Eyedea
published by
A BoozmanHof Quarterly Magazine Spring 2011
Will Minimally Invasive Glaucoma Procedures Reduce Our
Need for Drops? - page 6
Cool Stuff for Eye Doctors - page 11
Committed to Infection Control - page 10
02 n Eyedea
To Our Readers
A Helpful Eyedea W
elcome to the inaugural issue of BoozmanHof’s Eyedea magazine. The purpose of this magazine is two-fold: education and support of local physicians as well as their patients. At BoozmanHof, we have been serving you for over 30 years. As a relatively recent addition to the BoozmanHof team, I am humbled and honored to be part of both this fine institution and the Northwest Arkansas community. My decision to leave a university-based practice to join BoozmanHof four years ago was based on my desire to work with Drs. Randy Cole and Bill Hof to help develop a leading ophthalmology center focused on ophthalmic innovation and clinical research. Ultimately, our goal is to provide the patients of our area access to high-quality and compassionate eye care. Currently, our clinical research team is involved in a
wide range of Food and Drug Administration-approved clinical trials providing cutting-edge technologies to patients in the areas of cataract surgery, glaucoma and anti-inflammatory medication, novel drug delivery systems and minimally invasive glaucoma surgery.
In Eyedea magazine, we will keep you informed of ongoing clinical trials, provide important educational information regarding advances in ophthalmology, assist ophthalmic practices with coding, educate primary care physicians regarding the diagnosis and management of common ophthalmic problems and update you regarding improvements in ophthalmic ambulatory surgery care.
We desire this publication to be much more than a BoozmanHof advertisement, and also hope to support and provide you information that is genuinely beneficial to you and ultimately your patients. To that end, in future issues, we will be highlighting medical practices in our area that partner with us on a regular basis. Furthermore, we have hired Matt Young, an experienced and highly respected editor in the ophthalmic news field to be our editorin-chief for Eyedea. As possibly the first publication of its kind, we will rely heavily on your feedback as to how we can best serve you. By working together with the entire Northwest Arkansas medical community, we hope to develop a win-win relationship with all of you that will benefit all of the patients in our region. Sincerely,
Doctors C. William Hof, M.D. Randall E. Cole, M.D., F.A.C.S. Steven D. Vold, M.D.
Website www.boozmanhof.com Eyedea published by
Editor and Publisher Matt Young Copy Editor Hannah Nguyen Designer Winson Chua
Cover Image: T2 Copyright Š 2011 Stephan Max Reinhold, www.liquid-art-gallery.com Media MICE Pte Ltd 6001 Beach Road, #19-06, Golden Mile Tower, Singapore, 199589 Phone: +65 8186 7677 Fax: +65 6298 6316 E-mail: enquiry@mediamice.com This publication is published by Media MICE Pte Ltd who is solely responsible for its editorial content. All rights reserved.
Steven D. Vold, M.D. President & CEO Cataract & Glaucoma Surgery BoozmanHof Eye Clinic, P.A.
In this Issue...
04
06
08
Vision impairment slows
Glaucoma surgery gets
When should you have an
cognitive performance
minimally invasive
eye exam?
11 Surgery goes 3D
Eyedea n 03
O.D. Corner
Extending Our Eye Care Family by Kevin Gardner, O.D. Director of Practice Development
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rowing up in the small town of Lamar, Missouri, I developed a special connection to eye care at a young age. My mother, blinded in one eye with a tennis ball when she was 16 years old, started seeing an ophthalmologist regularly many years later when I turned 11. My grandmother also worked for the town optometrist for more than 30 years—the same man who later wrote a letter of recommendation for me for optometry school admissions. Eye care has always been a central theme in my family, and now, I’d like to take this opportunity to welcome you to my extended family of optometrists and eye care specialists. In doing so, I’d like to share a little bit of what I’ve learned about the intersection of optometry and ophthalmology. Some years ago, I was part of an optometry practice that doubled its locations—from two to four—within about a year. Initially, that practice wasn’t doing any kind of medical care or co-management. It was mainly involved in retail, selling glasses and contact lenses. I knew we had to work at something different, and we did. Instead of relying on glasses and contact lens revenue, we made a decision to purchase new diagnostic equipment and bill for those services, increasing our professional services revenue. Co-management is a great way for optometrists to get involved in the medical side of eye care, involving, under Medicare, payment of 20% of the total surgical fee for services related to postoperative care. Today, sales of glasses and contact lenses are widely available online.
Profit margins have been squeezed. Service-oriented medical practices is key to the survival of any optometry office. With aging baby boomers, it’s the perfect time to get involved with comanagement and expand the medical professional services in your practice. Co-management generates additional professional services revenue and we at BoozmanHof want to help this area of your practice grow. We believe that co-management is a great way for ophthalmology and optometry to work together to give the patient the very best care possible. Co-management enhances your practice and is good for patients. Patients trust you as their primary eye care provider. When you send your patients to BoozmanHof you can be confident your patients will receive the very best of care. BoozmanHof has been active in co-management with area optometrists for 30 years. We look forward to building new relationships to help optometrists and ophthalmologists work together to provide excellence for patients of Northwest Arkansas. Some optometry practices may be reluctant to take the first step to get involved with co-management. Other optometrists already are involved in co-management. I want every practice to know that I personally am here to help. If you have questions about co-management and how it can benefit your practice, call me at 479-246-1700, or email me at kgardner@boozmanhof.com. We at BoozmanHof want to assist with new co-management relationships and help other relationships grow. We want you to know that we are co-management friendly, and we really do appreciate our relationship with you.
O.D. Senator Was at the Beginning of BoozmanHof’s Proud History
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ohn Boozman, O.D., is now a U.S. senator, and this fact reminds everyone involved at BoozmanHof of the clinic’s proud history. Sen. Boozman founded Boozman Eye Clinic in 1977 with his older brother, Fay Boozman, M.D., an ophthalmologist. The clinic merged with C. William John Boozman Hof, M.D., in 1981, thereafter becoming BoozmanHof. While the Boozman brothers later went onto political life, Dr. Hof’s passion has been in medical missions, and he has operated on patients all over the world. Partnering with the Lighthouse for Christ Mission, he currently volunteers as an ophthalmologist in Mombasa, Kenya several weeks each year. In this setting, he restores sight for many patients and trains doctors in advanced ophthalmic diagnostic and surgical techniques. Along with the Boozman brothers and Dr. Hof, Jim S. Myers, O.D., also was a founder of BoozmanHof in 1981. Dr. Myers is a frequent lecturer at national optometric meetings on various aspects of ophthalmic disease, and has served as a consultant for numerous leading eye clinics across the country. He performed some of the original research on the material used in some of the first soft contact lenses. From its internationally recognized prophylaxis regimens to prevent infection to its use of the most advanced glaucoma procedures performed anywhere, BoozmanHof continues to set the bar high in ophthalmic care.
04 n Eyedea
Clinical Trials
See Better, Think Clearer
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isual impairment can slow cognitive performance in older adults. That’s according to a recent study in Optometry and Vision Science, which investigated simulated visual impairment on cognitive performance in 30 older adults. “Simulated cataract significantly impaired performance across all cognitive test performance measures,” researchers found. “In addition, the impact of simulated cataract was significantly greater in this older cohort than in a younger cohort previously investigated. Individual differences in contrast sensitivity better predicted cognitive test performance than did visual acuity.”
Clinical Trials at BoozmanHof
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oozmanHof is part of the clinical trials of many new glaucoma devices, according to Steven Vold, M.D. “We are fortunate to be able to offer the patients of Northwest Arkansas access to the best, new technologies in ophthalmology,” Dr. Vold said. Here is BoozmanHof’s current clinical trial involvement: • The CyPass (Transcend Medical, Menlo Park, Calif.), which Dr. Vold described as a “suprachoroidal microstent,” was implanted in the United States first at BoozmanHof. • BoozmanHof is involved in clinical trials studying the iStent (Glaukos, Laguna Hills, Calif.), the first ab interno micro-bypass implant for the treatment of glaucoma. • The clinic is involved in evaluating Nevanac (Alcon, Fort Worth, Texas) as a once-a-day drug in the setting of cataract surgery. Currently, the drug usually is used three times daily. • Randall E. Cole, M.D., is currently
involved with a study evaluating the newest toric IOL design by Abbott Medical Optics (AMO, Santa Ana, Calif.). • BoozmanHof will evaluate TrueVision Systems (Santa Barbara, Calif.) to visualize and guide toric IOL surgery. • The clinic is involved in clinical research of AqueSys (Irvine, Calif.), which is developing a novel implant for the treatment of glaucoma. • Ologen (Aeon Astron Corporation, Taipei, Taiwan), a collagen matrix for tissue repair, will be compared to mitomycin C (MMC) with trabeculectomy for the treatment of glaucoma at BoozmanHof. Ologen may help promote normalized wound healing and functional bleb formation. Patient participants benefit during these trials as well from cutting-edge technologies. “Patients receive this care at no charge to them,” said Dr. Vold. “These services are only available to patients at top-tier research centers in the United States.”
Near, Intermediate and Distance Vision Improvements Pinpointed after IOL Implant
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ntraocular lens (IOL) manufacturers often tout the benefits of their technologies, but researchers recently pinpointed improvements in uncorrected distance (UDVA), intermediate (UIVA) and near visual acuity (UNVA) with the AcrySof IQ ReStor IOL +3.0 D. Among 147 patients, mean UDVA improved from 20/56 preoperatively to 20/22 at six months postoperatively; UIVA improved from 20/73 to 20/30; and UNVA improved from 20/83 to 20/25. “Commensurate significant post-
operative improvements were observed in the patient-reported uncorrected functional vision, satisfaction with un-
corrected vision, and social activities,” the researchers noted in the Journal of Cataract & Refractive Surgery.
Eyedea n 05
Wowing Lens Patients Just Like LASIK Patients Near
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lthough LASIK has become synonymous with superior vision over the last decade, ophthalmologists are looking at lens-based surgery as the way for patients to achieve excellent visual acuity less impacted by the visual deterioration of age. “There are significant cataracts in an increasing number of people in their 40s and 50s,” said Randall E. Cole, M.D., Medical Director, BoozmanHof Eye Surgery and Laser Center. “When somebody gets to be 50 and they are interested in a solution to where they don’t need glasses much, we’re looking hard at putting a lens in their eye.” Given enough time, everyone gets cataracts. A corneal treatment will not help the eventual visual loss they cause, but a lens-based one does. Current “lifestyle” intraocular lenses (IOLs), termed as such because they enhance the lifestyles of many patients by providing superior quality of vision, often leave patients spectacle independent—something that many have come to expect in the LASIK era. “Over the last two years, I have put in 400 lenses for presbyopia and astigmatism correction,” Dr. Cole said. “I have been extremely pleased with the results. Patients are functioning amazingly well with very few side effects.” Dr. Cole appreciates the AcrySof IQ ReStor (Alcon, Fort Worth, Texas) AcrySof IQ ReStor IOL +3.0 D
AcrySof Toric IOL
Far
Neutral
The Crystalens moves in order to focus at different distances. Crystalens illustration appears at top right. (Image source: Bausch & Lomb)
multifocal lenses. “It has really exceeded my expectations for what we would ever achieve in terms of spectacle independence for distance, intermediate and reading vision,” Dr. Cole said. Dr. Cole also uses the Tecnis Multifocal IOL (Abbott Medical Optics, Santa Ana, Calif.) with good results. The Tecnis Multifocal IOL is less dependant on room illumination than other IOLs such that the ability to read is optimized in lower light conditions, Dr. Vold added. The IOL also has a proven high quality range of vision, and in particular, posterior diffractive steps also contribute to a comfortable reading distance, according to the manufacturer. The surgeons also know when to avoid these lenses altogether in select patients, or opt for toric IOLs instead. “I usually don’t use a lifestyle IOL on patients with more than 1 D of cylinder,” said C. William Hof, M.D., Co-founder, BoozmanHof. “With my surgical incision, I can knock off up to 0.75 D of astigmatism.” Beyond that, Dr. Hof likes to implant a toric lens for astigmatism ranging from 1.25 to 2.5 D. Dr. Cole also Tecnis Multifocal IOL uses toric lens implants to correct astigmatism. “Astigmatism correcting IOLs are better, safer, more accurate and less invasive than doing
(Image source: AcrySof images provided by Alcon. Tecnis image provided by Abbott Medical Optics)
[incision-based astigmatism surgery] with a diamond blade,” Dr. Cole said. Accommodative IOLs also yield excellent results in patients who are not good candidates for multifocal lenses. Steven D. Vold, M.D., likes the Crystalens (Bausch & Lomb, Rochester, New York) for patients with mild-tomoderate glaucoma who need maximal quality of vision in terms of light levels and minimal side effects. “The Crystalens is really a monofocal lens that adds a little bit more in patients that are not good candidates for the multifocal lens,” Dr. Vold said. “I continue to use all three of these presbyobia-correcting IOLs. We are currently the only facility in Northwest Arkansas that offers every lifestyle IOL option to our patients.” Dr. Hof explained further that while multifocal lenses must split incoming light toward different focal points, the Crystalens focuses 100% of light at the same place, and simply moves in order to focus at different distances. “By adjusting the prescriptions of each eye, we can maximize the range of vision of these lenses, including near vision,” Dr. Hof said. Fortunately, all of these surgeons are on the patient’s side when choosing the appropriate lens. The bottom line, according to Dr. Hof, is that the lifestyle IOL is “a true technological advance. “This is a real improvement in the technology of delivering eyesight, although it is still not perfect,” Dr. Hof said.
06 n Eyedea
Cover Story
New Horizons in Glaucoma Surgery
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Photo credits: Matt Poe
cant technological advances in surgery, Dr. Vold said. he days when glaucoma patients are being treated with First is the Trabectome (NeoMedix, Tustin, Calif.), which surgery as a last resort are coming to an end. is a technique for ab interno trabeculotomy. The procedure Ophthalmologists are keenly aware of the challenginvolves using a microcautery technique to remove the inner es of compliance in glaucoma management. It’s a continuous wall of Schlemm’s canal and the inner wall of the trabecular struggle to get patients to take their pressure-lowering eye meshwork. drops when they don’t notice any immediate visual difference “You can get patients off of one to two medications in doing so, despite the fact that drops preserve vision. after surgery and lower the pressure as well,” Dr. Vold said. Those medications, which to some patients seemingly “People also recover quickly.” don’t do anything, are becoming more expensive too. A second option is canaloplasty, which is It’s no wonder that surgeons are looking a good one for patients on two to three medimore at surgical options to treat glaucoma, cations and also at high risk for complications particularly minimally invasive ones, accordfrom trabeculectomy. The innovative proceing to Steven Vold, M.D., the only fellowshipdure opens Schlemm’s canal and reduces trained glaucoma subspecialist in Northwest pressure without the need for a bleb. Arkansas. Easier, safer procedures are avail“Patients can go home the same day, and able now, and they obviously don’t need recovery is much shorter, typically two to three continuous application. The Trabectome procedure weeks” Dr. Vold said. “Combined with cataract Laser trabeculoplasty, for one, has besurgery, recovery is a little longer but still faster than with stancome more of a first-line treatment, Dr. Vold said. Minimally dard filtration surgery. The effect also is a long-lasting one.” invasive surgery also is beginning to provide intermediate Endoscopic cytophotocoagulation, which ablates the measures—somewhere between first-line treatment and the tissue of the ciliary body epithelium, is a third option. This gold-but-troublesome standard: trabeculectomy. reduces the amount of aqueous production, thereby lower“Ultimately, surgeons have waited until patients had ing pressure. Typically, it is used in combination with cataract bad uncontrolled glaucoma to opt for trabeculectomy or a surgery. tube shunt,” added Dr. Vold, but newer, minimally invasive “It’s a way to get patients off of one to two medications,” surgical options are allowing for earlier procedures as well, Dr. Vold said. and typically reduce the number of medications that patients Goniosynechialysis is a fourth procedure, and for people rely on. who have experienced angle-closure glaucoma. The proce“There’s a huge interest in minimally invasive glaucoma dure disposes of trabecular meshwork obstruction. treatment,” Dr. Vold said. “Recovery is much more rapid and “It’s minimally invasive and gets patients back on their the operation yields far fewer complications.” feet quickly,” Dr. Vold said. Four established minimally invasive procedures are in BoozmanHof is beginning to use the CyPass device play at BoozmanHof, as well as numerous potentially signifi-
Canaloplasty, shown in these images, opens Schlemm’s canal via viscodilation with a catheter and reduces pressure without the need for a bleb. The center image shows a red beam of LED light that is at the catheter’s tip, allowing the surgeon to have visual contact with the tip.
Eyedea n 07 (Transcend Medical, Menlo Park, Calif.) in conjunction with cataract surgery as part of clinical research. “The CyPass microstent is placed within suprachoroidal space and enhances outflow of aqueous humor,” Dr. Vold said. “The surgery takes only a few minutes to do and patient recovery is remarkably rapid. A patient can achieve excellent vision within only a few days after surgery.” The procedure works best for patients with mild to moderate glaucoma. Dr. Vold is among the first clinical investigators for the new iStent (Glaukos, Laguna Hills, Calif.), an ab interno micro-bypass implant. The device already has obtained approval for use in select countries in Europe and is currently undergoing review by the Food and Drug Administration. “We do believe multiple stents will make a difference,” Dr. Vold said. Already, in more advanced cases of glaucoma, the clinic uses the Ex-Press Glaucoma Filtration Device (Alcon, Fort Worth, Texas) which can help to shorten recovery from trabeculectomy. In an article Dr. Vold authored in the November/ December issue of Advanced Ocular Care that reviewed minimally invasive glaucoma options, he noted: “Trabeculectomy and tube shunts have been the mainstay of glaucoma surgery for several decades. Although these surgeries are highly successful in terms of an absolute reduction of IOP, a significant percentage of patients do not reach their target pressure.” As a result, Dr. Vold said, “Other procedures are trying to come into the business and extend into that space.” Dr. Vold noted that BoozmanHof is the only eye surgery center in Northwest Arkansas that uses minimally invasive glaucoma devices and procedures like the Ex-Press, the Trabectome, and canaloplasty.
I’m Vouching for World-Class Eye Care at BoozmanHof By Timothy D. Buckley
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ightfully so, you are probably asking yourself, “Who is this guy, and how is he qualified to rate a medical facility?” My name is Tim Buckley, and it is my pleasure to be writing you as part of Eyedea. When I heard from BoozmanHof’s staff of their magazine, I asked if I could please contribute because I felt I can offer an industry insider’s perspective regarding the quality of health care at this institute. I have worked in the medical device industry since 1997. As first an engineer then marketing executive, I have had the pleasure to develop many new technologies for eye surgery. My career has afforded me the opportunity to work with some of the finest ophthalmologists around the globe. Without hesitation, I can honestly say that BoozmanHof ranks as one of the best. How do I know? I personally rate quality on numerous factors, including: an overall standard of excellence, patient safety, risk management and continual drive towards improving techniques in therapy. BoozmanHof has the absolute latest therapeutic technologies in the market. They make tremendous commitments and investments to ensure they have both the latest technology and associated training. For example, they recently invested in two very premium surgical microscopes, called the OPMI Lumera T from Carl Zeiss. This is high-end premium technology that approximately 20 centers in the United States have. This equipment allows the surgeon to improve surgical outcomes because of far superior visualization. That is just one example of many of their drive to achieve premium patient outcomes. In a year of uncertainty when many delayed investment, BoozmanHof kept one thing certain: their commitment to quality care. Great job. Editor’s note: Timothy D. Buckley is senior marketing manager at Transcend Medical (Menlo Park, Calif.)
08 n Eyedea
The of Vision Screening for Medical Experts
Photo credit: Matt Poe
By Matt Young Eyedea editor
A patient gets her eyes screened.
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even years into the ophthalmology writing profession, I was preparing for a medical eye mission to India and suddenly fascinated by the red reflex. How was it that I had written hundreds of articles on ophthalmology and could still be fascinated by this most basic of tests? Simple: I didn’t remember ever performing one. It’s funny how we become specialists in life without sometimes ever really understanding the basics. But it happens, especially as a cop reporter turned eye journalist. Once upon a time, I examined courthouse records for triple murders, and weeks later I was combing the depths of medical literature for mere nuances of innovation in ophthalmic surgical technique. Yet knowing that I knew so little about the red reflex seven years later—how humbling. For clinical professionals, it may be even easier to overrate one’s own expertise. When people rely on you, you really have to know the answer—but how well do you really know it? In this brief moment in time, I’m here to tell you that you don’t have to know anything—at least not about
when to get an eye exam. Maybe you really do know very little, and that’s perfect, because we’re going to learn together here—believe me. Let’s start…. There are recommended intervals to get regular eye exams, as outlined by the American Academy of Ophthalmology (AAO). Before age 3 is the first interval to be aware of. Eyes should be screened during regular pediatric appointments. If a there is a family history of strabismus, or amblyopia, or ptosis, or if the child appears to have any of those conditions, an ophthalmologist should be consulted. From age 3 to 19, eyes should be screened every one to two years during pediatric or family physician visits. From age 20 to 39, don’t take healthy vision for granted. Have an eye exam at least once between 20 and 29, and at least twice between 30 and 39. Be particularly vigilant about: • Visual changes or pain • Flashes of light
• Regular visits to the eye doctor to treat ongoing disease or injuries, or for vision exams for glasses or contact lenses should continue beyond this initial exam. For those 65 and over, get complete eye exams every one to two years to check for cataracts, glaucoma, agerelated macular degeneration, diabetic retinopathy and other eye conditions. Those that need vision exams more often than recommended above include: 1) people with a family history of eye problems, 2) African Americans over age 40, 3) those with diabetes, and 4) anyone with a history of eye injury. Anyone at any age with visual symptoms or at risk for eye disease, such as those with high blood pressure, should see an eye care professional to determine how frequently the eyes should be examined. Now knowing all of this, I think it has been a little too long since I had my eyes seriously checked. What about you, or your patients?
• Seeing spots or ghost-like images
Editor’s note: Matt Young is a contributing
• Lines that appear distorted or wavy
editor for EyeWorld magazine.
• Dry eyes with itching and burning. The AAO actually issued new eye disease screening recommendations in 2007 for aging adults. Therefore, from age 40 to 64, be aware of the following: • Adults with no signs or risk factors for eye disease should still get their eyes screened at age 40, which is when early signs of disease and changes in vision begin to happen. • This initial vision test will help preserve vision, and it also helps aid early detection of systemic diseases like hypertension and diabetes.
If you have a problem with your vision, Dr. Hof, pictured here, and all the eye care professionals at BoozmanHof are ready to provide you with excellent care. Call them at 800-428-3937 or 479-246-1700, or email them at info@boozmanhof.com.
Eyedea n 09
I
moved to Rogers, Arkansas from California in the 1970s; there was a great big earthquake and my family decided that we had had enough. I’ve enjoyed the more peaceful surroundings of Rogers, but I’ve enjoyed the miracles that happen every day much, much more. They happen all the time here at BoozmanHof. People who have corneal transplants are often just tickled to death about their experiences. They might not be able to see as well as you or I, but they are the ones that really appreciate vision. I don’t really enjoy medical coding, but I’ve done it for 23 years. I’m doing it for the patient. Medical coding is “by the book,” but the book changes daily and you
have to keep on top of it. You have to read a lot, explore a lot, and not believe everything you hear. It’s very trying. Admittedly, I have a fair amount of medical coding experience, and I’d like to help you in any way that I can to ensure your patients are getting the best care. I can’t imagine not being able to see. A lot of people take that for granted until they don’t have it anymore. I’m going to help you in the issues of Eyedea magazine, so that you can help patients. If you have questions related to medical coding, call me at 479-246-1700, or email me at jgeary@boozmanhof.com. I’ll personally respond to you, and we’ll also answer the best questions in the pages of Eyedea.
“
Admittedly, I have a fair amount of medical coding experience, and I’d like to help you in any way that I can to ensure your patients are getting the best care.
”
– Janis Geary
Ask Janis
Veteran medical coder provides answers to your ophthalmology management questions Now for our first Q&A…
Question: We co-manage cataract surgery care with an area ophthalmologist. Some of the ophthalmologists offer premium intraocular lenses or IOLs. How does co-managing work when these lenses are selected by the patient?
Answer: The optometrist would file the Cataract CPT code with the 55 modifier as usual, and receives 20% of the Medicare allowable for postoperative care. Our ophthalmologists offer these lenses but require that the co-managing optometrist attend a presentation that qualify and educate them on the
postoperative care and benefits of lifestyle lenses. When the optometrist completes his course he is qualified to co-manage and receive an additional fee (usually $200 per eye) for his extra time and postoperative care of the lifestyle lens patient. This fee is not billed to the insurance company; it is collected from the patient or financed. The patient is made aware of the extra fee before surgery, in writing. We give the patient a copy and send a copy to the comanaging optometrist. All optometrists are welcome to attend this training presentation at their convenience. You may contact Kevin Gardner, O.D., for more information or scheduling. Call 479-246-1700, or email him at kgardner@boozmanhof.com to reach him for details.
Quick Facts about Janis Geary, ACS-OH • Joined BoozmanHof Eye Clinic in November 1987 • Certification from the Board of Medical Specialty Coding (BMSC) in 2004 • Helped in the establishment of the Corporate Compliance Plan for BoozmanHof Eye Clinic • Coordinator for the annual BoozmanHof Coding and Billing Conference • BoozmanHof business office director
Photo credit: Matt Poe
Why Janis Wants to Help
10 n Eyedea
Surgery Center Update
Bugs Get
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ndophthalmitis, a terrible blinding infection, typically occurs around 1 of every 1,000 cases. At BoozmanHof, the rate stands at 1 in 28,000 after cataract surgery—a remarkable achievement. “From the first day we opened, we have used a comprehensive prophylaxis system,” said Randall E. Cole, M.D., medical director, BoozmanHof Eye Surgery and Laser Center. “We create as many barriers as we can to reduce infection.” Statistically, BoozmanHof’s ambulatory surgery center (ASC) ranks as among the best anywhere in keeping patients infection-free. Here’s part of what they do: • BoozmanHof gets everyone involved in prophylaxis—from physicians to employees to patients; • Patients use antibacterial soap for three days before surgery; • They also use topical antibiotics for three days preoperatively; • The ASC uses vancomycin and gentamicin—two strong antibiotics—in the irrigating solution; • The ASC defers surgery if the patient has an active or untreated systemic infection. “We have been fortunate that our system is very effective,” Dr. Cole said. “We continue to do things most practices just don’t do in terms of having an extremely clean environment.” Steven D. Vold, M.D., joined BoozmanHof after previously serving as
By Matt Young Eyedea Editor vice chairman at the Scott & White Eye Institute, Texas A&M Health Science Center College of Medicine, Temple, Texas, and also after working at the prestigious Wheaton Eye Clinic in the Chicago area. He was immensely impressed at how well the BoozmanHof system worked. “In addition to being a busy cataract surgeon, Dr. Vold operates on extremely sick eyes using procedures like trabeculectomy and glaucoma drainage devices,” Dr. Cole said. “He performs some of the most complex and high risk surgeries in all of ophthalmology where the risk of infection would be much higher. In the 3.5 years that he has been here he has been extremely pleased with the postoperative outcomes.” It is critical that patients use antibiotic drops as instructed to be infection-free, Dr. Cole said. The ASC has used Vigamox (Alcon, Fort Worth, Texas) and Zymar (Allergan, Irvine, Calif.)—two powerful fourthgeneration fluoroquinolones—“since the day they came out,” said Dr. Cole.
These are used three days before the surgery, four times per day. “Some surgeons will argue that, ‘Hey, we just need to use them an hour before surgery to achieve good aqueous concentration,’” Dr. Cole said. “The point is not aqueous concentration. The point is killing bacteria in the flora around the eye. You can’t do that in an hour.” Dr. Cole noted that 80% of postsurgical eye infections are caused by bacterial flora from the patient. It is therefore important to use antibacterial soap and topical antibiotic drops well before surgery to control bacteria that are around the eye, he said. The other 20% of infections come from the surgical environment. “That’s where most epidemics come from,” said Dr. Cole (pictured here). “Poor sterilization, dirty instruments, autoclaves that aren’t working, and lack of adherence to aseptic technique are critical factors here.” Photo credits: Matt Poe
N
Chance Here
Eyedea n 11
Cool Stuff
Journey to the Center of the Eye
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ho knew 3D could be helpful as well as entertaining? The guys at TrueVision Systems (Santa Barbara, Calif.) did. Journey to the Center of the Earth is nothing compared to 3D surgery. Ok, you don’t get Brendan Fraser coming out at you. But you do get to watch surgery in a particularly meaningful way. Patients and their family members can witness their surgical options preoperatively in 3D. Then, LIVE, surgeons can operate more comfortably by witnessing surgery on a projector or monitor in 3D, surrounded by better informed colleagues. “TrueVision provides a vastly improved 3D view of a surgical procedure in high-definition,” said Steven D. Vold, M.D. “I can operate more comfortably and my operating room staff can see what I see, which gives them an advantage to anticipate my needs during surgery. With these benefits patients are ultimately the winners.”
A Macular Degeneration Option from Left Field
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enentech must be apoplectic over the competition—itself. Genentech (South San Francisco, Calif.) makes Lucentis, a treatment for age-related macular degeneration (AMD) reported to cost a couple thousand dollars per dose. Genentech also makes Avastin, originally sold for the treatment of metastatic cancers, and reports subsequently surfaced that it’s good at treating AMD too—at only about $50 per dose for amounts needed for the eye! True, Lucentis is Food and Drug Administrationapproved for treating AMD, while Avastin is not. And the availability of Medicare in the United States means that Lucentis injections are covered, although co-payment required still makes Lucentis significantly more expensive than Avastin in many instances. Of course when at all possible, financial considerations should be secondary to ensuring patients receive the best medicines. That said, it has yet to be seen which medication truly is the best; both already are reported to be safe and effective, with the ability to improve vision in AMD patients. A large study comparing the two is underway and backed by the U.S. government. We should hear more about which is best later this year. Until then, suffice to say that it’s cool to have cheap treatment options, but cooler still to have two potentially great choices for AMD treatment.
(Image source: TrueVision Systems)
You’ve heard of Botox; how about Juvederm?
F
or a while, the only talk about town seemed to be Botox (Allergan, Irvine, Calif.), that minimally invasive, injectable, cosmetic option to reduce facial wrinkles. It’s a great option—no doubt—but a relatively ephemeral one, lasting for several months. Surgeons report Juvederm (Allergan) potentially lasting longer—months to years, also depending on the location of treatment. The mechanisms of action are different too. Botox: muscle relaxant. Juvederm: dermal filler. Technically, Juvederm is an injectable gel made from naturallyoccurring hyaluronic acid. As for the best news: you’ve got TWO true beauty options now! AND they’re an easy phone call away: (800) 428-3937. BoozmanHof performs these injections on Wednesday afternoons. Before Juvederm
After Juvederm
Before Botox
After Botox
(Image source: Allergan)
12 n Eyedea
We Value Our
Relationship with You W
hen you send patients to BoozmanHof Eye Clinic, you can be confident that your patients will receive the very best care, with the latest technology, from experienced skilled physicians. We will work closely with you and your staff to ensure that your patients obtain the best possible results. Once a treatment plan is formulated, our surgical counselors will work with your office in arranging the return to your care. Since its beginnings as Boozman Eye Clinic in 1977 and later as BoozmanHof, our practice has endeavored to offer the latest innovations in ophthalmic surgery. We offer the precision of wavefront-guided LASEK and a full range of new lens options for cataract patients, including apodized diffractive optics technology (the AcrySof IQ ReStor) and accommodating IOL technologies (Crystalens). Our fully accredited, Medicare-approved surgery center accommodates every outpatient procedure we perform, including cataract surgery, LASEK, glaucoma and retinal surgeries. Staffed with experienced eye care professionals, our facility offers the very best in ophthalmic surgical technology in a comfortable, patientfocused environment. We look forward to working with you and your staff! BoozmanHof Eye Clinic offers: • Experienced surgeons and staff • State-of-the-art operating room and laser suite
• An inviting, spacious clinic • Comfortable reception and recovery areas
Our Doctors
(From Left) Dr. Randall E. Cole, M.D., F.A.C.S., Dr. Steven D. Vold, M.D., Dr. C. William Hof, M.D.
If you have any question or if there is anything that we can do for you, please don’t hesitate to give us a call at 800-428-3937 or 479-246-1700, or email us at info@boozmanhof.com. Visit our website at www.boozmanhof.com
Procedures include: • Advanced Surface Ablation (LASEK) • Astigmatic keratotomy • Aqueous shunt to extraocular reservoir (Ahmed FP7 or Baerveldt shunt) • Avastin/ Lucentis intravitreal injections • Blepharoplasty • Botox/Juvederm • Canaloplasty (transluminal dilation of aqueous outflow canal with suture) • Cataract extraction with intraocular lens implantation (lifestyle, toric and aspheric lenses available) • Ciliary body destruction (endoscopic cyclophotocoagulation)
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Corneal transplants including DSEK Ectropion/Entropion repair Endothelial keratoplasty Excision of pterygium with conjunctival graft Ex-Press Glaucoma Filtration Device Focal Grid Laser Iris repair iStent glaucoma procedure Laser peripheral iridotomy Nd:YAG capsulotomy Panretinal photocoagulation (PRP) Removal of skin lesions
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Repair of laceration of cornea or sclera Repositioning of the intraocular lens Scleral reinforcement with graft Strabismus surgery Temporal artery biopsy Trabeculectomy (with Mitomycin C or Ologen) Trabeculotomy (with the Trabectome) Transcend CyPass glaucoma implant Visian ICL (Implantable Collamer Lens) implantation Vitrectomy