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OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

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OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

MARCH 2018

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OPTOMETRIC OFFICE EDITORIAL STAFF VP, Editorial John Sailer | JSailer@ FVMG.com Editor-in-Chief Jeffrey Eisenberg | JEisenberg@FVMG.com

Table of Contents 6

Assistant Editor Cara Aidone Huzinec | CHuzinec@FVMG.com Creative Director Megan LaSalla | MLaSalla@FVMG.com Production and Web Manager Anthony Floreno | AFloreno@FVMG.com

Cover image courtesy: Topcon Medical Systems, Inc.

Contributing Writer Michael Chaglasian, OD, FAAO

BUSINESS STAFF President/Publisher Terry Tanker | TTanker@FVMG.com Executive Vice President Shawn Mery | SMery@FVMG.com Vice President, Marketing Debby Corriveau | DCorriveau@FVMG.com

EDITORIAL ADVISORY BOARD Jeffrey Anshel, OD • Sherry Bass, OD • Murray Fingeret, OD • Ed De Gennaro, MEd, ABOM • Deepak Gupta, OD • Alan Homestead, OD • Nikki Iravani, OD • Bill Jones, OD Alan G. Kabat, OD • Kenneth A. Lebow, OD, FAAO • Jerome A. Legerton, OD, MBA Scot Morris, OD • John Schachet, OD • Eric Schmidt, OD • Leo Semes, OD Peter Shaw-McMinn, OD • Joseph Sowka, OD, FAAO Jennifer Stewart, OD • J. James Thimons, OD

DEPARTMENTS 2 | Views 4 | One-to-One 6 | Product Buzz 14 | New Product Gallery 50

16 | Think About Your40Eyes 30

INDUSTRY ADVISORY BOARD Dwight Akerman, OD, Alcon Laboratories, Inc., a Novartis Company Steve Baker, EyeFinity • Joseph Boorady,OD, TearScience, Inc. Sally M. Dillehay, OD, Visioneering Technologies, Inc. Dave Hansen, OD, Ophthalmic Consultant • Carla Mack, OD, Alcon Laboratories, Inc. Dave Sattler, Dave Sattler Consulting Michele Andrews, OD, CooperVision, Inc. • Ellen Troyer, Biosyntrx, Inc. Millicent Knight, OD, Johnson & Johnson Vision Care, Inc.

Throughout this magazine, trademark names are used. Instead of placing a trademark or registration symbol at every occurrence, we are using the names editorially only with no intention of infringement of the trademark.

FEATURES

What steps did you take to build your new service? (Check all that apply.)

50% 10% 13% 18% 33% 26% 26%

Do you type o service th

NO 19%

YES 81%

ort ent ing ff ce iate ify) pm sta vertis y supp spa ation ssoc pec qui r ice d ficend loc an a se s off ase a ndust re e f a o e o e r e l i m ir p ur o mo incre seek add nd yo a sec h er ( hire n oth a exp or ope

8 | Instrumentation: Glaucoma Diagnostic Technology Still Advances

Have you added any type o new product or service to your practice in the last year?

10 | Contact Lenses: Skip the Teenage Angst of Compliance 12 | Docs Speak Out

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VIEWS

Jeffrey Eisenberg

PROTECTING KIDS FROM WHAT WE CAN As much as we might want to, all too often we’re reminded that we can’t protect the children in our lives against every possible danger 24-7. As a parent, I’m still working on accepting this. However, we try to offer them anything within reach that improves their well-being and protect them against everything that we possibly can. That includes their health—and their eyesight. With correct wear and care, contact lenses can offer kids many visual benefits, convenience when playing sports and, in some instances, higher self-esteem. When not worn correctly or not purchased from a reputable source, they can lead to painful, possibly sight-threatening, infections. When you consider that six out of seven teenagers engage in at least one behavior that puts them at risk of a contact lens-related infection, encouraging compliance seems like a Herculean task (page 10). It’s not. The truth is that nearly the same number of adults engage in at least one risky behavior as well. And, as Brook Messer, OD, FAAO, points out about teenagers, “Most of the time they just need a reminder of how to take care of their lenses.” Her advice: Treat teenagers as adults. Assume they are responsible. That’s how you’ll connect with them and hopefully get your message across. In addition to contact lenses, you already protect your patients’ health in other ways, whether it’s by prescribing correction for myopia (or halting its progression),

diagnosing a binocular vision disorder that’s been affecting school performance, or treating any other ocular conditions they have. One additional thing you can do: Remind them to take breaks from screen time. According to the Vision Council, 72% of Americans say their children get more than two hours of screen time daily. Also, 31% of Americans say those same children, as a result, experience headaches, neck and shoulder pain, eye strain, dry or irritated eyes, reduced attention span, poor behavior and irritability. Along these lines, you may be missing an opportunity to help your patients who are digital device users, a new survey from CooperVision shows (page 6). For example, just 14% of contact lens wearers surveyed had spoken with an ECP about digital device use, yet 78% said they would be very interested in exploring ways to reduce eye fatigue with an ECP. And, nearly one in three would be willing to pay a premium for that help. Also in this issue, Michael Chaglasian, OD, FAAO, describes how glaucoma diagnosis continues to improve (page 8). Testing takes less time, so you may have an easier time convincing them to return for follow-up tests. Patients can also participate in their diagnosis by monitoring their IOP at home, providing you with valuable information about their diurnal IOP in the process. While you can’t protect your patients, including teenagers, from every possible danger, there still are things from which you can protect them.

*** Jeffrey Eisenberg | Editor-In-Chief | JEisenberg@FVMG.com

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forth, each one of these companies will be maintained as a separate, standalone organization. JE: With the acquisitions, you’ll have access to Paragon’s Corneal Refractive Therapy (CRT) contact lenses, Procornea’s orthokeratology lenses and Soflex’s specialty lenses. Are these business areas that you plan to actively pursue? For example, there’s been a lot of interest in using orthokeratology lenses to slow the progression of myopia in children. JCA: Overall, myopia management is an area of interest for CooperVision. We’ve been investing resources in this area for many years now. The acquisition of Procornea and Paragon complements our myopia management strategy. JE: Will these acquisitions make more products for managing myopia available to optometrists in the U.S.?

ONE-TO-ONE Juan Carlos Aragon In January, CooperVision, Inc. announced the creation of its Specialty Eye Care business unit, which encompasses Soflex, Procornea and Paragon Vision Sciences. These companies, which CooperVision acquired within the last two years, design and manufacture highly specialized contact lenses for the management of myopia and other indications. Juan Carlos Aragon, OD, has been named president of the new business. In this interview, he discusses how the new business unit fits within the overall CooperVision structure and how this will benefit ODs. Jeffrey Eisenberg: Is the new Specialty Eye Care business a part of CooperVision or does it operate separately? Juan Carlos Aragon: It’s a CooperVision-owned business, but at the same time, it functions somewhat independently from our core business. With the creation of a separate business unit, we now have a management team dedicated solely to Specialty Eye Care, which enables us to really focus on building this area of the business. JE: Do the three companies that make up the Specialty Eye Care business—Soflex, Procornea and Paragon Vision Sciences—still operate as separate entities, or are they now part of this new business? JCA: They are wholly owned subsidiaries of CooperVision. CooperVision acquired these three companies over the past 18 months, and they will continue to function independently, maintaining their corporate names. From an organizational standpoint, the three companies report to me. Although we will share certain resources, expertise, technologies, and so

JCA: Yes. We will be able to leverage CooperVision’s resources to make these innovative products available to a larger number of U.S. eyecare practitioners. JE: What other research areas does the Specialty Eye Care business plan to explore? JCA: Myopia management is probably our number one opportunity in the Specialty Eye Care business. But closely behind that, we are quite interested in scleral contact lenses. The usage of scleral lenses is increasing significantly worldwide, and North America is not an exception. This is an area that we are exploring through Paragon, Procornea and other potential partners in that arena. We are not limiting our potential portfolio of products to contact lenses alone. We plan to explore additional technologies related to contact lenses. Contact lens-related dry eye, as an example, is an area of interest to us. We are open to exploring the licensing, development and acquisition of products and technology that make the contact lens-wearing experience more successful for the patients of our ODs around the world. JE: What advice do you have for ODs to grow the contact lens portion of their practices despite competition from alternative retailers? JCA: CooperVision has always worked very closely with eyecare practitioners to make sure that our products are dispensed appropriately and fit appropriately by eyecare practitioners for their patients. Now, CooperVision has the ability to make an even larger portfolio of offerings—Specialty Eye Care products— available to eyecare practitioners across North America. These are lenses that are not normally available through alternative channels of distribution, because they absolutely require a professional fit and more interaction between doctor and patient. It is less of a commoditized business. You can find a longer version of this interview at OptometricOffice.com.

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PRODUCT | BUZZ LAUNCHES, PROMOTIONS, MERCHANDISING, EVENTS AND OTHER THINGS TO KEEP YOU IN THE KNOW.

Globally, nearly 4 out of 5 (78%) contact lens wearers are interested in exploring ways to reduce eye tiredness with an ECP

COOPERVISION REPORT: ECPS MISSING DIGITAL OPPORTUNITY Nearly four out of five contact lens wearers would like to explore ways to reduce digital eye fatigue with an eyecare practitioner, and nearly three out of four are willing to pay a premium for a contact lens that accomplishes this, according to the latest Digital Device Usage and Your Eyes report from CooperVision, Inc. YouGov.com conducted a multifaceted survey among 9,343 adults, including 1,282 contact lens wearers, in the U.S., Australia, France, Germany, Spain and the United Kingdom. Results showed that: • Some 19% of individuals who use vision correction and 18% of individuals who do not are concerned about the amount of time spent looking at screens. This edges higher—to 26%—for contact lens wearers. • Just 14% of contact lens wearers said that they had spoken with an

ECP about digital device use, yet 78% said they would be very or somewhat interested in exploring ways to reduce eye tiredness with their ECPs. • Nearly one in three contact lens wearers responding to a follow-up survey would be willing to pay a premium for an option that reduces symptoms of digital eye fatigue. To download the report, go to CooperVision.com/Digital-Report.

providing one bill. The survey also revealed that practices spend an average of 70 minutes managing soft contact lenses and that ODs underestimate the effort by 20%. Also, more than 90% of practices agree that consolidating orders through a distributor makes their practices run more efficiently. To learn more, contact Angela Moore at ABB OPTICAL GROUP, AMoore@ABBOptical.com or 954.733.2300 x 7614.

ABB OPTICAL RELEASES PRACTICE EFFICIENCY REPORT “Access and choice” and “one- to two-day shipping” are the two most important considerations ECPs have when ordering soft contact lenses, according to ABB OPTICAL GROUP’s fall 2017 practice efficiency survey. Other important considerations include online ordering, direct-to-patient shipping and

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EYEFINITY PROGRAM CERTIFIES STUDENTS IN EHR USAGE Eyefinity launched its Student Certification Program, which provides optometry students nationwide an opportunity to learn Eyefinity EHR and become a certified user. Topics include the ins and outs of documenting exams in the largest PM platform in private-practice optometry and HR integrations for government regulations. Students can earn a badge as an Eyefinity EHR Certified User to share on social media pages, including LinkedIn. The next Go Live sessions are scheduled for June 14 and August 31. Call 800.269.3666, or go to Eyefinity.com.

STUDIES CITE BENEFITS OF LIPIFLOW FOR MGD Two studies in Clinical Ophthalmology demonstrated clinical benefits of Johnson & Johnson Vision’s LipiFlow treatment for meibomian gland dysfunction (MGD). LipiFlow and LipiFlow II (pictured, right) were introduced by Tear Science, which J&J acquired last year. In the first study, a single LipiFlow treatment significantly improved mean meibomian gland function and significantly reduced mean dry eye signs and symptoms from baseline to three months for soft contact lens wearers with MGD compared to those in an untreated control arm. LipiFlow treatment also increased comfortable contact lens wearing time by approximately four hours per day, on average. In the second study, one 12-minute treatment with LipiFlow was significantly more effective at improving dry eye symptoms associated with MGD than three months of oral doxycycline taken daily. Go to TearScience.wpengine.com/LipiFlow/.

TANGIBLE SCIENCE LAUNCHES DISPOSABLE CONTACT LENSES Tangible Science, LLC has expanded its product family to include disposable contact lenses that are FDA-approved and that use the polymer-based science behind its Tangible Hydra-PEG coating in custom contact lenses. The company’s disposable lenses incorporate a reformulation of proprietary Tangible polymer into the lens material and in the lens packaging. Its first offering will be a daily disposable hydrogel lens sold and distributed by SynergEyes. Call 650.241.1045, or go to TangibleScience.com.

CENTER DISTANCE FLEXOPTICS EXPAND SYNERGEYES’ DUETTE PROGRESSIVE LINE SynergEyes, Inc. has expanded its Duette Progressive hybrid line with the addition of a new lens featuring Center Distance FlexOptics, with an adjustable center distance zone size ranging from 1.8mm to 4.0mm and driven by photopic pupil size. Available add powers are +0.75D to +5.00D. The Duette Progressive line now offers hybrid lenses customizable for the continuum of presbyopia, even for patients who have astigmatism. Call 877.733.2012, or go to SynergEyes.com.

News Imprimis Pharmaceuticals, Inc. now dispenses preservative-free dorzolamide and a preservative-free dorzolamide/timolol formulation, a move the company began after dorzolamide and the commercial products, Cosopt and Cosopt PF, were added to the FDA Drug Shortage List. EyePromise and its parent company, ZeaVision Holdings, LLC, named chairman and CEO Dennis Gierhart, PhD., as its interim-president and promoted Bob Kearns to senior vice president of sales, Brad Hogenmiller to vice president, technology & marketing, and Patrick Curran to senior director of sales. The Neuro-Optometric Rehabilitation Association, International has named Gary Esterow, who founded and operates Esterow Communications, as its executive director. TearLab has passed the acceptance review phase with the FDA for the clearance of its TearLab Discovery Platform, the company’s nextgeneration in-vitro diagnostic testing system, and hopes to bring it to market in the second half of this year. OCuSOFT Inc. announced that it has formed OCuSOFT U.K. Ltd. from which it will offer OCuSOFT Lid Scrub Original and OCuSOFT Lid Scrub PLUS products in this region. VSP Global appointed Michael J. Guyette president and CEO to succeed VSP Global board member Rob Lynch, interim president and CEO since April 2017. The University of the Incarnate Word, Rosenberg School of Optometry has launched the Fellowship in Ocular Disease and Optometric Surgery in rural Logansport, LA, to provide optometrists with advanced clinical training.

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INSTRUMENTATION

GLAUCOMA | MANAGEMENT SWEPT-SOURCE OCT, FASTER PERIMETRY AND HOME IOP MONITORING ARE SOME OF THE LATEST ADVANCES IN DIAGNOSING GLAUCOMA. By Mi cha el Chaglasian, OD , FAAO In ancient Greece, eye color was often used as a diagnosis of glaucoma, and it was thought of as a disorder of the crystalline lens.1 Glaucoma diagnosis has come a long way since, with knowledge about changes to the optic nerve, diurnal IOP, and the advent of automated perimetry and optical coherence tomography (OCT). And, new technologies continue to come into play to improve the diagnosis and monitoring of individuals who have glaucoma. Here are three such examples.

SWEPT-SOURCE OCT Swept-source optical coherence tomography (SS-OCT) is the third generation of OCT imaging, following spectral domain (second) and time domain (first). SS-OCT uses interferometry to create depth profiles, or A-scans, which provide cross-sectional and volumetric images. The major advantages of SS-OCT are faster scan speed and higher-resolution images, thought to provide improved disease protection. SS-OCT is an exciting prospect for practices that heavily utilize OCT, especially retina practices, as SS-OCT can improve efficiency. Early reports indicate that OCT-

Angiography also shows dramatic improvements with SS-OCT. Last month, Topcon Medical Systems, Inc. announced that its DRI OCT Triton Series (pictured above) has received 510(k) clearance from the FDA. The DRI OCT Triton offers easy image capture and a 1Îźm, 1050nm light source with a scanning speed of 100,000 A-scans/ second. The DRI OCT Triton penetrates ocular tissues to visualize deeper pathology and displays highresolution fundus images with clear retinal vessel and macular mapping to allow Pin-Point Registration of the deepest pathology. The instantaneous capture of a high-density data cube, comprised of 512 B-scans, reduces interpolation between slices and allows the most revealing imagery. SS-OCT provides thicknesses measurements of the macular retinal nerve fiber layer and the ganglion cell layer plus inner plexiform layer in the macular area. The ability to measure the macular inner layer thicknesses using SS-OCT may aid in the diagnosis of glaucoma.2 In open-angle glaucoma patients, one study found, decreased peripapillary choroidal thickness in

glaucoma patients, though this was not affected by glaucoma severity. Also, macular choroidal thickness was not significantly decreased, and choroidal thickness did not show any global or localized relationship with glaucoma severity.3

SITA FASTER Humphrey Field Analyzer SITA Faster, or ZEISS HFA3, enables patients to complete 24-2 testing in about two minutes. A company white paper states that the SITA Faster 24-2 test has been shown to run 30% faster compared to SITA Fast, and 50% faster compared to SITA Standard.4 As a result, patients may be more willing to present for frequent visual detection which, in turn, allows earlier detection of progression. Shorter visual field test times have been a frequent request from both patients and practitioners. The dilemma was that shorter often meant less sensitive and more variable. SITA-FASTER appears to have found the best middle ground.

HOME IOP MONITORING Given that IOP fluctuates throughout the day, measurement of diurnal intraocular pressure is important in

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glaucoma diagnosis and management, as single in-office measurements may miss the peak or highest IOP in 69% to 75% of patients.5 While continuous IOP monitoring during the day and night may have been outside the realm of everyday practice, new devices have made it possible for patients to monitor IOP from home.

changes or fluctuations in IOP. During the 24 hours the patient wears the lens, it transmits data wirelessly from the sensor to an adhesive antenna worn around the eye. The patient wears a portable data recorder that receives and transfers data from the antenna to the ECP’s computer via Bluetooth.

In March 2017, for example, the Icare HOME tonometer received FDA clearance for use in the U.S. The Icare HOME features patented rebound technology, automatic right eye/left eye, red and green light signals to help patients correctly position the tonometer, and an automated measuring sequence that can take either a single measurement or a series of six measurements with one touch of a button. The Icare HOME involves no puff of air and requires no drops.

It is important to realize that the device does not measure IOP. Rather, it shows the range of time during the day in which IOP may increase so that ECPs can determine the most critical time of day to measure the patient’s IOP.

One study found that IOP, as measured with Icare HOME for four to six weeks peaked upon awakening and at mid-day and that diurnal IOP measured in the first seven days showed strong correlation to diurnal IOP across the entire study period. Also, patients rated the system as easy to use.6 Another study declared monitoring with Icare HOME was “feasible,” but reported that IOP measured about 0.21mm Hg higher on Icare HOME than Goldmann applanation tonometry.7 Full assessment of diurnal IOP in glaucoma patients has taken a major step forward with the Icare HOME tonometer. Identifying the peaks and troughs of the IOP curve is critical toward developing an individualized treatment and recognizing those patients that are at high risk for progression. Solely relying on in-office IOP measures is simply too limiting. Another home monitoring device, a soft silicone contact lens called SENSIMED Triggerfish, received FDA approval in 2016. This lens, from Sensimed AG, is intended for one-time use to detect even tiny

REFERENCES 1. Leffler CT, Schwartz SG, Hadi TM, Salman A, Vasuki V. The early history of glaucoma: the glaucous eye (800 BC to 1050 AD). Clin Ophthalmol. 2015 Feb 2;9:207-15. 2. Lee KM, Lee EJ, Kim T-W, Kim H. Comparison of the Abilities of SD-OCT and SS-OCT in Evaluating the Thickness of the Macular Inner Retinal Layer for Glaucoma Diagnosis. Gonzalez P, ed. PLoS ONE. 2016;11(1):e0147964. 3. Song YJ, Kim YK, Jeoung JW, Park KH. Assessment of Open-Angle Glaucoma Peripapillary and Macular Choroidal Thickness Using Swept-Source Optical Coherence Tomography (SS-OCT). PLoS One. 2016 Jun 16;11(6):e0157333 4. Callan T, Lee GC, Larson E. HFA3 SITA Faster Results Are Equivalent to SITA Fast and SITA Standard Carl Zeiss Meditec, Inc., Dublin, CA. 5. Huang J, Katalinic P, Kalloniatis M, Hennessy MP, Zangerl B. Diurnal Intraocular Pressure Fluctuations with Self-tonometry in Glaucoma Patients and Suspects: A Clinical Trial. Optom Vis Sci. 2018 Feb;95(2):88-95.

Evidence suggests that Triggerfish is safe, well tolerated and provides reproducible results, yet some studies show that it only provides data on relative changes in intraocular pressure rather than absolute intraocular pressure.8 In addition, its validity at estimating intraocular pressure compared to other methods is still controversial. The most common temporary side effects were pressure marks from the contact lens, ocular hyperemia and punctate keratitis. Glaucoma diagnosis obviously has come a long way since ancient Greece. O|O

6. Huang J, Katalinic P, Kalloniatis M, Hennessy MP, Zangerl B. Diurnal Intraocular Pressure Fluctuations with Self-tonometry in Glaucoma Patients and Suspects: A Clinical Trial. Optom Vis Sci. 2018 Feb;95(2):88-95. 7. Takagi D, Sawada A, Yamamoto T. Evaluation of a New Rebound Selftonometer, Icare HOME: Comparison With Goldmann Applanation Tonometer. J Glaucoma. 2017 Jul;26(7):613-618. 8. Dunbar GE, Shen BY, Aref AA. The SENSIMED Triggerfish contact lens sensor: efficacy, safety, and patient perspectives. Clin Ophthalmol. 2017 May 8;11:875-882.

WHERE TO FIND IT Icare USA 888.422.7313 | Icare-USA.com

Michael Chaglasian, OD, FAAO, is the chief of staff of the Illinois Eye Institute and associate professor at the Illinois College of Optometry and is the current President of the Optometric Glaucoma Society.

Sensimed AG 41.21.621.9191 | Sensimed.ch Topcon Medical Systems, Inc. 800.223.1130 | TopconMedical.com Carl Zeiss Meditec, Inc. 800.342.9821 | Meditec.Zeiss.com/USA

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CONTACT LENSES

SKIP | THE TEENAGE ANGST OF COMPLIANCE

ADOLESCENTS ARE NO WORSE THAN ADULTS WITH COMPLIANCE, BUT YOU CAN STILL REMIND THEM OF ITS IMPORTANCE.

photo credit: CDC/ Amanda Mills.

By J ef f rey Eisenberg In October, the headlines were filled with warnings and horror stories about teenagers wearing illegally sold costume contact lenses, resulting in eye infections that probably looked spookier than the wearer’s original intent. Okay, but isn’t this a careless mistake some teens make just to be the coolest—and creepiest—at a once-a-year costume party? Not entirely. In 2016, an estimated 3.6 million adolescents ages 12 to 17 (14.5%) wore contact lenses, but 85%—more than six out of seven— reported engaging in at least one behavior that puts them at risk for a contact lens-related eye infection, according to a report from the Centers for Disease Control and Prevention. The most frequently reported risk behaviors in adolescents were not visiting an eye doctor at least annually, sleeping or napping in lenses, and swimming in lenses. Still, it’s not necessary to stop from

fitting teens. For example, Brook Messer, OD, FAAO, of Minneapolis, regularly prescribes contact lenses for children and teens, yet doesn’t see high levels of noncompliance. “Most of the time, they just need a reminder of how to take care of their lenses,” she said.

SAME AS ADULTS The idea of 85% of teenage contact lens wearers putting themselves at risk of an infection sounds frightening, but it’s actually comparable to adults. Specifically, 81% of young adults and 88% of older adults also reported risky behaviors, according to the CDC. The most frequent: Replacing lenses at intervals longer than those prescribed, replacing lens storage cases at intervals longer than those recommended, swimming in lenses, and sleeping or napping in lenses. By contrast, the CDC said, adolescents were significantly less likely to report replacing lenses at intervals longer than prescribed and replacing lens storage cases at intervals longer than recommended. Adolescents and adults mostly reported purchasing contact lenses through their ECP, but adults were actually more likely than adolescents to purchase lenses over the internet.

Also, the CDC found, 14.6% of young adults and 11.4% of older adults reported experiencing a red or painful eye that required an office visit compared to 4.2% of adolescents. Additional research bears this out. Mark A. Bullimore, MCOptom, PhD, FAAO, of University of Houston College of Optometry, conducted a literature review of nine studies representing 1,800 patient years of wear in 7- to 19-year-olds. Analysis of the data, published in Optometry and Vision Sciences in June, found a low rate of corneal infiltrative events: 136 events per 10,000 years. One large retrospective study included suggested that the rate of these events was lower in younger children: 97 per 10,000 years in 8- to 12-yearold children, compared to 335 per 10,000 years in teens aged 13 to 17 years. Microbial keratitis was uncommon, with no cases reported in the prospective studies. And, in one retrospective study he included, there were no cases of microbial keratitis in younger children and 15 cases per 10,000 years in teenagers—similar to that reported in adults.

THE MESSAGE Still, you might want to tailor your message to teens. For example, Messer said, teenagers may need

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reminders, such as to wash their hands before handling their lenses, not to wear lenses overnight and to follow the care regimen. “For kids, it’s more about educating them about what can go wrong and reinforcing to them that if something does go wrong, it could impact their ability to wear contact lenses in the future,” Messer said. “So I think it’s just finding something that resonates with them, whether it’s a picture of an eye infection or telling them that someday they won’t be able to wear contacts. That sort of sticks with them.” In some instances, the problem isn’t lack of education but simply forgetting to replace the lenses on schedule. “So we try to come up with solutions, like a reminder in their phone or something like that to get them to replace the lenses more often,” she said. In the fall, Messer reminds patients about the dangers of ordering costume contact lenses from unlicensed vendors and without professional care. “Sometimes we’ll have a little counter display [that says] ‘Ask us about Halloween lenses,’ or on our social media pages there will be little blurbs about safely wearing costume lenses,” she said.

THE CARE REGIMEN Messer often finds that teenage patients are less willing to digitally rub their lenses as part of the cleaning regimen. So, she typically switches 15- to 16-year-olds from multipurpose to hydrogen peroxide care systems and educates them on proper use. “Once they hit 15 to 16 years old,” she said, “they’re responsible enough to understand how to use a peroxidebased system. … So switching them into something like CLEAR CARE [Cleaning and Disinfecting System] that isn’t quite as dependent on a rub-

for each day of wear lessens the worry of proper cleaning and the hassle of noncompliance.

bing regimen with their lenses helps me know that their eyes are staying safe.” (For more on hydrogen peroxide care systems and a list of specific systems, see “Why Hydrogen Peroxide Is My First Choice,” October 2017.) Don’t forget about the contact lens case. When Messer sees an adolescent contact lens patient sporting a red eye, the cause is often an unclean lens case, Messer said. She usually suggests to them that they replace the case every time they get a new box of solution. Or, they might try boiling the case or running it through the dishwasher to kill germs.

THE DISPOSABLE ROUTE Be aware, however, that some teens “tend to be less compliant, listen to instruction less diligently, and sometimes hygiene can be an issue,” said Mary Lou French, OD, MEd, FAAO, of Orland Park, IL. “Females overuse makeup, and males tend to forget to bathe.” The answer to compliance is often daily disposable lenses. “Parents may balk at the cost, which is a different conversation but emphasizing the hygiene issue is what usually works the best,” she said. One-day lenses eliminate deposits, debris, and allergens that may accumulate on extended wear contacts. And, inserting a fresh contact

“I have found from experience that daily disposable contact lenses provide the most success in compliance,” said Anar Maurya, OD, of Atlanta. “Convenience and ease of care with daily disposables is optimal for the young age group. Without the hassle of daily cleaning and storing, parents and practitioner can be put at ease that the youngster will handle the contact lenses well without increased risk of infections.” Another advantage: If a child rips or drops a contact lens, another one can be opened without a significant financial burden. “For this reason, daily disposable lenses prove to be cost-effective for families with children and can be purchased in three-month, six-month, or annual supplies,” Maurya said. (For a listing of daily disposable lenses, see “AT A GLANCE: Daily Disposables,” October 2017.)

EACH VISIT Messer reminds teenage patients at each visit the importance of being responsible. She asks them how they clean their lenses and has them bring their case in at each visit for inspection. “Those are things that I ask them to do when they’re in the exam room, and sometimes it just takes reminding because they’re motivated and they need to do other things, too,” she said. “You just need to remind them how to best care for their lenses. For teens, I think it’s just treating them like adults and approaching them in a way, assuming that they have responsibilities and that they can take responsibility over their lenses—and speaking to them in that way, and trying to connect with them so they’ll actually listen.” O|O O p tometr ic O ffic e. c om | March 2018 11

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DOCS | SPEAK OUT NEW REVENUE STREAMS No doubt, you are feeling the pressures of reduced reimbursements from third-party payers and competition from alternative sources from which patients can get their materials. To compensate for this, you may be thinking about finding new ways to grow your practice and better serve your patients. We asked doctors about what new revenue streams they’ve added in their practices and what advice they had for others. Some common themes occur: using new technology to provide more care for dry eye patients, fitting specialty contact lenses, investing in new equipment, and garnering referrals from satisfied patients.

What steps did you take to build your new service? (Check all that apply.)

23%

YES 77%

40 30 20

50% 10% 13% 18% 33% 26% 26%

10 0

ort e ent ing ff ace tion sociat sta vertis y supp ipm p u e s c q a s r i d e c a st ff re e ffic d lo an a ase ndu re o mo ur o on ire mo incre seek i e add nd yo a sec h r i h n a exp or ope

oth

PLEASE DESCRIBE STEPS YOU TOOK TO ADD A NEW REVENUE STREAM TO YOUR PRACTICE. “Added two clinic slots to see advanced dry eye, purchased the TearLab Osmolarity Test and purchased LipiFlow/LipiView systems.” “We are adding a Pentacam to our office for general care as well as remodeling our frame room, as we also include new software support for our new services.” “We added an OCT. We used to refer out all glaucoma suspects. We are now keeping them in-office and following them with this technology and office visits. One partner does all specialty contact lens fits and LASIK, and the other

Do you plan to offer any type of new product or service in your practice in the next year?

NO 19%

40 35 30 25 20 15

YES 81% Have you added any type of new product or service to your practice in the last year?

does glaucoma.” “For dry eye, added instrumentation, the TearLab. Added a new associate and discuss with patients the availability of myopia control for children.” “Added myopia control center, orthoK fitting sets, IOL Master to measure axial length, and multifocal contact lens (NaturalVue).” “We added vision therapy. To get the word out, I spoke to two different groups of various agencies involved in early development intervention.” “Increased office space dedicated to dry eye. Added diagnostic testing equipment as well as instrumentation to manage lid disease.”

What type of services have you added? (Please check all that apply.)

39% 27% 13% 6% 37% 8% 21% 13%

10 5 0

r s s s s ion other rvice nte cal apy cal nse t le ceuti eceuti n ther ase ce rts vis c y se a a t n o o r e i n a p m t s s s co di vi nu ed cos lty eye add cia dry not spe e v I ha

“Working with ophthalmology group with two cornea specialists and a plastic/ reconstructive surgeon who refer dry eye patients.” “Discussing myopia control with patients who fit the profile for successful CRT fits.” “Opening up a dry eye center, dedicated phone line and a new separate website. Purchased BlephEx and LipiFlow.” “Added new topography and meibomian gland analysis to assist with scleral/GP contact lens fits as well as dry eye treatment.” “In-office BlephEx procedures. Fitting more scleral lenses, not just for keratoconic patients but for dry eye patients as well. Added TearLab services about two years ago.”

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“New associate and introduction of a myopia control program.” “I have been expanding my nutraceutical offerings but am slowly moving my patients to direct shipment for the companies we use because i am running out of room to stock so many new products.” “We expanded our practice in the later part of 2017. With an additional exam lane, giving us four in total, I am going to use the new addition for vision therapy and occupational therapy a few days a week.” “First, you have to maintain the basics, so reviewing recall process to keep encounters up each day in key performance areas is important, then using the database and external marketing to enhance a specialty area. We selected multifocal contacts and shell contacts (especially as a solution to ocular surface diseaserelated contact lens dropouts). We have an OSD center, so we added BlephEX and may add MiBo Thermoflo along with our existing TearLab.” “I recently purchased an OCT, which will allow me to offer a broader service to my patients.” “Purchased an OCULUS Keratograph 5M for its dry eye module. Have been using it to evaluate dry eye patients.” “Target marketing.”

BASED ON YOUR EXPERIENCES, WHAT ADVICE WOULD YOU OFFER OTHER EYECARE PRACTITIONERS? “Adding new technology every year, whether it is in the lab or the medical area, and educating patients about it has increased referrals a ton in our practice. I once heard at a CE class from a wonderful practice-management guru that every year patients come in, they need to see something new or be educated about something new, even if it is as small as changing a rug or picture in the office.” “Stay ahead of the trends. Find new services that distinguish you from others.

Focus on service rather than materials.” “If you are standing still, you are falling behind. Stop complaining that things should not be the way they are, and start defining your practice and your care to this ever-changing world.” “Do everything you can to please the patients that you have. Patients are not as loyal as they used to be, and any little thing will quickly send them away as well as send them to Google for a negative review.” “The healthcare world is going through tremendous changes. I’m in my late 60s, and I know that if I don’t change and grow, the world will leave me behind. In my area, only one physician is not part of a hospital or group network. The days of solo eyecare practice are limited.” “Word of mouth is our biggest referral source. Customizing the experience for each patient and giving them a fun experience like they have never had is our goal. This has gotten our referrals and reviews online to be our number one source of advertising.” “Always do what is best for your patient because word of mouth is the best advertisement that you will ever require.” “Specialty lens fitting—sclerals, multifocals, hybrid, ortho-K—has made my practice thrive over the last 10 years. Attend Vision By Design conference. Get good at fitting these, and drop every vision plan. Also include low vision services. It’s very easy to have a profound impact on patients with these needs. Be an InfantSee volunteer. It’s well worth the effort to gain new patients from these visits.” “Identify an area of specialty interest and make the investment to differentiate your practice, enhancing patient services and growing the overall practice.” “Go ahead and try. Get a list of patients who might benefit from the new service and promote it.” “Find a specialty you enjoy and network with other ODs/MDs. Share special cases you have seen.”

“Make sure you have dependable, responsible, caring staff.” “Explain how a one-on-one service can better aid a patient’s vision care vs. online.” “Plant seeds every year for new services/products. Even if the patient declines, they will know you have new offerings available. I never want the patient to wonder why they had to hear about things outside our office.” “Take advantage of the knowledge available to you by the companies that support the private-practice optometrist.” “Don’t be afraid to offer scleral lenses in your practice. It is a big referral source once the word gets out that you fit them.” “I have had great success carrying Bruder masks, Cliradex wipes and foam, p.r.n. omega 3s, OPTI-FREE PureMoist and ACUICYN over the last two years or so. They form a nice revenue stream for the office, and the patients appreciate the convenience.” “Address device usage and blue-blocking technology with each patient at every annual exam.” “Just try something; you’d be surprised. Don’t sell yourself short.” “You need to offer better service, a specialty niche, and accept fewer vision plans. Your quality of care and life will improve immensely. Only 10% of our services involve third-party payers.” “Don’t panic, as change will always be part of business, but do something now. Key indicators suggest we have opportunities to expand medical care and differentiate our practices with specialty services. Go beyond refraction and contacts. Make the most of each encounter, addressing all your patients’ medical, nutritional and ophthalmic eyecare needs and wants, and provide great experiences.” O|O O p tometr ic O ffic e. c om | March 2018 13

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THINK ABOUT YOUR EYES

ELECTRONIC MEDICAL RECORDS BENEFIT PATIENTS AND PRACTICES Use of electronic medical records, or EMRs, continues to grow in optometrists’ offices. That’s a good thing. My office has utilized EMRs for 10 years, and the improvement to our office efficiency has been remarkable. For example, we no longer need to decipher handwritten notes, and we have a clear record of a patient’s visit for office staff to reference. EMRs help with diagnosis, as certain entries will trigger additional testing and questions. This ensures a thorough exam for each patient. During audits, our EMRs reflect the quality of care we provide. For example, the records show that we have been thorough in our quality of medical/vision care. These include quality of care measures as part of Medicare’s Merit-based Incentive Payment System, or MIPS. These include documentation about medications being used, and education about nutrition, physical activity and tobacco cessation. Not only have EMRs helped us provide the best possible care to our patients, but they also provide benefits on the business side of our practice as well. Using EMRs, we can review quarterly and yearly results of dispensing of glasses and contact lenses. We also use them to improve the speed of ordering and delivery, which keeps patients happy and returning to us for their vision-correction needs.

Sue E. L owe

Sue E. Lowe OD, FCOVD, FAAO, is a member and past president of the Wyoming Optometric Association and among the 18,000 practices listed on the Think About Your Eyes online locator. First Vision Media Group supports Think About Your Eyes as a media partner.

PATIENT COMMUNICATIONS In addition, we manage patient communications through this system as well, which allows us to send automatic appointment reminders and track and respond to any messages.

about the importance of their vision health and efficiency with their time is a high priority for our office, especially since some of our patients travel longer distances for a visit.

The doctor-patient relationship has improved, as patients think of us as a state-of-the-art practice that keeps up with all clinical care guidelines. EMRs have made scheduling testing and exam time more efficient, further improving our practice capabilities and the quality of care our patients receive.

I’ve been a supporter of Think About Your Eyes since its inception, as is the Wyoming State Optometric Association, of which I am a past president. We work hard in our office to educate patients about the importance of vision health. The advertising and awareness from Think About Your Eyes amplifies those efforts and benefits both our profession and our patients. O|O

My practice serves a large geographical area, with patients from different states. So, communications with patients

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8.4 base curve now available!

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