report that free form technology, the combination of design software algorithms plus digital surfacing capability, decreases optical aberrations and distortion by 20% to 30%.

Corridor Length

Technology exists to improve the width of best possible optics by 20% to 30%. Near Verification Circle

Because higher prescriptions have more inherent aberrations, those patients with high prescriptions will benefit most from free form technology. Minimum Fitting Height

Though we can surface to 1/100 of a diopter accuracy, most doctors write prescriptions in units of 0.25 diopters. th

It is mathematically impossible to provide both “edge to edge clarity” and “thin lenses” for prescriptions with high sphere, NOVEMBER 2012 | EYECAREPROFESSIONAL | 25


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Fitting Cross When the optician measures from the bottom of the frame to the center of the pupil, the measure is a “fitting height”. Corridor Length The distance between the bottom of the fitting cross and the top of the near verification circle is the corridor length. Corridor length is a parameter opticians can customize with top tier free form lenses. Either match the previous lens or determine a corridor length best for your patient’s activities of choice. Near Verification Circle The near verification circle indicates the best reading area. Most semi-finished progressives define a width of 4 to 5 mm. In general, for most prescriptions, free form lenses will have wider sweet spots than conventional progressive lenses. Minimum Fitting Height Most manufacturers recommend a minimum fitting height, for conventional progressives, which allows removal of approximately 1 mm of the near verification circle. Calculate a Free Form minimum fitting height by adding about 4 mm to the corridor length. In either case, consult your manufacturer for exact specifications.

face, he will see through the compensated Rx exactly as he saw through the phoropter when the doctor measured the “Prescribed Rx”. Vendors do not share the calculations used to arrive at the Compensated Rx, because methods are proprietary. However, vendors do include the Compensated Rx with the finished order so that opticians can verify the accurate prescription. Jason Kvam, Supervisor of Technical Services at Seiko Optical Products, Inc., cautions opticians to use what they know. Carefully consider each patient’s prescription, and never overpromise a WOW. Think back to the formulas for calculating Effective Power and Compensated Power. These equations validate that the benefits of free form are even greater with higher corrections and for patients with significant astigmatism. In addition, pre-adjusting the frame, before taking measures for an accurate order, is still critical to delivering best possible optics and physical comfort. Also, taking accurate ‘As Worn’ measures will sometimes confirm that your patient’s fitting parameters are average. Many vendors offer free form lenses perfect for the average patient. Jason says, “At Seiko we don’t require customers to measure Vertex distance or Pantoscopic tilt. We base all compensated RX’s on the average ‘As Worn’ position of all patients which is 12mm Vertex distance and 8 to 10 degrees pantoscopic tilt.” Some sport prescriptions are compensated to the wrap angle provided by the optician.

Deliver the Free Form Progressive “WOW” Once you create a Free Form power progression from the distance lens to full reading, similar to the power profile your patient successfully wore in the past, then you are ready to optimize the free form advantage. Increase the width of the sweet spots by 20% to 30% by including the measures of fitting height, vertex distance, pantoscopic tilt and wrap with your order.

Just like in days gone by, modern opticians can practice Old Time Common Sense to prevent the consequences of the progressive non-adapt. Simply design the Free Form progressive power profile, from distance to full add power, to match what your patient wore successfully in the past. Corridor length is a Degree of Freedom opticians can control to improve success with new technology lenses.

Optimize Lenses for Position of Wear

Then assure the free form advantage by including ‘As Worn’ values with your order or take the additional measurements that the manufacturer recommends. Be careful what you promise. Set expectations of visual improvements that are possible when you evaluate your patient’s prescription numbers. With knowledge of optical science plus good old fashioned common sense, you can earn continued customer loyalty and avoid the expense of remakes. You can make progressive non-adapts go the way of the dinosaur, and deliver on your promises of the free form WOW. ■

Top tier Free Form lens designs will customize the doctor’s prescription so that your patient experiences the “Prescribed Rx” when they wear the glasses uniquely fitted to their face. When opticians provide measurements of fitting height, vertex distance, pantoscopic tilt, and wrap, proprietary software will generate the “Compensated Prescription”. When you verify the lens, you will measure the compensated Rx and not the original doctor’s prescription. According to the manufacturers, when your patient wears the lens, exactly as the frame fits his or her

Progressivelenses.com 26 | EYECAREPROFESSIONAL | NOVEMBER 2012


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THINNER. STRONGER. IDEAL FOR ANY FRAME INCLUDING DRILL MOUNTS.

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T H E

U LT I M AT E V I S I O N


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THE MOBILE OPTICIAN

Ginny Johnson, LDO, ABOC

CRAZY

The first patient hand off came with no instructions, which seemed odd to me coming from a doctor who gets it. Within seconds her less is best approach made total sense to me. I invited the patient to have a seat at the dispensing table while I pulled up his exam results on my laptop. Before I could say one word the patient plopped down and went on a political rant. He took me to a right wing, left wing, liberal tea party while I worked to politely interject and cue him back to his optometrist’s office. When he finally ran out of political hot air he said he would not be updating his prescription. He didn’t want to risk ruining his blinking recovery time by purchasing -3.00 sph. lenses when he could quickly get back to decent vision with his -2.50 sph. lenses. He didn’t care if things were blurry sometimes even though that was his chief complaint for today’s visit. He hoped I understood and didn’t think he was crazy. I said I would make sure to let the doctor know his decision. He had been given a patient report recapping the visit and a copy of his new prescription and I told him we would be right here if he needed us.

For thinking today would be normal I’m crazy for trying And crazy for sighing Am I crazy for blaming the moon? LAST TUESDAY was a mentally strange patient day. Every single patient that I worked with had some sort of craziness going on. I know it wasn’t all in my head because throughout the day, in my brief conversations with the doctor, we both felt like we were on a full moon funny farm. I’m told we can fix vision problems but we can’t fix crazy. Nobody wants to mess with Mother Nature. 28 | EYECAREPROFESSIONAL |NOVEMBER 2012

The second patient had already diagnosed himself as a cheapskate and wanted magic OTC readers that worked miracles. He didn’t need to wear his eyeglasses full time. The doctor prescribed occupational lenses with AR. The patient made up his mind before he came in that he wasn’t going to spend any extra money and only wanted what was free through his vision plan. He did not want to pay for something not knowing if it would work for him and be stuck with it which would be a waste of money. I said I didn’t blame him. Luckily our ultimate goal is not to take money from patients and stick them with something that doesn’t work. We spent the next several minutes discussing his vision frustrations. He asked if it was possible to have the lenses made and try them out for a few days before he paid us. I said that’s not possible yet but maybe it will be one day. Then I said it didn’t look like I was going to be able to help him since his basic plan allowance didn’t match up with the vision correction he was requesting for free. I said that maybe down the road when those OTC readers get bad enough and it’s worth it to him to pay for what he needs then he should come back and see us. I asked him to have a seat in our sub wait area and the doctor would call him back shortly to finish the exam. I turned to go to my next


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patient and he stopped me and said he’d like to go ahead and order the lenses that I recommended. My next patient wanted me to tell him if I saw a scratch on his left lens near the top left corner. I inspected his left lens and confirmed that there was indeed a tiny scratch and I would be happy to order him a new lens. He stood there for a few seconds and said I made him feel a lot better about things. He thought maybe it was his mind playing tricks on him because he felt like his body was floating and thought it might have something to do with the scratch. If I didn’t notice a scratch he was going to make an appointment with his neurologist. I made sure that he knew that I wasn’t advising him not to make an appointment with his neurologist. I had never heard of a tiny scratch in the corner of a lens causing body floaters. In order to leave work early and come in for his annual contact lens exam our next patient didn’t care what it took. He struggled to get through the door with three heavy duty strands of copper electrical wire draped over his left shoulder that trailed about five feet behind him. His boss allowed him to leave early as long as he agreed to bring the wire back to work in the form of a 36” wreath. As he waited to see the doctor he worked on braiding the wires while ignoring his surroundings. When his name was called he managed to dodge the other patients and apologized for taking so long to get down the hallway as he avoided scratching up our walls with his long wire male veil. On his way out he said that he would see us next year and there’s no telling what to expect.

A teenager and her mother came in next to order a pair of replacement eyeglasses. Her mother’s story to the first desk staff was that her daughter had broken her current glasses beyond repair. The teenager totally bypassed the front desk and walked straight over to a section of age appropriate, eye catching frames and started trying them on. She began to tell me that her auntie threw her glasses away because she thought they were fake. By fake she meant not real prescription eyeglasses. Then she noticed her mother looking our way and quickly told me to keep her momma away and not let her come anywhere near us. OMG. LOL. I told her there was no way I was going to tell her momma that. So what’s the real story about what happened to your eyeglasses? With her back turned on me she admitted that she broke them because she wants to wear contact lenses. Her mother refuses to talk about contact lenses until she can prove she will wear her eyeglasses. Her unaided visual acuity is 20/80 OU. Her mother insisted that we order the exact same frame and lenses through their vision plan. A staff member who has known the teenager since she was a toddler told her that she needs to start wearing her eyeglasses if she plans on getting a driver’s license next year. The teenager just shrugged her shoulders and rolled her eyes and said she ain’t wearing nothing. Thank goodness it was finally time to take my crazy thinking cap off for the day. I guess tomorrow I’ll just shoot for the moon. I’d be crazy not to. ■


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PATIENT CARE Lindsey Getz

Family Framework Finding something for the whole family equates to an easy profit boost TODAY’S FAMILIES know that eyewear is more than a necessity, it’s an accessory. Finding something that suits everyone in the family can be an easy way to boost your revenue. If you see Mom or Dad for visits, encourage them to bring their kids in for an appointment. Or, if you don’t see a patient’s spouse, ask about whether they may need frames and offer a discount. Even if another family member isn’t in a regular prescription you can point them to your reader rack which is surely more stylish than the drugstore variety. Offering a family or multi-frame discount just may be enough incentive to bring everyone into the office. But making the sale also means knowing what works style-wise for everyone from Mom and Dad to the little ones. A little bit of fashion expertise just may lead you to making sales with the whole family. The Hot Trends Today’s big eyewear trend is the “geek chic” look, says Dennis Fortuna, owner and optician at Fortuna Optical in Marlton, N.J. “It’s the heavier, chunkier styles that people are looking for nowadays,” he says. The geek chic style seems to be transcending age and gender. “We’re doing a lot of plastic frames for men and women of all ages,” Fortuna adds. “We’re also seeing a lot of color. The hot colors right now are the varying shades of purple and violet.” This thicker, bolder look is so popular right now that it’s actually trumping brand, adds Frederic Meserall, optician with Meserall Vision and Hearing in Haddonfield, N.J. “For most people it’s more the look than the brand name,” he says. “More 30 | EYECAREPROFESSIONAL | NOVEMBER 2012

people are coming in and saying ‘I saw this look—do you have it?’ And they don’t necessarily care who made the frames.” While men have traditionally not cared as much about the fashion behind their frames, that is starting to shift. “Men are definitely caring a lot more than they used to,” says Meserall. “We’re finding that most men seem to be as fashion conscious as women now. They are taking much more time in selecting their frames. And they’re also going for that darker, thicker, plastic look. We’re even seeing men do more color—maybe an olive or a navy blue. Most men aren’t looking for a frame that disappears on their face anymore.” Although the chunkier styles are big right now, there will always be a place for rimless designs and more classic styles. Both men and women like the subtle look of rimless. It also has that “appeal” that won’t fade with the trends of the time. “Trends do tend to come and go,” admits Fortuna. “Of course the bolder, chunkier styles have been in for a couple of years now so it might be sticking around for a while.” And if your patients like the idea of a trendier frame, but aren’t bold enough to go with a bright color or a heavy, thick style, you can still point them toward plastics but help them select something a bit more subtle. Many patients continue to like the plastic styles that feature small accents like rhinestones on the temples. For the Kids Encouraging Mom or Dad to bring the kids to the eye doctor is important for more than just boosting sales. As part of your


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duty as an eyecare provider it’s important that you encourage parents to have their children’s eye health examined. Most pediatric offices don’t do vision screenings until the child is a little older, and may have already been able to benefit from the use of glasses. And since kids don’t know what their vision is supposed to be like, they often don’t complain or point out any problems. Educate your patients about the importance of bringing their children in for a visit.

“The geek chic style seems to be transcending age and gender.” If kids do need to be fitted for glasses, there are a lot of options to choose from and today most kids enjoy the experience of selecting frames. “Kids seem to be more into color—doesn’t matter if it’s metal or plastic,” says Fortuna. “But kids do often want something that looks like Mommy and Daddy’s glasses so we are doing some bolder plastic frames for kids, too.” “The trends for kids frames are definitely getting bolder,” agrees Meserall. “There was a time when kids didn’t want to wear glasses but now they’re much more receptive to it. It’s actually looked at as a trendy accessory. And if Mom and Dad are in frames, they want to look like Mom or Dad and are happy to pick something out.” While brand seems less important to parents when picking out chunky plastic styles, kids may still care about the name on the frame. “If the child is into sports, they may like a Nike pair,” says Meserall. Point of purchase displays and merchandising materials may also have more of an impact on kids so consider using those posters and other displays in your children’s section. When a child sees their favorite singer or an athlete wearing glasses they may be even more excited about picking out their own frames. With all of the choices available nowadays, getting the entire family into glasses they love shouldn’t be too much of a challenge. As usual, the key is education. Encouraging your patients to bring their whole family in for an exam and emphasizing the importance of seeing kids young is not just a sales tactic but part of your responsibility as an eyecare practitioner. Once you have examined everyone and ruled out any eye health concerns, the focus can shift to frames. Getting the whole family into the dispensary and offering multi-frame discounts and other incentives may be an easy way to get each person into a new pair of eyewear. ■


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SECOND GLANCE Elmer Friedman, OD

My Cataract Surgery – “A Piece of Cake” we first became friends he and his wife invited Lillian and I to dinner at their apartment. We had a wonderful time together. At one point his wife excused herself to diaper their new daughter. We selected that very same child, now grown, to perform my upcoming cataract surgery. I hadn’t a worry in the world since I saw her develop into a world class surgeon and had no qualms about her skills and success. I was, however, hesitant about my ability to conduct myself as a model patient. My threshold of pain is very low and my anxiety is high. I asked for sedation concentrated enough to make me forget my name. I have seen the operation performed, on film, numerous times. I must admit, it gave me a queasy feeling. Sigmund Freud reported that any damage or violation to the eye is considered by the male as tantamount to castration.

There were many news events around the world that occupied our thoughts this year. As a bona fide octogenarian I was aware of a different sort of litany of events like: swelling of the ankles, knee pains, lower back pains, shoulder pains and carpel tunnel syndrome. HAD ENOUGH? NO? I also am experiencing arthritis of my joints, post nasal drip, additional fat and fascia where my abs ought to be, hearing loss and a sudden abundance of strange crusty growths of varying colors and dimensions that seem to have appeared on my skin overnight. How about the results of my prostate removal? Please, let’s not go there. In August I realized that my VA could not be increased by a spectacle change better than 20/40 due to my advancing cataracts. Surgery dates in September were arranged. I have been friendly with an ophthalmologist and his family for more than fifty years. His talented group includes his wife, daughter and son in law in a highly successful practice. When 32 | EYECAREPROFESSIONAL | NOVEMBER 2012

My daughter, Randi, had cataract surgery this year and I was happy to have her act as my mentor. She said that the operation was like Ivory Soap: 99 and 99/100th percent pure. Her experience and those of others who came out of the woodwork was to emphasize that it was, “a piece of cake”. While I was confident about the surgery, I grew impatient with the waiting period. I was required to increase and add tear producing supplements to my diet and start a regimen of drop preparations to ready the eye for the date of surgery. I thought of my good fortune to have lived to this moment that gave me the advantage of modern, up to date advances in technique and instrumentation and caring attitudes by the surgical staff and teams. When one thinks of early history of cataract surgery one trembles at the very thought of needing surgery at that time. It is as ancient as any known form of surgery. Before 2000 BC it is possible that the Babylonians used lens depression to cure cataracts by forcing the lens from its zonular attachments through digital pressure on the globe. Japanese surgeons around 2000 BC had access to relatively advanced metallurgy and used sharp needle knives and fine gold canulae to suck out liquefied hypermature cataracts. I cannot imagine that their reception area would be filled with anxiously waiting patients, their hands holding the fees of grain and pelts. Not exactly “a piece of cake”.

Continued on page 34


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Experience performance and comfortable viewing in changing light conditions with KODAK TransitionsÂŽ Lenses. Two great brands from Diversified Ophthalmics, Inc.

Â&#x2021;ZZZGLYRSWFRP

Kodak and the Kodak trade dress are trademarks of Kodak, used under license by Signet Armorlite, Inc. Transitions and the swirl are registered trademarks and Transitions Adaptive Lenses is a trademark of Transitions Optical, Inc. 3KRWRFKURPLFSHUIRUPDQFHLVLQĂ&#x20AC;XHQFHGE\WHPSHUDWXUH89H[SRVXUHDQGOHQVPDWHULDOV Š2012 Signet Armorlite, Inc.


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But they were thankful that they didn’t need to wrestle with a third party plan. The clay tablets had no room for the small print. There are early Hindu references to a technique referred to as “couching”. This procedure was performed through a corneal incision. An instrument presses on the lens itself to displace it into the vitreous. Special prayers were offered in the hope that the capsule would remain intact. Early references exist in the Bible. Records exist from 400 BC, during the era of Hippocrates as well as Roman records from 10 AD to 200 AD. There are also early Arabic records regarding cataract surgery. These are few since unsuccessful surgeons were decapitated when they failed. It wasn’t until 1748 when Daviel performed the first extra capsular surgery in Paris, leading to advances toward implants and the phacoemulsification procedures of today. Increased knowledge of pharmaceutical ophthalmic drugs led to the use of atropine to dilate the pupil for surgery and help to prevent post operative synechiae. It was used topically and by injection. This was followed by significant improvement in illumination of the surgical area. First, by spot projecting lamps which were often used with blue or other filters to show up the capsule and lens cortex. Magnification glasses and telescopic loupe glasses helped presbyopic and hyperopic physicians support their needs by affording a better microscopic view of the operative field. Suturing was rare in the 1900s, so as a result the patient’s head was immobilized between sandbags or pillows. They were restricted to soft, non constipating food for 10 days following the operation. It calls for another toast celebrating how far we have come to better serve our cataract patients. New designs of multifocal intraocular lenses are now available. These lenses provide near as well as distance vision correction. We are cautioned that proper patient selection and good counseling is extremely important in order to avoid unrealistic expectations and post operation dissatisfaction. The latest design is called the Crystalens. This design allows the focusing apparatus to move back and forth, thus giving the patient a sense of more natural vision. A common practice makes use of the monovision concept. One eye corrected for distance and the alternate eye for intermediate vision. Another type of intraocular lens is the light sensitive one which as far as we know, is still undergoing FDA clinical trials. Once this type of lens is implanted its curvature can be altered with light of a certain wave length. A testimony to the skill of our modern surgeon is revealed in discovering that, in some cases, surgeons may opt for inserting an additional lens over the lens already in place. These types of procedures are called “piggyback” IOLs and are usually considered an option when the results of the initial implant are not optimal. They feel it is safer than replacing the original implant. 34 | EYECAREPROFESSIONAL |NOVEMBER 2012

I exhibited some impatience while biding my time for the main event. Strangely, the closer I came to the kickoff the calmer I became. And why not? I had one of the best surgeons in the area so my confidence was high. Also, I was at the gate, everything was in readiness. All I had to do was show up. Finally, I arrived at the surgical center at the allotted time and was greeted like an old friend by the receptionist and surgeon’s aides. I grew calmer. I was donned with an operating room, germ free gown over my purposely loose fitting clothing. You know the style. The one with the opening in the back that always leads to embarrassment. Thank goodness I was spared that experience. They provided me with a comfortable chair with a commanding view of the TV. They checked my vital signs and asked questions to make sure I was the right guy for the procedure. I provided a suitable artery for the IV to supply the all important sedative to relieve anxiety. General anesthesia is sometimes used in cases of very young children or adults with medical or psychiatric issues. Pupillary dilation was accomplished and topical anesthesia was added. A young assistant walked me into the operating room and invited me to lie upon a table already prepared for me. I wormed my way into the proper position. My face was covered and only revealed the ocular area to be serviced. I was aware of the good doctor’s arrival at the scene and her initial instructions for me. I was a little confused at which part of the target to watch but she said that she was pleased at my compliance. It seemed like only moments later that she reported a successful conclusion to the procedure and gave me a fond farewell. I had only a little awareness of the actual cutting, sawing and trimming. A reward was awaiting me in one of the consultation rooms. I was served a muffin and orange juice followed by several pats on the back for my performance as a partner in the operation. A team of aides then pressed a small volume of papers into my hands and summarized the contents for me. A regimen was charted for me that showed which drops to administer and when. I arrived at the pharmacy with various and sundry scripts for antibiotic, anti inflammatory, tear refreshers and a credit card to pay for it all. Name a letter in the alphabet and I’ll bet that I had a medication that started with that letter. I asked the pharmacist if my medication was the time release type. He said. “Yes, they begin to work after your payment clears.” But seriously, folks, I’m not complaining. My vision is now better than any other time in my life. To those of you who are anticipating cataract surgery I say, “Relax, it’s a piece of cake.” ■


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To participate, sign up online at feaind.com. No other discounts apply. Use of Vision-Ease Lens voucher will not be applied. Lenses must be purchased through FEA industries to qualify. Promotion open to Eye Care Professionals only, and ends December 31, 2012. Payouts will be made once at the end of the entire promotional period, distributed by January 15, 2013. You must have permission from the practice owner to participate.


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OPTICAL SCI–FI Mary Armstrong, ABOC

There is under consideration an optical dispensary concept melding existing and emerging technology innovations to support the currently popular DIY (Do It Yourself) trend. Think of it as not only an augmentation of the online internet eyeglass purchase escalation, but as a means to take advantage of, instead of fighting, the trend. A recent industry survey reports that of the 77% of Opticians who are not now selling online, 31% will be in two years. For those apprehensive about jumping in, architect Rem Koolhaas was quoted in the September issue of The Smithsonian, “The acceptance of certain realities doesn’t preclude idealism...exists at the tipping point between the world as it is and the world as we imagine it.” If your route has been more like that of a salmon – expending all your energy swimming upstream for a single spawn and die in an ever shallower pool, rather than like martialing your art, Aikido-style – going with the flow, leveraging your resources, your New Year’s resolutions might include technological upgrades to Do It Yourself solutions for you and your customers. My proposed Spectacular franchise experience potentially integrates existing technologies such as AccuVIEW®, the Hoya Spectangle® personalized progressive lens fitting (see Sept 2012 EyeCare Professional), VisionWeb®, Indizen Optical Technologies (IOT) free-form surfacing, National Optronics 4-T Tracer® and EMR® processes as entry points to offer further consumer purchasing enhancement packaged services. The actual computer console: “Customer Short Cut Circuitry”, additionally supplies the missing internet links using I-Pad® camera, ACEP Smart Mirror®, Smart Cards, Retina Scan ID, myTelecare® (no surprise as a leading Houston cancer hospital sends their X-rays to India for reading), CodeBaby®, FEDEX® and UPS®. Imagine a pair of giant eyeballs perched (or resting inside of an even larger eyeglass frame) atop an SUV, ala Library Book Mobile, parked at a mall or in a medical building complex, preferably one with ophthalmology and/or optometry prac36 | EYECAREPROFESSIONAL | NOVEMBER 2012

tices. Customers step to the side door to have their retina scanned, which opens the door. A handicap access button is available providing wheelchair lift. Upon entering, a recorded voice states, “Welcome and Thank You for visiting this Spectacular location. Please be seated at the console on your right.” An ergonomically correct office chair is available. “If you require wheelchair accommodation, please press the yellow button on the console. The chair will slide to the left.” A pressure plate under the chair location activates the top of two screens displaying a CodeBaby® Avatar, which prompts the customer to create a personal profile which will upon completion dispense their optical “Smart Card” or directs them to swipe their existing, previously obtained “Smart Card”. An opportunity to update their profile is provided. Upon swiping, the lower screen formatted like an ATM with touch screen selection buttons, is illuminated to allow selection of responses to prompts spoken by the CodeBaby® avatar in the top screen. “Please select from the following to begin placing your eyewear order:” The menu displays a progressive list of choices. For example, an introductory, but abbreviated selection for demonstration example purposes: 1. Fill a new RX? 2. Select a new frame? a. plastic b. metal c. rimless d. men’s/women’s, children 3. View yourself modeling any frame (the swipe card data profile selects the optimum size, color, etc.). 4. Lenses only? a. Frame tracing b. Submit frame (a slide drawer opens, like a bank night depository. A photo receipt is issued.) 5. Price $xxx.xx/ Delivery date.


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6. Delivery method: Spectacular or customer location of choice, FEDEX, UPS. 7. Submit order 8. Credit card payment; Invoice Receipt issued 9. Dr. Directory available 10. Insurance information 11. Online refraction 12. 3-D frame printing ** Most importantly, at the top of every screen is the help advisor prompt: “If at anytime in the process you’d like a Personal Professional consultation, a live (Licensed) ABO Certified Optician will be delighted to assist you for $XX.00 per quarter hour (minimum), payable at the time of service.” The opportunity to finally enact compensation for the designer consultant services you provide has finally arrived. What’s your time worth? How much will you need to fund this new overhead? The unspoken message is clear: “No Free Adjustments; No Free Parts Replacements.” The optical translation of “No shirt, no shoes, no service” and “No Free Lunch” has formally debuted! If they’ve opted for this service by booking an appointment in advance through myTelecare®, the vehicle’s optician, newly promoted Designer Eyewear Consultant, will be available to greet them after pre-screening by the CodeBaby Avatar, one suggested choice being perhaps an Optical Super Hero named “SPEX”, who suggests that the customer make the preliminary entries (DIY). To those entertaining incredulity, I offer reminders of “Bicentennial Man”, 1999, the Space Foundation’s Annual Symposium Exhibit Hall interactive original dialogue Robot greeter, and this year’s “Robot & Frank.” If no live consultant appointment was previously made, they may select their future date and time from the displayed calendar (in the same manner as searching online for airline flights) or opt for a myTelecare® representative to set an appointment. Who are your role models and/or idols in the business world? What traits do they exhibit that you admire? What measures have they taken to make them stand out as the “Go To” artist in their field? To implement freedom and self-actualization, you must choose to set the boundaries of your communication. While you’re tallying your holiday – frame and lens inventory – this December, you’ll have plenty of time to summarize the achievements and advancements that occurred in the optical business for 2012, and whether or not your career has progressed equally as well. Shift from laboriously educating your clientele one-by-one about your value-added services versus online eyewear purchases, posting your pricing by cafeteria pricing and mini-

tweaking your website. Just change the way you do business. Enable your customers to help themselves. For years, in lieu of on-site Human Relations Departments, Wal-Mart and Home Depot have had in-store kiosks for job application; Target has the same for their Bridal Registry. Elevate the perception of the value of your skills by making your customers demand YOU. Manufacture your own exclusivity. You can even make house calls. Ever had a car windshield replaced in your own driveway? Onsite delivery goes back to the Milk Man. We all know the aging population would welcome door-to-door eyewear assistance without leaving the campus. Let Roboptics take care of all the precision redundancies and simultaneously propel you to Rock Optix Stardom, instead of nominating yourself for a Frankenbotch Award. Time Magazine’s July issue consumer press article: “Eyes on the Price” gave optical a bashing. If you are one of the 13 million viewers of CBS/60 Minutes, the October 7, segment on Luxottica made you acutely aware that every optician, dispenser, and doctor is being challenged with how to differentiate their services and products. The designer frame manufacturing vertical supply chain consolidation ensures profits for that frame maker. With the purchasing power of a franchise, you might even qualify for a volume discount from the Big Mozzafella. Eyeglass lab manufacturers have always made every single pair a customdesigned product. Oscar de la Renta upped the ante in 1975 as the first to offer an exclusive line of six women’s couturier signature eyeglass frames. With so much technology variety available, this is an excellent time for opticians to cut themselves in on the mark-up for their part in the customer delivery. Another current example of designer services is Compounding Pharmacy Labs, a self-policing, FDA exclusive, company making one drug at a time for one patient at a time. Eye care professionals have straddled and struggled with balancing the medical and the retail sales blended aspects of the vision ware business. Now there’s even more opportunity for diversifying by partnering to reduce transportation costs and enhance product availability and convenience with ancillary professions. Invite TuneAmp® along for the ride or get yourself oriented. Consider automating your part of the business, deflecting the consumer button-pusheuring to the automation, instead of having the consumer pushing your buttons. “A.I.” = “ArtOfficial Intelligence” and “Angel (or Angle) Investors.” If you’d like to amend your own constitution, declare your own independence, put on your anti-reflective coat to manage your anti/anecdotes on your new path to Frame and Fortune. With a New Optitude, you can have the last laugh at the next episode of MTV’s “Under Employed.” ■ NOVEMBER 2012 | EYECAREPROFESSIONAL | 37


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OD PERSPECTIVE Jason Smith, OD, MS

Eye Care Emergencies: Now or Later? I really enjoy practicing in the world of primary eye care. Refractions, non-invasive procedures, and providing eyewear and contact lenses to the public are a worthy calling for eye care professionals. But sometimes the medical and vision needs of patients become a little more complicated, and we must coordinate a higher level of care at a secondary or tertiary level with internists, MD’s, and ophthalmologists. There are many levels of medical and eye care emergencies that we are called upon to resolve every day. There are some “emergencies” that are really minor problems to the eye care professional but may be considered a serious problem by the patient. Having a screw come out of a pair of eyeglasses is not a medical emergency, but when the patient is a 12 diopter myope and cannot see to drive, we must do everything possible to solve the problem quickly. A patient with a ripped contact lens who is leaving on vacation and does not have glasses or any other contact lenses may need help ASAP. But this is not a medical emergency. And, the most popular “emergency” is that emerging presbyope who has never worn glasses and “this morning”, cannot read the newspaper for the first time. The question that has to be evaluated is whether this really is presbyopia or could it be a retinal problem, cataract changes, or something worse. These presbyopic refractive changes must be differentiated from a myopic shift due to diabetes or a hyperopic shift due to a metabolic problem. According to an August, 2012 Review of Optometry article, “Duke-Elder suggested that hyperglycemia causes a myopic shift, while a decrease in blood glucose levels leads to a

hyperopic shift due to the osmotic force between the crystalline lens and aqueous humor that results from changes in molecular concentration. Some studies in which hyperglycemia was induced have shown a change in the thickness and/or curvature of the lens, altering its refractive index. Sito and Associates stated that the thickening of the lens correlates with the refractive shift towards hyperopia.” Patients also often call because of simple sub-conjunctival hemorrhages that appear very severe to the patient because they are seeing blood in the eye. Usually patient reassurance is all that is necessary, but there should be a review of the patient’s blood pressure and blood pressure medications as well as telling the patient that these hemorrhages can appear from holding a sneeze, vigorous coughing or over exertion. Other less serious problems includes itchy eyes, redness, burning, and light sensitivity (photophobia). Some eye drops can cause pupil dilation. These drops may be adrenergic drops which can dilate a pupil. This pupil dilation needs to be differentiated from a retinal problem, an afferent pupillary defect, or a neurological problem and should be considered an emergency until proven otherwise. There are other scenarios that entail listening to a patient on the phone when suddenly we realize that what is being described is not a minor problem, but is something that we must address immediately. Some of these more serious eye problems include a foreign body embedded in the cornea, conjunctiva, or elsewhere when not wearing safety glasses. I recently saw a case where a student was hit in the eye with a racquetball and was not wearing safety/sports glasses. There have been documented cases of vision loss by children playing soccer. Children “heading” a soccer ball can cause head injuries to a young, developing brain and can lead to vision problems. Patients who have undergone cataract surgery can suffer from retinal detachments after the surgery. There are other cases where people have a loss of their visual field in one or both eyes. This is an emergency Continued on page 40

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situation where the underlying problems can be glaucoma, tumors, or aneurysms affecting the visual pathway. Large foreign objects stuck in the globe of the eye should never be touched or removed. Something of this serious a nature is probably best handled in the emergency room of a hospital. When a patient calls the office of an eye care professional and is concerned about a sudden loss of vision, one of the worst possible causes is a retinal detachment. This sudden loss of vision is an emergency situation and timing is of the utmost importance. This is a case where a retinal specialist will have to intervene in order to do some form of retinal surgery to re-attach the retina. Sending a patient to a hospital emergency room will only delay a potentially positive outcome, unless a retinal specialist is on-call. This is a patient that needs to be seen on an emergency basis in a clinical eye care setting. ECPs should have the phone numbers of every medical specialist and ophthalmologist on their cell phones so they can make that important phone call for their patient. What population group is at risk for retinal detachments? Those people who have had previous retinal tears, retinal detachments, or posterior vitreous detachments. High myopes are also at risk. Do not be lulled into thinking that retinal detachments cannot occur with lower amounts of myopia, because they do. The aging eye can be more at risk for retinal detachments, especially when you reach age 40 and beyond. Those people participating in contact sports who do not wear safety glasses are at high-risk for eye trauma and retinal detachments. The racquetball that is moving at 50 miles per hour can do major damage to the human eye. Boxers, baseball, basketball, and soccer players are also at risk. Diabetics who have retinal traction are at risk. Those families with a history of retinal detachments, previous eye injuries, and cataract surgery can place the eye at risk for retinal detachments as well. What are some of the signs that can accompany a retinal tear or a retinal detachment? These signs may also be similar to a posterior vitreous detachment where the vitreous has detached from the retina. Flashes of light in the eye can be described by patients as “lightning bolts, starburst effects, or a flash cube from a camera.” This is the result of the retina being moved, pulled on, tugged, or torn. This has been referred to as a

40 | EYECAREPROFESSIONAL | NOVEMBER 2012

“neuro-electrical” phenomenon because the retina is a neurological tissue which receives electrical impulses of photons of light energy that has now been disrupted. The flashing lights are caused by the vitreous gel pulling on the retina. The changes to the vitreous allow the gel to push against the retina. Sometimes the flashes of light are accompanied by a shower of floaters.The floaters can be small pieces of cellular debris that have floated into the vitreous or can sometimes be one “blob” of dark material. Most floaters appear dark simply because they are casting a shadow on the retina. Some people describe their retinal changes like looking through a “cobweb”. The floaters are caused by the condensation in the vitreous gel and frequently are described by patients as spots, strands of hair, or little flies. There is no safe treatment to make the floater go away. The possibility of having a vitrectomy occurs only in extreme or emergency cases. Other symptoms include “clouds” or “curtains” coming over one’s vision and peripheral vision loss is not unusual. If the patient experiences a shadow or curtain that affects any part of their vision, this can indicate that a retinal tear has progressed to a detached retina. There is no pain associated with retinal tears or detachments since the retina has no sensory nerves. Sometimes people try to “wipe away” what they think is a smudge on their eyeglasses that is not going away. A true tear will develop when fluid separates the retina from its underlying tissue. Once the retina has been torn, liquid from the vitreous can pass through or under the tear and accumulate “behind” the retina. As more of the vitreous collects behind the retina, the retinal detachment can progress and possibly detach a significant amount of the retina. As eye care professionals, we love the challenge of being problem solvers whether it be putting a screw in a temple to repair a child’s glasses or making a phone call on behalf of a patient who has just suffered a serious injury. We are fortunate to be part of a profession that is diverse, challenging, and rewarding personally and professionally. But we must always be vigilant to “expect to see the unexpected”. And, we must be aware that the patient who believes that there is just a foreign body in their eye may have a far more serious condition to be treated. ■


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LAST LOOK Jim Magay, RDO

Tortoise & Beyond... Just about every material under the sun (and under the sea) has been used in the making of eyewear. ROM THE NOW ENDANGERED TORTOISE – not the Mazzuchelli stuff – I mean the real swimming thing, tortoiseshell eyeglass frames started appearing sometime in the early 1900’s. The color was usually nearly black or a deep dark brown. They had shapes loosely based on the Windsor style but with a heavier look due to their thicker material. Made popular by the actor Harold Lloyd who wore them in his famous 1917 film “Over the Fence” and in all of his film’s after.

F

used to make Corsairs and Cambridge frames. Sad to see all the cheap, lightly gold plated product today. A frame designer recently told me the products of the future will be made from composites like carbon fiber, polyurethane, rubber, materials using nanotechnology, titanium and all its offshoots, and even green (as in recyclable) plastics eliminating petroleum based plastics. We are seeing a lot of luxury frames with wooden bits, horn, and other natural materials. At least one designer is even considering ceramics for frames – that would be extremely durable – unless dropped, but I think his idea was to use it as a decoration on a more practical material.

The real deal – a hawksbill turtle shell at the Boston Science Museum.

Wikipedia tells us: Tortoiseshell or tortoise shell is a material produced mainly from the shell of the hawksbill turtle, an endangered specie In 1973, the trade of tortoiseshell worldwide was banned under CITES (the Convention on International Trade in Endangered Species).

Throughout the 70’s I recall many innovative products. New kinds of plastics – remember Optyl? My sister and I appeared on a local Springfield, MA TV show promoting the material – we heated the frames – bent them all out of shape, then heated them again – and presto, they went back to their original form. We had plastics laminated with fabrics – I once visited a factory in New York or on the Connecticut line that made frames with colorful fabric laminates and classic shapes, can’t recall the name (Lumor?) when they stamped the fronts – the lens shape made a great looking blank and we were given bags of them for my children’s nursery school. (This would be a good contest – who recalls the name of this factory?)

Walrus tusks, ivory, bone, driftwood, solid gold, silver, copper, iron, you name it, it has been tried one time or another. Years ago my Dad was given a hand-carved pair of bone frames with a horizontal slit (no lens) for glare protection from an Eskimo village. And my antique collection contains several blacksmith made iron and brass frames from the 1700’s.

One thing about frame design – the frames must stand up to the most strenuous conditions. Human skin and sweat are highly corrosive. The ph of the skin is between 4.5 and 6.2, quite acidic. I read once that a simple corrosion test was immersing frame material in Coca Cola, as it has a ph of 2.5 to 4.2. I guess if it can take rust off a bumper it can be used to test frame materials.

Visiting the Universal Optical Factory in the 70’s, one could see the bank vault like storage area holding the gold filled material

Can’t wait to see what the next 50 years will bring in frame materials! ■

46 | EYECAREPROFESSIONAL | NOVEMBER 2012


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EyeCare Professional Magazine November 2012 Issue