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NEW RELEASES FOR FALL / PAGE 6
MAKE SURE YOUR PRACTICE IS EHR READY / PAGE 20 September 2012 • Volume 6, Issue 57 • www.ECPmag.com
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SEPTEMBER 2012
EYECAREPROFESSIONAL
Vol. 6 Issue 57
Features 6
Courtesy of Allison America
Contents
Magazine
NEW RELEASES FOR FALL Usher in the new season with the latest releases in eyewear and sunwear. by ECP Staff
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CONTACT LENS CONSUMERS ACT What dispensers should know about the FTC law that covers prescribers and sellers of contact lenses.
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by Anthony Record, RDO
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“HOSPITAL” DISPENSING ECPs could learn a lot from the nurturing experience that the best hospitals offer their patients. by Judy Canty, LDO
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ELECTRONIC HEALTH RECORDS Changing government legislation and technological advancement means that the future is now for EHR. by Corrie Pelc
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INTERVIEW: FEA INDUSTRIES FEA Industries’ Bill Heffner, IV discusses their Personalized Progessives and Independence Coatings. by Paul DiGiovanni, LDO
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EVOLUTION OF THE EYE The development of our most complex organ has come a long way, but there is much left to discover. by Elmer Friedman, OD
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On The Cover: RUDY PROJECT USA www.rudyprojectusa.com info@rudyprojectusa.com
Departments EDITOR/VIEW .....................................................................................................4 MOBILE OPTICIAN .........................................................................................28 PRACTICE PROFILE.........................................................................................30 MOVERS AND SHAKERS.................................................................................34 CONTACT LENS CORNER...............................................................................38 INDUSTRY QUICK ACCESS............................................................................42 ADVERTISER INDEX .......................................................................................44 LAST LOOK .......................................................................................................46
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EDITOR VIEW Jeff Smith
EYECAREPROFESSIONAL
Magazine
The Newest Eye-Pad
A
n exciting new device from France allowed a paralyzed man to send his first tweet last month using eye movements. Not only was he able to type, but he could draw and sign his name in cursive on a computer. The technique, described in the July 26 edition of Current Biology, relies on a novel head-mounted display that uses a camera to track eye movements and then relays that movement data to a computer. Subjects can use it like a pen to write numbers, letters, figures, and even draw using a very simple technique comprising an oculometer and a computer screen. This remarkable feat is based on a visual illusion that enables the eyes to follow smooth and clear trajectories after only several hours of training.
“Contrary to the current belief, we show that one can gain complete, voluntary control over smooth pursuit eye movements,” says Dr. Jean Lorenceau, director of research at the French National Center for Scientific Research, who conducted the study at the University of Pierre and Marie Curie in Paris. “The discovery also provides a tool to use smooth pursuit eye movements as a pencil to draw, write, or generate a signature.” Under normal circumstances, it is extremely difficult to voluntarily produce the smooth, controlled eye movements required for legible script. The effort triggers bursts of rapid eye movements called saccades—the fastest movements the human body can make. So Dr. Lorenceau and his team developed a flickering screen containing static discs at different contrast levels. When observing the discs directly they appear still but when moving your gaze around, the discs appear to move in the same direction. He stumbled upon this discovery by moving his own eyes in front of an unusual visual display in his lab and realized it created some abnormal effects. After a half-hour training sessions with volunteers, individuals were able to write words on a screen at a rate of 20 to 30 characters per minute—equivalent to the normal speed of handwriting. The advance could be of great benefit for people deprived of limb movements, such as those with Lou Gehrig’s disease, as well as stroke sufferers. It might also help to improve eye movement control in people with certain conditions such as dyslexia or ADHD and/or for experts, such as athletes or surgeons, whose activities strongly rely on eye movements. Dr. Lorenceau is now working on enhancing the eye writer, and will soon begin testing it with patients who have neurodegenerative diseases. 4 | EYECAREPROFESSIONAL | SEPTEMBER 2012
Publisher/Editor . . . . . . . . . . . . . . . . . . . . . . . Jeff Smith Production/Graphics Manager. . . . . . . . . . . Bruce S. Drob Director, Advertising Sales . . . . . . . . . . . . Lynnette Grande Contributing Writers . . . . . . . . . . . . . . . . . . . Judy Canty, Dee Carew, Paul DiGiovanni, Gary Fore, Elmer Friedman, Lindsey Getz, Ginny Johnson, Jim Magay, Warren McDonald, Laura Miller, 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 (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 57 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.
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TITAN NEXT GENERATION INTRODUCING THE LATEST ITERATION OF A DESIGN MASTERPIECE.
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New Releases
Fall
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1. Eastern States Eyewear Jaguar Eyewear’s fall optical collection encompasses a full release for both Jaguar’s classic collection and the youthful Jaguar Spirit collection as well. Constructed of a mix of metals and plastic, Jaguar Spirit stands apart with its youthful, sporty design graced with strong, contrasting colors. www.eseyewear.com
2. LINDBERG The new 9800 Strip design represents a delicate blend of details from LINDBERG acetate and titanium plate designs, sculpting a fashion-conscious range distinctive for its softer, subtly curvaceous impact. The upper surfaces of these frames feature more pronounced curves of the eyebrow lines, along with unique screw-free acetate/lens/titanium sandwich detailing typical of LINDBERG technical finesse. www.lindberg.com
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3. Viva International Group From the GANT Eyewear Fall/Winter 2012 collection–- the G Tupper is a key men’s style with a distinctive round shape. The frame’s rich handmade acetate finish is available in black and navy/tortoise. A keyhole bridge adds a vintage element to this contemporary style, along with two metal studs on each corner of the frame’s front. www.vivagroup.com
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4. friezeframes friezeframes launches their first 100% American made collection, Americana. Hand crafted in Southern California, the Americana Collection consists of nine vintage inspired styles for both men and women available in over 30 trend setting colors. The Seattle in Black/Pink Glitter (pictured) will help all of your customers bring out their inner diva! www.friezeframes.com
5. REM Eyewear PCH from Lucky optical features an inspired pattern laminated into the acetate temple, which gives the frame a dynamic design. Rich coloring of the frame provides the customer with bold beautiful selection of feminine color options. The Lucky clover on the temple tip reflects the iconic symbol that is synonymous with the brand. Available in Black, Brown and Plum. www.remeyewear.com
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6. OGI Layered Italian acetate and a swooping arch shape combine to produce Seraphin’s Hennepin. Havana tortoise mixed with white, beige, purple or coral gives the Hennepin a flirty personality with an abundance of style. Chrome hinge accents add a wink of sophistication to the Hennepin’s persona. www.ogiframes.com
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Charmant
CHARMANT TITANIUM adds four new styles to the “statement” series; two for women and two for men. CH12068 is a fashionable ladies floating lens titanium frame with spring hinge and temple design with two-tone linear accent. Available in Size: 50-18-135, in Colors: Black, Brown, Burgundy, Purple. www.charmant.com/us
Rudy Project
Revolution Eyewear
True Religion eyewear portrays the same Hippie, BohemianChic-Flare with a Vintage-Feel-Vibe that their jeans emit, using the finest quality components. The collection has many shapes from modified ovals to aviator. Rich materials are seen throughout the collection in zyl, leather wrapped and stitched temples, and an array of colors such as Cocoa, Golden Bronze, Olive, Brown Horn. Featured is RICKEY KHWI. www.revolutioneyewear.com
J.F. Rey
Rudy Project is unveiling a new concept, guaranteed to make heads turn: Limited Edition “The Will To Win” Diamonds Artist Series – select products incorporating luxurious design with Swarovski crystals. Included in the Diamonds Artist Series is the Hypermask Performance sunglass in black gloss, the new 2013 DeeWhy sunglass, and the Wingspan, the most worn aero helmet at the 2011 Ironman World Championships. www.rudyprojectusa.com
Silhouette Eyewear A great classic never goes out of style. Silhouette’s newest collection, Titan Next Generation, is a modern take on a classic favorite. Perfect for the eyeglass wearer looking to make a polished statement, Titan Next Generation features an updated style while maintaining the innovative screwless, lightweight design elements found in every Silhouette product. www.silhouette.com
J.F. Rey is set to launch its very own Petite Collection for those with smaller faces. The unique designs of the Petite Collection are highly thought out and are meeting the needs of those that require smaller sizes yet do not want to compromise on design. “They should have the same choices and designs as everyone else. They aren’t small, they are FUN SIZE!” says J.F. Rey. www.jfreyusa.com
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Eyeking
Guess
Hobie Polarized Sun Readers are enhanced sunglass lenses that assist consumers with low vision by offering magnification in varying degrees of power. With 3 different style options, these premium polarized sun readers offer a larger degree of optical comfort. All three sunglass styles offer 100% UVA/UVB/UVC protection and feature injected polycarbonate polarized lenses with scratch-resistant HydroClean™ technology. www.eyeking.com
The Nessa frame has a retro cat eye shape, and is perfect for adding a pop of color to any style. The purple and turquoise ombre frames have high definition glitter python printed temples and a purple gradient lens for added color and flare. www.guess.com
ic berlin!
Eyes of Faith
A new twist on the Eyes of Faith signature stained-glass style. This style incorporates an elegant, classic ladies front shape with the faith-inspired, 3-hue “glass” design embedded in the temple. Perfect for those who love delicate, colorful details. Available in size 51-16-135, in Platinum Sea, Shiny Bronze, and Brown www.eofoptical.com
Morel Eyewear Koali takes the new collection to the watery depths of the ocean, with frames inspired by coral reef and more particularly the anemone. The 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. Available in three shapes, and in a palette of four color combinations per model. www.morel-france.com
Shown is linearity in red rough, from the rough (unpolished plastic) collection. Untouched, inviting, raw, naked…the provocative beauty of raw acetate. Pure elegance coupled with a rough and raw spirit. After the award winning power law black rough - from silmo d’or in the sunglasses category – other classics are joining the rough range, including new models in a tricolor style which has never been seen before. www.ic-berlin.de
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Allison America
Missoni vintage capsule – A special restyling with unmistakable Missoni clothes and four unforgettable seasons of rushed acetates (styles MI764 and MI765). www.allisonamerica.com
Trevi Coliseum Eyewear
Cotton Club 331 is a cutting edge frame design with a stylish retro look, constructed of the highest quality Mazzucchelli Zyl temples and brush metal fronts. It features spring temples and adjustable nose pads for added comfort and durability, backed by a two year warranty. These Italian made frames are available in 2 distinct colors, Classic Black and Gun Metal with a multi colored temples. Sold exclusively in North America by National Lens. www.national-lens.com
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Lenses now available in house: s Varilux Physio Enhanced Eyecode™ s Varilux Physio Enhanced Fit™ s Varilux Physio Enhanced Azio™ s Varilux Physio Enhanced India™ s Varilux Physio Enhanced ™ s Varilux Physio DRx™ s Varilux Physio Short DRx™ s Varilux Comfort Enhanced™ s Varilux Comfort DRx™ s Varilux Comfort Short DRx™ s Definity® s Definity Short™ s Essilor Ideal® s Accolade Freedom™ ®
Including the full Crizal portfolio:s: s Crizal SunShield™ UV s Crizal Avancé UV™ s Crizal® Alizé UV™ s Crizal Easy UV™ s Crizal UV™ lenses with Optifog™ Technology ®
Coming soon in house Varilux S Series
Ask us about our premium package program. RECEIVE $10 OFF on all Varilux brands and Essilor Ideal™ lenses that include any Crizal® brand AR. RECEIVE $20 OFF on all Varilux Physio Enhanced Eyecode™, Varilux Physio Enhanced Fit™, Varilux Physio Enhanced Azio™, Varilux Physio Enhanced India™, Varilux Physio Enhanced™, DEFINTY® and DEFINITY Short™ lenses that include any Crizal® brand AR.
© 2012. All rights reserved. Unless indicated otherwise, all trademarks are the property of Essilor International and/or its subsidiaries. CVD 1/12
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MANAGING OPTICIAN Anthony Record, ABO/NCLE, RDO
Fairness to Contact Lens Consumers Act: What You Should Know I was working on the front lines of my optical shop the other day, and a young woman entered. I was helping another patient, so I simply smiled and said, “I’ll be with you in just a moment.” She replied, “I only have one quick question: Do you sell contact lenses?” I said we did, so long as she had a valid prescription, to which she explained, “Oh no...I don’t need a prescription...I just want to change the color of my eyes.” It is for these times at work, and in life, I wish I had an electronic game-show-like buzzer that I could press, and say, “Oh sorry! Thanks for playing.” After all, in the United States there is no such thing as a non-prescription contact lens. That event, coupled with some strange questions I’ve been getting in recent CE classes tells me that maybe we need to revisit some of the guidelines put in place by the FCLCA (Fairness to Contact Lens Consumers Act). Next year marks the 10th anniversary of what is arguably the thing given to us by our last president – George W. Bush – that most affects eye care professionals. I am of course referring to the Fairness to Contact Lens Consumers Act, hereafter referred to as the FCLCA. It was passed by Congress and subsequently signed into law by Bush in 2003. The law mandated that the Federal Trade Commission (FTC) develop guidelines and enforcement regulations, which they did the following year, by way of the Contact Lens Rule. What ECPs know (that apparently the young woman in my shop did not) is that despite the fact there may be no need for vision correction, a contact lens is a foreign body being placed on the cornea. So whether a patient’s correction is plano or +/5.00, the material, base curve, and diameter of that device must be prescribed after a thorough eye exam; not to mention the need for follow-up care to make sure the eye is maintaining a healthy state despite contact lens wear. Additionally, all contact lenses – even ones intended solely for cosmetic purposes – are classified as medical devices by the United States Food and Drug Administration (FDA), and as such cannot be legally purchased in the United States without a valid prescription written by an optometrist, ophthalmologist, 14 | EYECAREPROFESSIONAL | SEPTEMBER 2012
or a doctor of osteopathy. Before the FCLCA was enacted, prescribers could “force” their patients to purchase their contact lenses where they had been examined. This sometimes put an unreasonable financial burden on the patient – or as the law refers to them, the consumer. Also, prior to 2003, when a person purchased contact lenses over the Internet, upon checkout, the seller merely had a field on the order form that read something like: “Do you have a valid doctor’s prescription? Check yes or no.” Now how many people do you think checked no? So ostensibly, to make contact lens wear more affordable and accessible, while at the same time, making sure that consumers were indeed under a doctor’s care...abracadabra...we have the FCLCA, which lays out rules to be followed by prescribers of contact lenses, and sellers of contact lenses. Prescribers: The regulations of the FCLCA apply to any person who is licensed by any state to prescribe contact lenses. The first guideline calls for what can best be described as automatic prescription release. The FCLCA states that when the contact lens fitting is complete, the patient must be given a copy of the prescription – whether they ask for it or not! No extra fee may be charged for the prescription release, and the patient may not sign a form waiving the right to a copy of the Rx. Bottom line – that patient should be handed a copy of the Rx the moment the fitting is complete! Failing to comply with the automatic prescription release can result in a fine of more than $10,000. Also the prescriber may not indicate an expiration date less than one year – unless it is medically necessary.
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A prescriber must also provide or verify the contact lens prescription not only to the patient, but to anyone who is acting on the patient’s behalf. While that seems a little murky, what it means is if another contact lens seller calls and asks for verification of a person’s contact lens prescription it must be given: all pertinent information including any corrections and the expiration date. Sellers: What exactly constitutes a contact lens seller? Well, any person or entity that sells contact lenses! Chances are if you’re reading this magazine you are a contact lens seller. Most opticians and optometrists, and many ophthalmologists are contact lens sellers. Wal-Mart is a contact lens seller, as are all of the online entities that sell contacts directly to the public. What does the FCLCA have to say about contact lens sellers? Basically, the responsibility lies with the seller to make sure that the consumer is able to make the purchase ONLY if he/she is in possession of a valid (that is, not expired) contact lens prescription. As a front-line ECP you validate prescriptions every day. How? By looking at a prescription you are handed; making sure it’s signed, not expired, and looks legitimate, that’s how. However, it’s not that easy for an online seller. For better or worse, the FCLCA is why you get those annoying phone calls every day attempting to verify the validity of a contact lens prescription. I have been told by more than one optician that when they’re busy, they simply ignore the request for verification. Be careful here. By simply ignoring the request
you may be unknowingly facilitating the very thing you wish you could prevent. By that I mean the FCLCA states that when a request for verification is sent, the clock begins to tick. An ECP (in most cases this means the prescriber) has eight business hours to respond to the verification request. Now here’s the sticky part: If a prescriber fails to respond to that request for verification within eight business hours, that contact lens seller can assume that indeed, the prescription is valid. By the way, many bricks and mortar ECPs use this provision of the law to their advantage, in two ways. First, if they discover the prescription is valid, they do nothing. This saves the time and hassle of responding and effectively achieves the same result, that is, verifies that the Rx is valid. Second, sometimes they use that eight hours to their advantage by calling the patient. The call might go something like this: “Hi Miss Jones. I just received a call for prescription verification from your online contact lens vendor. I just wanted you to know that we have those lenses in stock. Maybe you could avoid the wait and all the shipping and handling costs by just getting them here.” Some ECPs also try to capture the business with complimentary cleaning solutions, cases, or an extra pair free (think trial lenses). While it’s not perfect, for now it’s all we have. You can learn more about the FCLCA and the FTC’s Contact Lens Rule at the FTC’s website (ftc.gov) or by calling (877) FTC-HELP. ■
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DISPENSING OPTICIAN Judy Canty, LDO
It’s Not the Sale That Counts It’s not about the decor, the frame selection, or the lenses you offer. It’s about the service before, during and after the sale that counts.
It would help you to know that the hospital in question doesn’t have the best reputation for care. As with most healthcare facilities these days, it’s part of a larger hospital group and many people feel that it had lost its hometown feel. We bought into this opinion with absolutely no actual experience, just word-ofmouth advertising. We discovered that there was a huge gap between opinion and reality. Following are my perceptions of how this business bridged the gap between rumor/opinion and reality using excellent customer service strategies.
YOU CAN BLAME the full moon for any number of crazy patients and situations if you choose. However the reality is that only you and your staff can control how difficult situations are either created or resolved. I recently had the “opportunity” to spend about 14 hours in a local hospital emergency room. If ever there was an environment of controlled chaos, it’s in the only hospital emergency room in town. While the business of health care was being stretched in unimaginable ways, every staff member who came through the curtain, regardless of position or title, was calm and helpful. If the answer to a question was not readily available, it was at least acknowledged and eventually answered. No one ever forgot that other facilities were on the other end of the Mid-Town Tunnel and that we were free to leave at any time. However, the care we received so far exceeded our expectations that we stayed for the long haul, which is now entering its second week. You may be asking yourself what this scenario has to do with customer service. A lot. 16 | EYECAREPROFESSIONAL | SEPTEMBER 2012
They are proud of the staff and don’t mind telling everyone. Be it pictures with short bios on the walls or nametags that identify both name and specific specialty designations, we knew who we were working with and why. All staff members have business cards with specific contact information for our convenience. Time is available during their working hours for education. (I overheard a conversation between nurses in the holding/recovery area agree on when they could take some time for a short CE course.) Education has benefits far beyond your practice walls. There are tax benefits, professional recognition benefits and the knowledge that, should an employment opportunity occur, your practice will have the pick of the best of the best to fill that position. Looking at your practice website, how is your staff recognized? Pictures with short bios or Doctors only? Yes, ECPs may own the practice, but in most cases, the staff has far more contact with patients and, as the owner, your patients deserve to know who is helping them and why they are qualified to do so. Staff members are proud of the work they do. The staff at the hospital knew what equipment was new, what procedures were most current, where they were expanding and how it would benefit the patients they serve. They were Continued on page 18
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“If ever there was an environment of controlled chaos, it’s in the only hospital emergency room in town.” eager to share their areas of expertise when asked. This feeling of ownership has created an incredibly loyal team. We all know that no job is perfect. The stars will never align and point us to the perfect environment. However, occasionally some of the stars will align and direct us to the best possible place to be. When that happens, staff members will be your best cheerleaders. Your staff should know what’s new and what’s “tried and true” and how it benefits your patients. Everyone, from doctor to housekeeping took time to listen. There is no better way to understand your patients’ wants and needs than to listen more than you talk. Everyone who came into the room asked what else could be done and if there was a need, it was communicated immediately and professionally. No shouting down the hall or mutterings about too much work. That old adage about having two ears and one mouth is often forgotten. We are so excited to talk about the “latest and greatest” that it’s easy to forget that to most patients, it’s just glasses. Yes, some patients seem to enjoy eating up chunks of your day, but there are some ways to take some of that time back. Rather than sit and listen, create notes in your dispensary files so that you can refer to past visits and, perhaps shorten the next visit. Nothing makes a person feel more special than someone who remembers when and why they were in the last time, even if you’re reading the information off a computer screen. You may even prevent an unnecessary visit, with a follow-up phone call or a hand-written note in the mail. Everyone had a plan for the next steps in the process. Suddenly, we were thrust into a completely unfamiliar environment where it would be very easy to be swept along in a flood of technology and unintelligible terminology. However, the professional staff, both doctors and nurses, were careful to explain what was happening, what was
18 | EYECAREPROFESSIONAL | SEPTEMBER 2012
going to happen and to make sure that everyone understood the entire process. If something changed, we were kept informed, not with platitudes and “happy talk”, but with common sense explanations and expectations. Poor, inadequate or inaccurate communication is the Achilles’ Heel of most organizations. Every patient should understand what to expect during their visit to your office, from insurance coverage to the exam and beyond. Your practice website should have a page to explain the steps from the front desk to the dispensary, including information on various tests and what they are for. That same information should be available in the waiting area along with an estimate of the time involved. In this age of multi-tasking and immediate gratification, the act of “waiting” can be infuriating. The dispensary should also explain the eyewear process from fitting to delivery, including a realistic estimate of processing time, assuring that no eyewear will be dispensed until it meets your quality standards. Explanations of lens and frame options should be honest, simple and “jargon” free. If the dispensary staff can’t properly explain a product or service, get them trained, pronto. The best exam cannot survive a poorly executed dispensary experience. Our local hospital has spent millions of dollars on facilities, technology, staff and marketing. That’s very easy to see. However, rehabbing its image is a long and slow process. From my perspective, their less than stellar reputation is unwarranted. They have taken some very simple and relatively inexpensive steps to change the community’s perceptions. My job within the community is to communicate those changes to anyone within earshot. Providing good customer service is hard. It is demanding and often thankless. However, it is contagious. Everyone, from the most senior ECP to the newest staff member, should understand that providing great customer service is “just the way we do things here.” ■
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BENEFITS: 100% UVA/UVB Protection for all outdoor activities 30 color options to work with any frames Absolute color consistency with HOYA® anti-reflective HiVisionSM treatments Available in a broad range of HOYA designs
The clarity, crispness and durability of HOYA Diamond TintSM colors are unbeatable with proprietary pressurized pore processing from The HOYA Free-Form CompanyTM. Visit thehoyafreeformcompany.com or ask your territory manager for more information.
©2012 HOYA Corporation. All Rights Reserved. The HOYA Free-Form Company is a trademark of HOYA Corporation. HiVision and HOYA Diamond Tint are service marks of HOYA Corporation.
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PRACTICE MANAGEMENT Corrie Pelc
Electronic Records – Is Your Practice Ready? Tips on selecting and installing an electronic records system in your practice.
ttend any optometric conference right now and any class that discusses electronic records systems – be it electronic health records (EHR) or electronic medical records (EMR) – is bound to be standing room only.
A
Optometrists who have yet to adopt an electronic records system in their practice are starting to feel the pressure to do so, with technology becoming such a normal way of life and deadlines for the Medicare and Medicaid EHR Incentive Programs coming up fast. So how can an ECP make sure they are prepared to find a system that will meet their needs and be a benefit to their practice? EHR vs. EMR First off, its important to know that although most ECPs use these two terms interchangeably, there is a difference between an EHR and an EMR. According to Dr. Ian Lane, chief medical information officer for AOA Excel, an EHR is the sum total of all a patient’s health records from all health disciplines, while an EMR is the record of the patient’s account with a particular healthcare provider. “In other words, if it’s just optometry then that’s an electronic medical record, but if it’s optometry plus podiatry, ophthalmology, cardiology and others, then that would be an electronic health record,” Dr. Lane explains. Dr. Lane says the ability to electronically have information from various healthcare professionals all in one place is the direction healthcare is moving for a more collaborative approach. “You need to be able to have connectivity, to be able to transport your records not only from optometrist to optometrist, but to transfer records to any healthcare practitioner,” he adds.
Assessing Needs The next step in the process if for ECPs to assess the needs of their practice. That means looking at what is the most important part of their practice to find a system that works well in all aspects of the office, says Dr. John Scibal, president of Blackwell & Scibal Consulting. “It’s important to look at the practice and figure out if you’re retail-oriented, then make sure your people in your frame area are comfortable and enthusiastic about the system,” he explains. “If it’s strictly an ocular disease type of practice, maybe the inventory is not the most important.” Dr. Lane suggests ECPs create a detailed flow diagram of the existing patient flow in the office – who does what, what they do, how things are recorded – and focus on what works and what doesn’t. He says this will give an ECP a road map to follow when viewing demos of different software systems to see if it can follow the processes already in place. “And if it doesn’t, you’ll be able to tell very quickly if it offers a better alternative or is going to cause a major bottleneck in the practice,” he adds. Continued on page 22
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Latest Consumer Barometer Reflects Increases in Sunglass and Eyeglass Sales The latest information on eyeglass frames and sunglasses purchases and consumer sentiment for future purchases points to continued growth, according to the latest Consumer Barometer for the 12-month period ending June 2012 which reflects sharp growth in sunglass sales at retail and increases in eyeglass frame sales as well. The Barometer was recently released by The Vision Council which also issues VisionWatch reports, which detail overall sales volume for the year period. U.S. eyeglass frame sales rose over 3 percent from 2011 for the year ending June, to $8.5 billion. Sunglass retail sales performed even better, the report said, growing nearly 7 percent, to $3.5 billion. Sales of higher end sunglasses, costing more than $50, accounted for most of that growth with unit sales up 7 percent and the total dollar volume growing by almost 9 percent to $2.3 billion. Future sales prospects look equally positive as adults surveyed increasingly indicated higher levels of intent to purchase eyeglasses and sunglasses costing more than $50. For eyeglasses, 24 percent of adult eyeglass users indicated they were extremely or very likely to make a purchase within the next six months. Compared to 2010, when consumer intent reached its bottom, current purchase intent is 7 percent higher and more than 1 percent higher than in June 2011, the report indicated. Intent grew the most for three groups in particular, 18 to 34 year olds, those living in the Midwest and those with incomes under $60,000. Current intent to purchase is highest among 45 to 54 year olds, where 28 percent are planning a purchase within the next six months. Among adults with some form of managed vision care coverage, 30 percent reported a purchase to be likely. The outlook for sunglass sales is even brighter, with intent 5 percent higher than last year and 40 percent higher than in June 2010. A full 13 percent of U.S. adults reported being extremely or very likely to make a sunglass purchase costing more than $50 in the next six months. This info and other industry data on lenses, frames, sunglasses, reading glasses, contact lenses, eye exams and refractive surgery are included in both The Vision Council June 2012 Consumer Barometer and VisionWatch, the large scale continuous research study conducted by The Vision Council. Members of The Vision Council can download and access reports for free. More details are available from Shawn Shafer at (703) 740-2252.
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Evaluating Options Now with your needs known, what should an ECP look for in a quality system? According to Donna Lehmann, marketing communications director for First Insight Corporation, an EHR system should have a flexible configuration that lets ECPs customize exam forms, modify workflows, change colors, and add both selected items and data fields, all of which reflect clinical needs, personal preferences, and business requirements. “This allows for tremendous ease of use and acceptance within the office as screen and workflow is familiar to staff,” Lehmann says. “As with any new process, it often requires a change in attitudes and behaviors, and adding functionality and ease of customization can make or break your staff.” In addition to customization, Lehmann says to also look for a system that is user-friendly, such as one with a simple navigation that allow a user to quickly go where they need to enter exam information rather than being forced through a series of mouse clicks to get there. “Also ask your vendor if the software was developed with input from eye care professionals,” she adds. Dr. Lane says when evaluating systems to also evaluate the company behind the system, such as their customer service, training options, and eye care expertise. He also suggests looking at the technology platform the system is built on. “Everything is moving to the Web now and most of the systems available for optometry are built on having the server inside the office,” he explains. “It’s not essential that it has to be Web right now, but it is essential to know several years from now that (the ECP) will be able to migrate effectively up to whatever the technology is.” Preparing for Installation You’ve selected a system and you’re ready for installation – great! What do you need to know? Since every practice has a different number of staff, workstations and locations, Lehmann says it’s important to determine just what your needs are and what features you need or can leave behind. And an ECP needs to make decisions on
infrastructure investments, such as computers and servers. “Most practices will need to upgrade existing hardware to run the software efficiently,” she explains. “Always refer to your vendor’s hardware and software system recommended lists.” This is also the time for training. Dr. Scibal says it’s a disservice when training for the system is arranged, but staff members do not give the trainers their full attention. He suggests practices shut their doors for at least a half-day – or a full day if they can – to allow the entire staff to give their undivided attention to the trainers. And when it’s time to go live, Dr. Scibal recommends a practice cut their patient schedule by at least half to do a few dry runs. “If you do that for two days, then you’re going to uncover a whole lot of bugs,” he says. “(You can then) get with the company and trainers and say okay, what should we have done differently and how do we fix it for next time.” Enjoying the Benefits Once an EHR or EMR is selected, installed and is running smoothly, what benefits can an ECP expect? Dr. Scibal says the main benefit is efficiency. He says although ECPs may feel an electronic system is going to slow them down, that is not the case if they are doing it right. “These systems are sophisticated enough that if you spend the time, they’re all very capable of helping you be more efficient.” he says. And efficiency is also a patient benefit as an EHR can help improve patient care and allow an ECP to operate effective and profitable exam lanes with pre-built, problem-oriented assessments and plans, Lehmann says. For example, an EHR can help enhance patient communication such as automatically-generated appointment reminders. And a system with e-prescribing can help improve patient outcomes and increase practice efficiency. “You can make more informed real-time decisions by having the patient’s medication history and allergies at the point of care,” she adds. “I think (an ECP) should definitely move towards electronic records ... if you’re interested in your practice growing, taking advantage of the efficiency, and being able to measure your productivity,” Scibal says. ■
Medicare and Medicaid EHR Incentive Programs The Medicare and Medicaid EHR (Electronic Health Records) Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate “meaningful use” of certified EHR technology.
22 | EYECAREPROFESSIONAL | SEPTEMBER 2012
For details on these programs, including possible incentive amounts and important deadlines, visit www.cms.gov/Regulationsand-Guidance/Legislation/EHRIncentivePrograms
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FEA Industries
Personalized Progressives – Cutting Edge Lens Technology
EyeCare Professional’s Paul DiGiovanni, LDO, speaking with Bill Heffner, IV, I.T. & Marketing Manager, FEA Industries. Bill Heffner, IV
What’s new at FEA? We’ve recently added a number of new freeform machines from Schneider, including two generators, two polishers, and a robotic laser engraver. We’re investing heavily in technology so we can be at the cutting edge of the optical industry. This equipment makes it possible to keep our costs down and increase our efficiency. We’ve also just introduced a new way of surfacing traditional progressive lenses, which we refer to as “personalized” progressives. What is a personalized progressive lens? A personalized progressive lens is a melding of traditional progressive lenses with the latest in lens surfacing technology. We take traditional progressive lenses to the next level and make them as good as they can possibly be. With the traditional way of surfacing a progressive lens, you would take your progressive lens blank of choice, like a Younger Image, and surface it with one curve for the sphere power and one curve for the cylinder power. This results in one point of the lens being the optimal prescription, which is the optical center. As the patient’s eye moves away from the optical center to the periphery of the lens, they start to see more and more blur and distortion. Personalization takes in to account the movement of the eye, the vertex distance, pantoscopic tilt, and the wrap angle of the frame to correct for this distortion. It compensates for all of these variables to ensure that the power that the patient actually sees is the power that they’re supposed to see. In essence, this makes a traditional progressive lens into a compensated progressive lens. Isn’t this just another way of saying that your progressives are ‘digitally surfaced’? No. Digital surfacing is just a more precise way of traditional surfacing methods. Just because a lens has been
“surfaced digitally” doesn’t mean that it is a free-form lens, or that it is a compensated lens. While a digitally surfaced lens can boast an accuracy of up to 0.01 diopters, it still suffers from having peripheral blur and distortion because there’s no compensation for the change in curves and powers as the eye travels towards the edges of the lens. I understand that this is a FEA exclusive. Please explain the technology involved in manufacturing this type of lens. The difference in the technology that we’re using now, as compared to the traditional way lenses are surfaced, is that our technology recognizes the way the human eye moves. Traditional lenses are made so that they read the correct power at the optical center, when read by a lensometer. The human eye is certainly no lensometer, and will be looking out of the lens at all manner of different angles. Our calculation software takes into account all of these different angles, and makes the lens power at each individual point correct for that patients’ prescription. Does FEA also offer this personalization for other lenses, such as bifocals (FT 28s)? Is the same process used? Yes. By the end of the year we will be offering personalization on other multifocal lenses, which includes bifocals and trifocals. These lenses have been virtually the same for a long time, but now we’re able to build a better bifocal. As there’s still a large number of people that prefer to wear these lenses over progressives, we wanted to be able to offer them the option to upgrade their sight. This offers them better vision across the entire surface of the lens, while still being the bifocal that they’re used to wearing. How is FEA able to deliver this type of technology? Through our partnership with Indizen Optical Technologies (IOT), we’ve been able to apply the concept Continued on page 26
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of free-form surfacing to traditional lenses. We’ve done some custom programming on our end to integrate our system with theirs so that we can bring their Digital Ray-Path calculation technology to both traditional progressives and bifocal lenses. How will FEA’s personalizing of conventional progressives reduce non-adapts? The main advantage of this is that you’re able to offer your patient a better lens while keeping the same brand of progressive that they’re already wearing. Instead of trying to sell your patient on the idea of a high-end freeform progressive lens, you can still keep them in the VIP that they’ve been comfortably wearing for fifteen years and offer to make it even better. Personalization works very well in wrap/sunglass/sport frames as well, as we’re able to take the angles of the lenses into account when we surface it to ensure that the patient has the best vision they possibly can, even at the edges of the lens. For patients new to progressive lenses, the ECP is able to use the type of progressive that they feel best suits the lifestyle of the patient, and then make the optics of that lens even better. Explain the technology and new colors for your Independence A/R coating. We’re partnering with Leybold Optics to produce the best possible anti-reflective coating that we can. Over the past two years we’ve invested close to two million dollars in our in-house coating facility in order to create a superior product. To ensure this, we put every
Job tray being blocked and placed on a conveyor belt to be surfaced by one of FEA’s four Schneider free-form generators. 26 | EYECAREPROFESSIONAL | SEPTEMBER 2012
Independence-coated lens through one of our thermal dip hard-coating machines. This is the basis for a superior anti-reflective coating, as opposed to the UV-based backside spin coatings that most other optical laboratories use. We’re so confident in the performance of Independence that we send out our samples with steel wool, so you can see what we’re talking about. Since some people prefer one A/R color over another, depending on lens color, frame choice, and personal preference, we wanted to make sure that we could offer a superior coating that could appeal to everyone. To this end, we offer Independence in blue, green, and gold, all of which come with a lifetime warranty. Can you explain the promotion you will be running on your personalized progressive lenses in October? We don’t want people to take our word that personalization makes progressive lenses better; we want people to try it themselves. We’re going to be offering personalization for free, through the end of October, whenever anyone orders a traditional progressive lens from us. That’s it, no strings attached. ■
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THE MOBILE OPTICIAN
Games
Ginny Johnson, LDO, ABOC
ECPs Play We make it or we lose it Things that we say just might turn out right If I’m telling you the truth – do you believe me? Games ECPs play are totally outta sight! Since the summer Olympic Games are behind us I hope my ECP Games coverage will give you something to cheer about without beating a dead horse. Focus, perseverance, exercise, humor, jumping through hoops and over hurdles are just a few of the requirements for those ECPs participating in the Games. Game On means starting every morning with a positive outlook on the day. No excuses. No complaining. No moaning, groaning or whinese. If you dread going to work then others will dread being around you. I’m sure we all know someone affected by the alternative option of unemployment. Some mornings I will purposely take a different route to work where I have no choice but to pass the local unemployment office. Every time I drive by there I see a long line of jobless people that extends across the parking lot. It’s an unspoken suggestion for me to focus more on the bright side of being employed. Winning over new clients, customers and patients while consistently wowing the current ones takes practice everyday. Even though the rules may change overnight what remains the same is the need for differentiation. The higher your wow level of differentiation the more gold, silver, copper, paper and plastic wins you will have. Being calmly competitive and sincere when faced with the possibility of losing a patient is a good exercise to perfect. For instance - if your patient decides to take their Rx to the BOGT (buy one get two) place down the street - don’t disqualify, penalize or patronize in a condescending manner. Keep the focus on how your business will treat them before, during and 28 | EYECAREPROFESSIONAL |SEPTEMBER 2012
after they purchase eyewear from you. Don’t apologize for your fees. Don’t play the discount, price match game or predict what will happen if they go elsewhere. Focus on what you can do and not what the competitor can’t or won’t do. Keeping patient care priorities in line takes unwavering dispensary focus during those extremely busy times. Practice staying on task and not jumping the gun to assist someone when you have numerous other obligations in front of theirs. It’s great to be busy yet far from great when you forget to order a job, return an important call, miss a deadline...etc. I like to practice the lab tray stacking game when things get crazy busy. Each request gets a numbered tray in order of occurrence. When someone places an order for eyewear their job goes in a numbered tray. If someone calls and I’m with a patient and they only want to speak to me then that message gets a numbered tray. If a patient wants to be called back when a new shipment of frames arrive (which you haven’t even had time to order yet) the reminder gets put in a numbered tray. If the doctor wants my opinion on a matter that is not urgent then his/her request goes in a tray and I let them know that I will get back with them ASAP. Avoid getting sidetracked to low priority tasks or distractions and work efficiently to knock out the trays in order. Idiotic distractions during the day can affect a player’s performance towards the finish line. Here’s an exercise for those feisty ECPs that need some coaching on how to remain composed during an encounter with stupidity. When you find yourself getting upset or aggravated with a customer, client or patient after several attempts to help or please them then figure out how to bow out gracefully. Beet red ears are a good sign that you are upset. Remove yourself from the conversation ASAP. The only place ECPs should be allowed to show their hiney is in a proctologist’s office. Don’t forget that, it may be worth gold to you someday.
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Here’s a great balancing exercise to practice. When a patient arrives to pick up their eyewear/contact lenses do your best to balance that patient care evenly with the scheduled exam patients that are already in the office. You may need to ask/tell an indecisive patient to go ahead and take their time deciding on a frame and excuse yourself to dispense to the picker upper that has stopped by on their lunch break. When you can master the hurry up pokey patient we’re on a time schedule without rushing patients you are one step away from that gold podium. It helps to be backed by a team of players that are all happy to step in and help. This torchering exercise can keep your team’s spirits lifted. Make a happy torch for your office. Use a small poster tube and fill it with little pieces of paper that have happy grams written on them. Pass the torch around and make sure each player gets their happy on. You don’t need to have a ton of gold in your staff stash to fund this torch. Movie passes, gas cards, get to work late passes, don’t have to answer the phone all day passes, leave early passes are just a few examples of happy grams. Smiles will end up being free in the long run. Don’t play around or jeopardize anyone’s safety during the games. Have emergency guidelines to follow. No business is
exempt from five finger discounts or theft. Some ECPs use instant messaging to correspond with each other to stay on top of what is going on throughout the office. Keep a close eye on your frame inventory and the traffic going in and out of the dispensary. The team’s personal belongings should be kept in a safe place away from the public gaze. Close off any rooms that are not being used. Don’t flaunt cash or turn your back on an open cash box. If you ever encounter a serious threat or robbery give them the gold without attempting to play superhero or policeman. As we come to the close of the ECP Games coverage I would like to leave you with some advice I was given by one of our new judges on the panel. Judge Susan L. is our new patient that selected our office over the 50,000 other ones she could have chosen. She is 25 years old and said she never had a reason to have her eyes examined. Upon dispensing her new eyewear I will never forget how her face lit up when she first looked through her new lenses. She began admiring herself in the mirror and bragging on how well she could see. Then she said, “Thank you for selling me awesomeness.” It’s those types of compliments that make the ECP games worth playing. Now go get your Game On and Sell Awesomeness! ■
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PRACTICE PROFILE Lindsey Getz
NORTHWEST PEDIATRIC EYE CARE Karen L. Preston, OD, knew she wanted to be in pediatric eyecare from the day she made the decision to become an eye doctor. She doesn’t really know why, but she always knew kids would be her focus. And with the help of some mentors early on in her career, Dr. Preston catapulted quickly to success in the field.
As a young person, Dr. Preston did some filing work for her father who was in private practice optometry. That exposed her to the field early on. “It occurred to me that I really liked the small office feeling of my Dad’s job,” says Dr. Preston, who says that point was really driven home after working at Merrill Lynch for a year and realizing the corporate world just wasn’t for her. “I decided I wanted that small office feeling for myself so I chose to follow in my Dad’s footsteps.” During her years at the College of Optometry at Pacific University, Dr. Preston really began to focus on any aspects of eyecare that would be more likely to occur in childhood, including all developmental aspects of vision. In her fourth year she was recruited to work at the University of Washington doing some research on infant vision development. Davida Teller, PhD, became the second of three mentors that would truly shape Dr. Preston’s career—the first being her father. “I ended up spending three years in a post-doctoral fellowship with her studying how babies’ vision develops and how that translates into clinically valid data that we could use to treat individual children,” recalls Dr. Preston. “When it came time that my post-doctoral work was going to end, Davida asked me
if I wanted to stay on as a research scientist or go back to clinical, and I said ‘both.’” Dr. Preston wanted to continue to do research work with Dr. Teller but she also desired to get into private practice. So Dr. Teller made a call to her colleague Howard L. Freedman, MD, who would become Dr. Preston’s third key mentor. “I ended up going into private practice with him full-time,” says Dr. Preston. “We each maintained our own specialty areas. I was interested in doing vision therapy and developmental work and he was a surgeon at the highest level of national prominence. He showed me what a medical pediatric practice was all about and I complemented that well by focusing more on the aspects of a functional pediatric practice. Collaboratively, we formed a practice that was incredibly unique since we brought the two key pieces of the puzzle together.” ALL ABOUT THE KIDS After Dr. Freedman’s retirement, Dr. Preston ultimately went into private practice on her own. Today she heads Northwest Pediatric Eye Care in Bellevue, Wash. Dr. Preston has spent her Continued on page 32
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time focusing solely on practicing eyecare and never opened an optical dispensary. All of her revenue came through service profession fees. However, as her practice has grown she has found the need to expand and is about to add additional exam rooms, more doctors, and also an optical dispensary for kids ages zero to 12. “That’s an age group that is typically underserved in our optical community so I’ve decided that I’m going to open an optical that is solely dedicated to this group,” says Dr. Preston. “There will be no adult eyewear. Like my practice, it will really be focused on the kids.” In fact, Northwest Pediatric Eye Care is 100 percent about kids but from time-to-time Dr. Preston will see an adult if they are suffering from an issue that typically shows up in the pediatric population such as eye fatigue or eye misalignment issues. Because she is a true expert in these areas, adult patients are occasionally referred to her. “I also occasionally see adults with post-operative double vision,” says Dr. Preston. “I don’t do their eye exams. I just manage their double vision.” In working with kids, Dr. Preston says that a key is to really keep the attention on the patient—that being the child. “Many doctors feel the need to talk to the parents first but I try to always keep the focus on the child,” says Dr. Preston. “For instance, I always greet the child first. And then I try to make some conversation with them and help them feel comfortable. An easy way to do that is to pay attention to some of the fashion cues they are giving you. If a child is wearing a shirt with a character from a movie, then you know they really like it and it gives you something to talk about,” she says. “If you keep up with any of the latest kids’ trends it does help to talk to them about something they know. For instance, if a little boy is wearing a shirt from the movie Cars I might say ‘So you like Lightning McQueen, too?’ and then all of the sudden I have an immediate entry point with the child.” Besides Dr. Preston’s excellent rapport with children, everyone that comes to Northwest Pediatric Eye Care falls in love with the office. Done as a woodland theme (appropriate since the practice is located in “Forrest Office Park”), there is even a play-
ful stuffed bear named “Patches” that lives in a tree in the reception area. Dr. Preston says that the woodland theme will be emphasized in the office expansion. “I’m putting in a huge children’s play space that will even include a tree house and a log to crawl through with a slide,” she says. To design the new space, Dr. Preston is bringing back the interior designer she used when she first opened the practice. She says that one of the best tips he offered when things were running close to budget the first time around was to frame some children’s book pages instead of buying expensive artwork. “We looked through some great children’s books and picked out the pages I liked best,” she says. “That’s an easy way that other doctors can make their exam rooms very child-friendly without spending a lot of money. Frame some children’s book pages.” A BOOMING PRACTICE A combination of the dwindling number of pediatric practices out there as well as her true expertise in the field has Dr. Preston seeing patients all the way from Canada and Alaska. Dr. Preston says that the lack of interest in pediatrics is concerning to her. “Whenever I get the opportunity to talk about going into pediatrics I take it,” she says. “I have done some lecturing and tried to teach others how to do it and yet it just doesn’t seem to be catching on. Parents are getting frustrated by not having the access to the care their child really needs. They’re willing to fly to my practice from faraway places if that’s what it takes to get their child the proper care.” Dr. Preston calls Drs. Teller and Freedman the “best mentors she possible could have had” and says she owes everything to them. Dr. Teller has since passed on and Dr. Freedman retired about seven years ago leaving Dr. Preston to carry on a legacy of mentoring. “I always offer internships for students from Pacific University and I feel it inspires me to do the best job I can to try and launch their careers the way my mentors helped launch mine,” says Dr. Preston. “I continue to strive for the best with my mentors in mind. I want to effect changes in pediatric eyecare that would have made them proud.” ■
Progressivelenses.com 32 | EYECAREPROFESSIONAL | SEPTEMBER 2012
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MOVERS AND SHAKERS Optical Pioneers Hall of Fame
Viva International Group
The Optical Lab Division of The Vision Council has inducted the following industry veterans into the Optical Pioneers Hall of Fame: Kevin Bargman, manager, Essilor Laboratories of America, and former owner, Hawkins Optical David Rips Laboratories; Marty Bassett, president, Walman Optical; Bob Colucci, president, Independent Distribution Division, Essilor of America; Bob Dziuban, former executive director, Optical Laboratories Association; Mike Francesconi, vice president, Katz & Klein; and William D. Hernandez, former president, Practical Systems. The Optical Lab Division has also named David Rips, president, Younger Optics, as the recipient of the 2012 Directors’ Choice Award.
Viva International Group has appointed Timothy Parker as vice president of merchandising for domestic brands. Parker will report directly to Sherry Lay, Viva’s interim president. In his newly appointed role, Parker will be Timothy Parker responsible for overseeing Viva’s creative and business development teams, as well as the domestic side of the company’s brand management and marketing teams.
SUNY College of Optometry The State University of New York (SUNY) College of Optometry has named Stewart Bloomfield, PhD as the new Associate Dean of Graduate Programs and Research. He will also serve as director of the Graduate Center for Stewart Bloomfield Vision Research as of January 2013. Dr. Bloomfield has over 30 years of research and graduate education experience. After graduating SUNY Stony Brook and receiving his doctorate from Washington University, Bloomfield went on to receive international recognition for his research on retinal neurophysiology.
Michigan College of Optometry Ferris State University has announced the appointment of Bruce Morgan, OD, as interim dean of the Michigan College of Optometry. Most recently, Morgan has served as a professor in the MCO. He is chief of the Cornea Bruce Morgan and Contact Lens Service, and director of Residencies and Externships. Morgan has 25 years of experience as an optometrist and educator. He will replace the current dean, Michael Cron, OD, who announced his retirement last fall.
Optical Women’s Association The Optical Women’s Association (OWA) has named Heather Smith of VisionWeb as its newest board member. Smith has served on both the OWA programs committee and the sub-committee responsible for OWA Webinars. Heather Smith Smith joined VisionWeb six years ago as a marketing coordinator on a three-member marketing team. That was the start of her career in the optical industry.
California State Board of Optometry Fred Dubick, OD, MBA, FAAO has been appointed to the California State Board of Optometry. He treats patients at Studio Eyes Optometry in Burbank and serves as presidentelect of the California Optometric Association Fred Dubick (COA) – a statewide nonprofit dedicated to providing quality eye health care. Dr. Dubick has volunteered in many capacities, including as a member of the American Optometric Association (AOA) Disaster Preparation Project Team.
Opticote
Bob Sypniewski
Opticote, Inc. is pleased to announce that Bob Sypniewski has been named Vice President/General Manager. He is responsible for daily operations and charting the general direction of the company. Bob will celebrate 20 years with the organization this September.
Coastal Contacts
Maui Jim
Coastal Contacts Inc. has appointed Gary Collins as its president, a new position for the company. Most recently, Collins was senior vice president of Belkorp Industries, a private company. Belkorp has diverse holdings in a Gary Collins variety of industries including environmental services, real estate, sugar, agriculture, airlines and capital management. Prior to Belkorp, Collins was the president and CEO of Harmony Airways.
Maui Jim, Inc. has promoted two sales representatives to Territory Managers. Amy Marie Stavish will take on the responsibility of Southeast Regional Sales Manager. She joined the company as a Sales Executive after graduate Mike Stevens school at the University of South Florida. Mike Stevens will become the Western Regional Sales Manager. He joined the company after 15 years in the action sports industry, working as the Marketing Director and National Sales Manager for Club Sportswear.
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SECOND GLANCE Elmer Friedman, OD
The Miracle of the Eye THE TOPIC OF EVOLUTION CANNOT BE DEBATED WITHOUT DISCUSSING THE HUMAN EYE.
indebted to Trevor D. Lamb and The Scientific American Journal for much of the information we gleaned as we searched for an understanding of the subject. In no way do we intend to enter the arena of debate between the evolutionists and the intelligent design proponents. The former believing in a natural selection theory and the latter believing that an organ so complicated could not have been created via a selective process. They say that it is a system that cannot function in the absence of any of its components and therefore cannot have evolved naturally from a primitive form. Biologists have recently made significant advances in tracing the origin of the eye by studying how it forms in developing embryos and by comparing eye structures and genes in species to reconstruct when key changes arose. The results indicate that our kind of eye, common with vertebrates, took shape in less than 100 million years. The first eye was a simple light sensor started about 600 million years ago. It became an optically and neurologically sophisticated organ by 500 million years ago. More than 150 years after Darwin published his groundbreaking theories his scientific findings seem to have received much support. It explains why the eye, far from being a perfectly engineered piece of machinery, exhibits a number of major flaws. These flaws are like the scars of evolution. Natural selection does not, as some might think, result in perfection. It does however, tinker with the material available to it, sometimes resulting in odd effects.
Despite its simple and neatly circumscribed appearance, the human eye is an incredibly complicated structure. In fact, it is our most complex organ. Even with the most sophisticated, up to date knowledge and technical equipment the full complexity of the eye has yet to be fully understood. After one successful approach following the other it leaves us with the feeling that the development of the eye is more incomprehensible than ever.
During the Cambrian period, camera style eyes had developed. The photoreceptors all share a single light focusing lens. They are arranged in a manner that we might call a retina. Squid and the octopus have a camera style eye that superficially resembles our own, but their receptors are the same kind found in insect eyes. Vertebrates possess a different kind of receptor which comes in two varieties: cones for daylight vision and rods for nighttime vision. Biologists observed that many of the hallmark features of the vertebrate eye are the same across all living representatives of jawed vertebrates. They apparently inherited the trait from a common ancestor.
This author will attempt to show how this exquisitely complicated organ developed from a light sensitive spot to the fabulously complicated sense that we appreciate today. We are
Early in the development of the jawed vertebrate known as the Lamprey, the neural structure that gives rise to the eye bulges out on either side to form two sacs. Each sac folds in on itself to
Nilsson & Pelger’s Complete Eye Evolution Simulation
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form a “C” shape dimple retina that lines the interior of the eye. The rim of the pit begins to constrict to form a narrower opening. Around this point the pit begins to fill with a clear jelly-like material. It is thought that producing this jelly would be rather simple for most creatures. This jelly helped to hold the shape of the pit and helped to protect the light sensitive cells from chemical change. It also protects this proto-eye from the inconvenience of mud being flung into it. The scientists who discovered this phenomenon celebrated with a toast and so they coined the expression, “here’s mud in your eye.” Photoreceptors are located on the exterior layer and afferent neurons on the interior layer. The initial stage served to detect shadows and orient the body in a proper manner. As the aperture continues to decrease, the visual acuity increases. Eventually the aperture becomes a perfect size for further eye development. In the next stage of embryonic development, as the retina is folding in on itself, the lens forms from the ectoderm and bulges into the curved, empty space formed by the “C” shaped dimple. The lens is formed from a ball shaped mass of clear cells with a slight increase in the refractive index. The mass is then refined with slight increases in the refractive index and produces greater and greater visual acuity. The image forming eye may have arisen from the non visual proto-eye in a geological blink of the eye. With the advent of the lens to capture light and focus images, the eye’s information gathering capabilities increased dramatically. Now that the eye has its lens, it appears that the aperture is in the wrong place. The eye will be more accurate if the lens moves toward the center of curvature of the light sensitive surface. After a period of development, the lens not only is able to move but increases in refractive index concentrated in the center of the lens. This improved image quality and reduced distortion.
retina. And how can we forget the blind spot at the retinal disc that cannot receive any visual message at all? Some feel that unless a scientist like a Richard Dawkins or someone else can actually make something as good or better than the human eye, they should reconsider their efforts in trying to make value judgments on things that are among the most beautiful and beyond the most astounding works of human genius and art. What seems to work very well on paper may not work so well when put to a real life test. Such experimental demonstration has yet to be done. If it were ever done, successfully, it would certainly create a sensation within the scientific community. Creationism and intelligent design theorists would take a terrific hit indeed IF such an experiment succeeded. Therefore the eye evolution theories are not really a true scientific theory. Such theories remain a working hypothesis at best at least for the present time. To the scientist who finally unravels the mystery and complexity of the eye: We at EyeCare Professional extend an invitation that we be the first to interview you and disseminate to the eye care providers of the world the results of your findings. We thank you, in advance. ■
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Further evolution formed retinal bipolar cells that are located between the photoreceptor layer and the output neuron layer. They closely resemble rod and cone cells. We now see that inverted retinas are the best eyes in the world for image detection, organization and interpretation. In order to accommodate the limited area that serves the central vision selective stress made the muscles move the eye across the visual field. For all of the miraculous features comprising the evolved eye, there are some flaws. For instance, the retina is inside out. With the exception of the fovea centralis, light must pass through the anterior layers and the retina, the nerve fibers and cell layers that scatter the light and degrade image quality before reaching the light sensitive receptors. Blood vessels line the inner surface of the retina further causing unwanted shadows on the
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CONTACT LENS CORNER Jason Smith, OD, MS
1 Day Soft Contact Lenses, Spheres and Torics – 2012 The world of soft contact lenses has changed very quickly over the past 10 years. As the world of plastic technology improves and changes, so has the availability of newer contact lens materials.
Sleeping in contact lenses became a great marketing tool for the various companies. There were some benefits in sleeping in contact lenses. Solutions were not required as often reducing the cost to consumers. The handling of contact lenses became less, reducing the possibility of infections. But there were other problems. There was considerable confusion among the public and among ECPs concerning how long patients should be sleeping in their contact lenses. Patients, who had been told to use their soft contact lenses for 2 weeks, were now using them for 1 month or longer. Patients wanted to reduce the costs of buying more contact lenses by using them for longer and longer times. Many patients still believe that there are no risks to this “overwear” problem. SOFT CONTACT LENS PLASTICS have been available in low water, nonionic polymers, high water, nonionic polymers, low water, ionic polymers, and high water, ionic polymers. These 4 groups were created by the FDA to clarify the categories of similar polymers for investigating solutions. The newest, 5th group of silicone hydrogel soft lenses are providing a new material that is providing higher oxygen permeability and more comfort to a majority of patients who are new fits or who are being refit with contact lenses. These lenses also provide improved UV protection. Soft lenses were first available for a patient to use 1 pair that would be used for 1 year. Sleeping with these lenses was never a consideration. Other lenses that followed included the VUE and Focus lenses that were manufactured by CIBA VISION (now Alcon). These and other lenses changed the contact lens market because soft lenses were now being mass-produced, they were available in plastic packets, and companies were promoting the safety and benefits of sleeping in contact lenses. More companies followed with other soft lenses and the times that were recommended for sleeping in soft contact lenses varied from 1 week, 2 weeks, monthly, and quarterly.
The problem of patient compliance to a wearing schedule that was dictated by the FDA, the manufacturer, and by the ECP was becoming significant. In a paper published in 1996 by Dr. E. Goodlaw in the Journal of Optometry and Vision Science, the problem of sleeping in soft contact lenses was described: “Although the risks associated with extended wear contact lenses are well known, there has not been an adequate explanation of why sleeping with the lenses increases the risk of infection. It is contended that the reduction in the available oxygen caused by contact lenses does not in itself explain the high rate of corneal infection caused by wearing the lenses while sleeping. The results of patient studies show that the risk of ocular infections, particularly corneal ulcers, is substantially increased with overnight wear of lenses. A review of the role of oxygen deprivation, atmospheric pollution, bacterial survival, infection-resistant defenses, and patterns of sleep indicates that oxygen deprivation is not the only factor in increased risk associated with wearing lenses while sleeping. It is suggested that the combination of the introduction of a irborne pollutants to the contact lens during the day, the reduced oxygen transmission through the contact lenses and closed eyelids, Continued on page 40
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and the lack of eye and eyelid movement during sleep create the conditions in which bacterial infection is most likely to occur.” The 1 day disposable soft contact lens may offer ECPs a way to reduce the risks of “overwear” and the hope to eliminate corneal infections. These lenses are to be used for 1 day only while awake, and then discarded. The need to use solutions which creates an added cost is eliminated. Handling lenses is now eliminated with the possibility of contamination with unclean hands and/or surfaces. Using contact lens cases is now unnecessary and they have always been a potential source for contamination and infection. The opportunity to use a 1 day disposable lens on an occasional or social basis can now be offered. The softball player who may have -0.50 Diopter of uncorrected myopia may find that using this type of lens may reduce the errors in the outfield. The seasonal allergy sufferer may also find this type of lens more beneficial for occasional usage or even during their allergy season. In a study by Dr. V.Y. Hayes, Dr. C.M. Schnider, and Dr. J. Veys published in the Journal Contact Lens and the Anterior Eye in 2003, “of 128 allergysuffering patients, 67% agreed that 1 day disposable contact lenses improved comfort when compared to the lenses that they were wearing prior to the study.” If you have patients that may have solution sensitivities, patients that do not want to put rewetting drops in their eyes, patients that have hygiene issues, patients that have allergies, patients that have been unsuccessful with weekly, 2 week, or monthly lenses, patients that have vision need for occasional use, social occasions, or for hobbies, patients that have excess protein buildup, or you have a specific patient that is not compliant, then the following companies are now selling 1 day soft contact lenses and 1 day toric lenses: Alcon Vision Care (formerly CIBA) sells the Dailies Aqua Comfort Plus with a base curve of 8.7 and a diameter of 14.0 mm. They also have the Focus Dailies with a base curve of 8.6 and a diameter of 13.8 mm. Bausch and Lomb has the Soflens Daily Disposable with a base curve of 8.6 and a diameter of 14.2 mm. Clearlab provides the Eyedia Fresh Daily Disposable with a base curve of 8.6 or 8.7 and a diameter of 14.0 mm. Cooper Vision sells the Proclear 1 day with a base curve of 8.7 and a diameter of 14.2 mm. Preferred Vision Group sells the Preferred Dailies with a base curve of 8.6 and a diameter of 14.0 mm. Vistakon sells the 1 day Acuvue Trueye with UV blocking. This lens has a base curve of 8.5 and a diameter of 14.2 mm. They also have the 1 Day Acuvue with base curves of 8.5 or 9.0 and a diameter of 14.2 mm and the 1 Day Acuvue Moist with base curves of 8.5 or 9.0 and a diameter of 14.2 mm. Orion Vision Group has the Day Star 1 Day Aspheric with a base curve of 8.6 and a diameter of 14.2 mm. Safigel sells the Safigel 1 Day with a base curve of 8.6 and a diameter of 14.1 mm. Toric 1 Day lens-
40 | EYECAREPROFESSIONAL | SEPTEMBER 2012
es are available from Cooper Vision-the Clearsight 1 day toric, base curve 8.7, 14.5 mm diameter, Vistakon-the 1 day Acuvue Moist for Astigmatism, base curve 8.5, 14.5 mm diameter, and Bausch and Lomb-the Soflens Daily Disposable for Astigmatism, base curve 8.6, diameter 14.2 mm. There should be no reason that any patient cannot be fit with a soft contact lens or a soft toric contact lens. Many patients who do have problems with their comfort have a fitting problem. If the fit is not exact then vision will be compromised and a patient will not be happy. There are certainly patients who have comfort problems based on dryness, protein buildup, or allergies and there are lenses available that can satisfy these patients. Some patients may feel more comfortable in the newer silicone hydrogel lenses. The soft lens must be centered symmetrically over the cornea and move freely on the bulbar conjunctiva. There must be adequate movement when blinking in order to allow oxygen and tears to continue to nourish the cornea. The various base curves and diameters that are listed allow the ECP to choose from different base curves and diameters which will affect the fit, the comfort level, and the visual acuity of a patient. If a lens appears to be too tight, the base curve should be flattened or reduced. Going from a base curve of 8.5 to 8.6 may improve this problem. The ECP can also reduce the diameter of the lens to improve the tight fit or the lack of movement such as changing the diameter of 14.2 mm to 14.0 mm. If a lens is too loose and moves excessively, the ECP can steepen the base curve such as changing the base curve from an 8.6 to an 8.5 or increase the diameter from 14.0 mm to 14.2 mm. Fitting parameters vary widely for every patient and there are always exceptions to every rule. If dailies do not fit correctly, there are many more options available including weekly, 2 week, monthly, and quarterly replacement soft contact lenses. The other factors that need to be evaluated include the material, the water content, the optical zone, the center thickness, the disinfection method, the Dk value, and the cost. Every contact lens company has trial contact lenses available for patients to try. An instructional lesson should be part of any fitting process which involves insertion, removal, care, and education about soft contact lenses. ECPs should check and recheck their patients after a week or two to be certain that the lenses prescribed are perfect for the patient’s needs and uses. And by Federal law, the prescription must be provided to the patient. A disclosure form should be signed by the patient indicating the time and use of their particular lens as well as which solutions were provided. Following these and other guidelines that are appropriate to each ECP will result in a happy patient that returns annually and will result in new patients calling you for your expertise. ■
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HOYA Launches New App to Help Move Market to Personalized Lenses The technological achievements of Hoya’s personalized progressive lens, HoyaLux ID MyStyle, can now be realized in all independent practices thanks to the development of Hoya’s new app Spectangle. Spectangle addresses many of the drawbacks required to prescribe personalized progressives including time necessary to take frame and fitting measurements, equipment investment and ease of operating measuring devices. Ideally, every dispensing table can now be equipped with iPads so no patient waiting while the measurement device becomes available. “We were amazed at the response received while testing Spectangle both in practices and at the big shows,” states Ron Barnes, Director of Project Marketing. “We want it now” was the common response of those previewing the app.” Spectangle allows the optician to take photos using the iPad camera, make adjustments on the screen, enter in Rx data and lifestyle preferences then push a button to send the order to the lab. “For an optician to explain to a patient while seated at the dispensing table the critical measurements required to ensure the ultimate personalized lens, creates such a point a differentiation that walking with the Rx becomes a thing of the past,” says Barnes. Visit www.thehoyafreeformcompany.com to learn more.
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LAST LOOK Jim Magay, RDO
Are “Smart” Cards in Your Future? WORCESTER, MA IS INDEED FORTUNATE. After being maligned for years as a rust belt leftover of the industrial age – the Olde Towne is now transforming into a state of the art technology center. Investments by BASF, WPI, and many others have given us a tilt toward biotech, while UMass has created a powerful economic engine in medical research.
While this was going on, the Mass College of Pharmacy and Health sprang up in the very center of town. MCPH’s latest creation – the newest Optometry School in the nation – is set for a September opening at the Lincoln Square gateway to our city. Dr. Kent Daum – Dean of the school; formerly with the Illinois College of Optometry, graciously gave me a walkthrough of the facility and all I can say is, “Wow”. Dr. Daum (quoted in an interview recently), said: “The new school of optometry is to be located in Worcester, Massachusetts. Other doctoral programs exist on the same campus (pharmacy, physical therapy, as well as a program in physician assistant studies). We find it exciting to have an optometry program where students in the optometry program work side by side with students in the other health professions, sharing labs, lectures and other professional endeavors, which will help build future working relationships with other practitioners. We are committed to a student-centered program that emphasizes clinical experience and competency.” From the high security front desk, to the state of the art dispensary (managed by old friend Gerry Hastings) the physical plant is beautiful. Simple, tasteful, and very modern, classroom spaces use electronic white boards and a variety of the latest audio/visual equipment, comfortable seating, and lots of spread out space for the lucky 80 students who will be attending the first classes this month. 46 | EYECAREPROFESSIONAL | SEPTEMBER 2012
The exam rooms were what really blew me away. Half of their space is occupied with state of the art Marco electronically integrated refraction stations, while the other half is beautifully but more traditionally equipped. (I think I heard a figure of $3 to $4 million dollars worth of refracting gear) Kent showed me his personal refracting room, in which the process is totally done by computer. A patient’s current eyewear is analyzed automatically and stored on a card (the built-in Intelligent Card (IC) Reader allows seamless integration) which is swiped on the phoropter stand to show the patient a before and after view of their new Rx. This is then transmitted to the dispensing office and from there to the lab via Vision Web for preparation after frame data has been entered or remotely traced. Lest you think these folks will be slaves to technology, fear not – they will be learning all the traditional refracting methods so when they volunteer for a VOSH trip to Guatemala they will be useful. Dr. Daum and his team are preparing students for a world with an aging population and rising rate of diabetes that will lean heavily on more quality eye care and eye care practitioners who can use these remarkable new tools to great advantage. ■
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