Optometric Office MAY 2019

OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

MAY 2019

CONTACT LENSES:

PHARMACEUTICALS:

PATIENT CARE:

FITTING PATIENTS WITH DRY EYE p 10

NEW CORTICOSTEROIDS FOR CATARACT SURGERY p 11

DOCS SPEAK OUT ABOUT ALZHEIMER’S DISEASE p 12

SAVING SIGHT SOONER | INSTRUMENTS FOR EARLY AMD DETECTION

p8

SUPPLEMENT TO VCPN MAY 2019

DRIVE PATIENT SATISFACTION WITH TRUE INNOVATION

Biofinity Energys® are the only contact lenses designed to help with eye tiredness and dryness associated with digital eye fatigue.1 When 78% of wearers are interested in ways to reduce eye tireness, yet only 14% report digital device use is brought up in their eye exam2, the opportunity to prescribe true contact lens innovation and to drive satisfaction is now.

95% of wearers who

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85%

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46%

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Unleash the potential of Biofinity Energys® and visit OnlyBiofinity.com/Energys to order your patient marketing kit.

SPHERE 1. US monthly single vision lens 2. CooperVision Digital Device Usage and Your Eyes Report,2018 3. CVI data on file, 2018. Online survey Biofinity Energys® CL wearers, USA.

TORIC

M U LT I F O C A L ©2019 CooperVision 7735 2/19

OPTOMETRIC OFFICE EDITORIAL STAFF VP, Editorial John Sailer | JSailer@ FVMG.com Editor Joanne Marchitelli | JMarchitelli@FVMG.com Creative Director Production and Web Manager Megan LaSalla | MLaSalla@FVMG.com

Table of Contents

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11

Contributing Writers Bridgitte Shen Lee, OD Zvi Pardes

DEPARTMENTS

BUSINESS STAFF

3 | One-to-One: Travis Rush, Sightbox

President/Publisher Terry Tanker | TTanker@FVMG.com Vice President, Marketing Debby Corriveau | DCorriveau@FVMG.com Regional Sales Manager Eric Hagerman | EHagerman@FVMG.com

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

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

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

2 | Views

4 | Think About Your Eyes: Caring for Patients With Dry Eye Disease 5 | Product Buzz 14 | New Product Gallery 16 | At-A-Glance: Lubricant Drops

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FEATURES 8 | INSTRUMENTS: Adopting Dark Adaptation Technology 10 | CONTACT LENSES: No More Dry Eye Dropouts 11 | PHARMACEUTICALS: New Corticosteroids for Cataract Surgery 12 | PATIENT CARE: Docs Speak Out About Alzheimer’s

www.Facebook.com/OptometricOffice www.Twitter.com/OO_Magazine www.Linkedin.com/showcase/Optometric-Office-Magazine

VIEWS

MAKING A DIFFERENCE

Joanne Marchitelli As optometrists and eyecare professionals you are already in a vocation that helps people. So it’s no wonder this field has a strong showing of volunteer efforts and altruism. We also frequently see social entrepreneurism with successful business models that give back—further expanding on the care that has been inherent in the work all along.

Companies are also no strangers to charitable giving. From non-profit organizations, such as the Brien Holden Vision Institute, charitable arms of for-profit companies, such as Essilor Vision Foundation, and mission trips through organizations such as VOSH/International, there are an amazing amount of opportunities to do good and do more for others.

Usually the only problem for a doctor in private practice is time.

Jordan Kassalow, OD, is the founder of VisionSpring, EYElliance, Scojo New York and the Global Health Policy Program at the Council on Foreign Relations. His career exemplifies what it means to give back. On his first mission trip after graduating from New England College of Optometry, he found his calling after fitting eyeglasses on a 7-year-old boy whose parents thought he was blind. He wasn’t. His vision was a minus 20, so without corrective lenses he couldn’t see. After that humbling experience he said he sought to create a career that honored two fundamental human needs—first, taking care of self and family, and then taking care of others.

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In his new book, Dare to Matter: Your Path to Making a Difference Starts Now, he shares his personal experience trying to balance real-life responsibilities with making a difference in the world. He offers advice on how you can explore your strengths and interests to create a fulfilling life and how you can carve out the time to make it possible. In doing so, he outlines some steps that help make it easier for you to make making a difference a part of your life.

Some of these steps include: • Create a realistic structure that works for you.

• Start by allocating a specific amount of time per week that you’ll dedicate to making your difference.

• Be prepared to try multiple approaches before you find a structure that fits your life. Don’t be afraid to experiment to make it work for you and the people who count on you.

The point isn’t to get it right the first time, but to build something that changes with you while you continue to work for change.

• If you find that, what Kassolow calls your “Do Good Discount” work, isn’t working financially, rather than asking yourself how much of your make-a-difference time you can reallocate to your remunerative work, first ask yourself how you can potentially reduce some aspect of your cost of living in order to retain some, if not all, of the time you want to dedicate to doing good.

• Once you’ve begun allocating a consistent amount of your time to making a difference, even if you have to dial that time back significantly, don’t stop completely.

If you have an hour, use the hour, and protect the hour.

It has value, you have value, and the difference you can make over the arc of your lifetime by integrating making a difference into your life is invaluable. *** Joanne Marchitelli | Editor | JMarchitelli@FVMG.com

JM: How did you differentiate Sightbox from other e-commerce sights selling contact lenses?

TR: Growing up within an optometry family, my father helped me understand the value of the health exam component of an annual eye exam. Since I’ve watched the evolution of telehealth enter the eyecare world, I understand the potential risks of using these new technologies irresponsibly based on the things my father used to show me when taking photos of the insides of patients’ eyes. There’s a lot that technology can’t do (yet), and I set out to help build a service that would keep the doctor at the center of this evolution and ensure that people maintain a relationship with their eye doctor and take advantage of these new tools to supplement that relationship, not replace it.

ONE-TO-ONE Travis Rush

Founder and CEO Sightbox Travis Rush, founder and CEO of Sightbox, launched Sightbox in 2012. As the son of an optometrist, the serial entrepreneur naturally found himself in the eyecare space with Sightbox, an all-inclusive vision care subscription service that includes an annual eye exam, fitting and 12-month supply of contact lenses with a monthly payment. The company, launched in 2012, was acquired by Johnson & Johnson in 2017.

Joanne Marchitelli: You have an interesting story in why you started Sightbox. Can you share why you founded a tech business focused on eyecare?

Travis Rush: I’ve spent the past 20 years building technologybased solutions for eyecare—from custom websites to email to internal office chat services to e-commerce. It was the learnings from working with technology in partnership with thousands of eyecare practices over the years, and also watching the evolution of technology in eyecare being primarily driven by consumer demand, that made me aware of the need for a solution like Sightbox.

JM: Your model takes e-commerce one step further by including an eye exam. Why did you include that service in the subscription?

TR: There is more to an eye exam than just being able to see street signs. There are over 250 medical warning signs that optometrists can see during an exam in their office.

Bypassing or skipping this part of the exam is a risk no one should be taking. We talk about eye exams as a two-part exam we refer to as a “vision and eye health exam” and both are equally important.

JM: Please explain how Sightbox connects patients and eyecare professionals. Is there a way for optometrists to sign up for consideration?

TR: First, it’s important to understand that we are not like a typical “network” of health professionals that are asked to sign a 20-page document to become an “in network” provider. There are no contracts or ongoing agreements.

Each new patient we introduce to an optometry practice is handled individually. We select practices based on proximity and scheduling availability. Of course there is also a reputation component as well. Meaning, if our members report having a poor experience in an office, we will talk to the office to get both sides of the story. But if it were to be a continuing theme, we may stop referring patients to that practice. But it is rare that this ever happens. We encourage all optometrists to go to Doctor.Sightbox.com and connect with our professional development team to ensure your practice is in our database and that your information is up to date.

JM: Is the fee paid to the optometrist for the exam a flat fee or does it reflect the location of the practice?

TR: We pay the cash-pay rate of the practice regardless of location. Basically, what the patient would have been asked to pay if they walked in off the street is what we pay, in full, the day of the exam. *** O p tometr ic O ffic e. c om | May 2019

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THINK ABOUT YOUR EYES

CARING FOR PATIENTS WITH

DRY EYE DISEASE So much education is needed about dry eye disease (DED). DED is multifactorial, chronic, progressive and inflammatory in nature. Patients do not know that DED is a disease, and if left untreated, it will get worse. Since it is also caused by lifestyle and poor hygiene, patients need to develop regular lid/lash hygiene and healthy digital habits to prevent DED from getting worse.

There is no “one cure” for DED! Patients expect a drop, a procedure, a pill or that one something that they can do for a month or two to make it go away. Patients need to follow their doctor’s prescribed treatment—even after they notice their symptoms improve.

The prevalence of diagnosed dry eye disease in the U.S. is around 30 million people. In a busy primary eyecare clinic, the actual percentage of patients with reported dry eye symptoms or observed clinical signs are much higher. At our practice, more than 50% of patients complain of symptoms that align with DED.

IMPORTANCE OF PATIENT EDUCATION Education on the “disease” nature of DED is vital. Many patients blame dry or red eye symptoms on allergies and attempt to treat the symptoms with over-the-counter drops, which may only provide temporary relief and mask the underlying chronic ocular surface issues. Annual eye exams are an ideal time to discuss the chronic eye issues that patients are experiencing but may not bring up because they don’t know there are effective treatment options. Optometrists don’t know if patients suffer from DED symptoms until we ask.

Every optometrist has dry eye patients in their exam chairs every day. Questions can be built into case history, and conversations can be included in the treatment recommendations.

All optometrists should follow the official TFOS DEWSII (Tear Film Ocular Surface Society, Dry Eye Work Shop Report II, [published summer 2017]) recommended four-step protocol in treating and managing DED. (See link below.)

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Bridgitte Shen Lee, OD

Bridgitte Shen Lee, OD, is the founder and CEO of Vision Optique and iTravelCE. She writes and lectures on the topics of digital eye health, dry eye disease, anti-aging eyecare, healthcare social media, and ocular aesthetics. Lee is one of the TFOS Global Ambassadors, and she is the official spokesperson and medical adviser to The Vision Council. She is one of 22,000 doctors listed on the Think About Your Eyes doctor locator. First Vision Media Group is a media partner of Think About Your Eyes.

The first step in the protocol includes the following: • education regarding the condition, its management, treatment and prognosis • modification of local environment • education regarding potential dietary modifications • identification and potential modification/elimination of offending systemic and topical medications • ocular lubricants of various types • lid hygiene and warm compresses of various types To learn more about the four steps of DED management, visit: TearFilm.org and click on the “reports” tab.

VALUE OF ANNUAL EYE EXAMS Dry eye is a chronic disease that too many patients attempt to treat on their own and do not know to discuss with their optometrists. As advocates for our patients’ vision and eye health, it’s our duty to diagnose and treat DED. An important first step is an annual eye exam, about which Think About Your Eyes serves to increase awareness. I’m proud to support these efforts. O|O

PRODUCT | BUZZ LAUNCHES, PROMOTIONS, MERCHANDISING, EVENTS AND OTHER THINGS TO KEEP YOU IN THE KNOW. capture extremely precise information on patients’ eye movements including eye alignment and teaming, object tracking, depth perception and dynamic visual acuity to build the eyetracking dataset.

Go to RightEye.com

TRANSITIONS REFRESHES WEBSITE NEW DATABASE FROM RIGHTEYE TO AID IN NEUROLOGIC RESEARCH RightEye recently launched a powerful new weapon in the battle against neurological disorders, traumatic brain injury and learning disabilities— a database of one billion data points.

The database, already being used by The U.S. Department of Veterans Affairs, U.S. Department of Defense, several universities, and more, will provide researchers with a new and deeper understanding of early indicators for neurological issues, which are anticipated to help in the development of new treatment options and interventions.

“Our ability to help science and medicine understand how the anatomy of the eye is linked to the brain opens up an entirely new world for providing better treatments to patients suffering from a host of health issues,” said Dr. Melissa Hunfalvay, RightEye’s chief science officer. “We are just beginning to touch the surface of this new frontier. As our system continues to get smarter with more data, we will continue to contribute more valuable insights on what the eyes indicate about our overall health.”

RightEye’s EyeQ tests incorporated more than 650 unique metrics that

Transitions Optical has launched a new website that aims to increase awareness of the importance of regular eye exams and premium eyewear options available through a comprehensive vision benefit. The website, HealthySightWorkingForYou.org, provides a wide range of information, educational resources and quantitative tools to reinforce the value of offering—or enrolling in—a premium vision plan. Employers and employees can find vision plan savings calculators, quarterly newsletters, eyecare tips, and research and white papers.

Go to HealthySightWorkingForYou.org.

GLOBAL COUNCIL ON MYOPIA MANAGEMENT ANNOUNCES INAUGURAL CONFERENCE The Global Council on Myopia Management scheduled its inaugural meeting in Toronto, Canada, June 7 to 8, 2019. International speakers will address all aspects of myopia management from current understanding of the underlying mechanisms of the disease to clinical treatment modalities of today and tomorrow, and integration of myopia management into clinical practice. Attendees can earn 16 hours of COPE-approved Continuing Education.

Go to MyopiaCouncil.org/Conference/ GComm-2019/

Allegro Ophthalmics has announced that world-renowned clinicians Richard L. Lindstrom, MD, Edward J. Holland, MD, and Eric D. Donnenfeld, MD, have joined the company’s newly formed Cornea Scientific Advisory Board.

Orasis Pharmaceuticals LTD, has initiated a Phase 2b clinical study in the U.S. evaluating CSF-1, a corrective eye drop for the treatment of presbyopia.

Glenn Ellisor, OD, and Jim Greenwood of Vision Source received the 2019 Person of Vision Award from Prevent Blindness.

The California Optometric Association (COA) announced that Ronald G. Seger OD, FAAO, has been named president.

Optometry and leadership run in Seger’s family—his father Charles E. Seger served as president of COA in 1960.

Alcon named Timothy C. Stonesifer SVP and chief financial officer.

LumiThera Inc. recieved a small business innovative research phase II grant from the NIH and the division of the National Eye Institute to support a prospective, randomized, multi-center human clinical trial in U.S. subjects diagnosed with dry agerelated macular degeneration.

Eyenovia, Inc. announced positive results from its second MicroStat Phase III study, called MIST-2. The study examined the safety and efficacy of the company’s firstin-class, MicroStat fixed-combination formulation, with target markets including the estimated 80 million annual pharmacologic mydriasis market in the U.S. Alimera Sciences, Inc. has announced the appointment of Samer Kaba, MD, as chief medical officer.

VSP Global has announced the appointment of Steve Baker, president of Eyefinity, to lead the newly established VSP Ventures.

continued on page 6

O p tometr ic O ffic e. c om | May 2019

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PRODUCT | BUZZ

CONTINUED

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

J&J’S ANTIHISTAMINE CONTACT LENS DEMONSTRATES POSITIVE PHASE 3 RESULTS Johnson & Johnson Vision shared positive results from two Phase 3 clinical studies evaluating the company’s investigational antihistamine-releasing contact lens (etafilcon A with 0.019 mg ketotifen). The results were published in the journal Cornea.

The antihistamine-releasing contact lenses are daily disposable lenses containing ketotifen, a drug that inhibits certain substances in the body that are known to cause allergic reactions and inflammation. The researchers recruited 244 patients in two multicenter, double-masked, randomized, placebo-controlled trials. After a screening, patients were randomized by eye to receive either the antihistamine-releasing lens or the placebo control lens. The lenses were then worn for either 15 minutes or 12 hours depending on the study visit. After the prescribed wearing time, allergens were dosed into the eyes wearing the contact lenses and the patients reported the severity of their itching symptoms using a 0-4 scale (where 0 equals no itch and 4 equals an incapacitating itch with an irresistible urge to rub).

Results showed the patients who wore the antihistamine-releasing contact lenses experienced both a clinically and statistically significant (p< 0.001) reduction in the average eye itch symptom at both time point evaluations (15 minutes and 12 hours) as compared to those receiving control lenses in the study.

“These Phase 3 study results are important on multiple fronts. Contact lens wearers who historically suffer 6 M a y 2 01 9 | Op to m e tri c O f f i c e .c o m

from itchy, allergy eyes had meaningful reductions in itching across two randomized, well-controlled studies,” said Brian Pall, OD, MS, FAAO, director, clinical science, Johnson & Johnson Vision Care, Inc. and lead author of the manuscript. “There was both a clinically and statistically significant reduction in ocular itching that occurred 15 minutes after lens insertion and lasted for the 12-hour study evaluation period. This marks the first time that contact lens technology has shown potential in a large-scale study to address itch stemming from ocular allergies.”

Go to JJVision.com

ALCON COMPLETES SEPARATION FROM NOVARTIS Alcon has announced its separation from Novartis is complete and the company is now an independent, publicly traded company. “For more than 70 years, Alcon has been dedicated to helping people see brilliantly and now, as an independent company, we are pursuing even more opportunities to further that mission,” said David Endicott, chief executive officer of Alcon. “We are poised to achieve sustainable growth and create long-term shareholder value as a stand-alone company. We have a long history of industry firsts and, as a nimble medical device company, we are sharply focused on providing innovative products that meet the needs of our customers, patients and consumers.”

Alcon is headquartered in Geneva, Switzerland, and its facilities in Fort Worth, TX, will remain a major operational center and innovation hub with a large base of employees. The company will continue its substantial corporate giving efforts, including the

RevCycle Partners recently launched WeCredential, a service for optometrists who seek to outsource their credentialing tasks. WeCredential has two offerings. The first is Managed Services, which focuses exclusively on the ongoing maintenance demands of credentialing. The second, On-Demand, helps practices solve credentialing issues tied to a specific event.

Bausch + Lomb announced the appointment of new leadership in its Pharmaceuticals and Consumer Health Care divisions in the U.S. Yolande Barnard, formerly the vice president, marketing and sales, U.S. Neurology, Bausch Health, will now serve as vice president and general manager, U.S. Pharmaceuticals, Bausch + Lomb. Chris Marschall, most recently vice president, marketing for Bausch + Lomb’s U.S. Consumer Health Care business, has been promoted to vice president and general manager, U.S. Consumer Health Care.

Chris Marschall

Yolande Barnard

Alcon Foundation and Alcon Cares, to help increase access to eyecare, providing sight-restoring surgeries, eye exams and other services to people in underserved communities around the world. Alcon also sponsors hands-on and virtual eyecare provider training and skills-transfer to strengthen the level of care and supports its communities through charitable donations and associate volunteerism.

Go to Alcon.com.

OCULUS Keratograph® 5M Please note: The availability of the products and features may differ in your country.

Specifications and design are subject to change. Please contact your local distributor for details.

Let’s Focus on Dry Eye! The Keratograph® 5M assists you in finding the cause of dry eye quickly and reliably. Summarize all data from your dry eye workup in the Crystal TEAR Report.

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INSTRUMENTS

ADOPTING DARK ADAPTATION TECHNOLOGY A marketing pro talks AMD, advanced diagnostic instruments and patient outcomes.

B y Zvi Pard es I’m not a medical researcher, optometrist, ophthalmologist or even a health practitioner of any kind. What I am is an optometry marketer, who spends every day helping practices grow by doing what they do best.

The intersection of technology and medical specialization has always been an important area of collaboration between EyeCarePro and the doctors we work with. Advanced patient care, smart financial decisions, and the right approach to marketing all go hand-in-hand to create a sustainable and profitable practice. This collaboration and strategic planning is what allows a practice to be effective in reaching and engaging new patients—and therefore helping the 8 M a y 2 01 9 | Op to m e tri c O f f i c e .c o m

greatest number of patients possible.

Age-related macular degeneration (AMD) has been an area of specialized focus for us and has led to specialized marketing approaches in areas such as low vision. And, of course, the technology a practice chooses to invest in is a large part of the equation. The decision-making that goes into choosing what diagnostic and treatment technologies a practice carries goes beyond accuracy and patient outcomes. It comes down to the kind of brand you want to build for your practice, the level of specialization you want to claim, and the growth direction you take in terms of dollars and cents.

TECHNOLOGICAL ADVANCES When it comes to detecting AMD, the technology has continued to advance at a frenetic pace. The OCT, for example, has been the standardbearer for detecting a range of ocular diseases for some time now, and it’s an essential piece of equipment for any practice serious about treating or managing ocular and retinal diseases.

Specific to AMD, the cross-sectional histological image of the retina captured by the OCT provides the means to detect the tell-tale drusen indicative of AMD. The newest modular enhancement to the OCT, the OCTA, allows for an even more in-depth examination of the macular regions.

Yet, when it comes to best patient

outcomes—as well as maximal profitability—diagnosis needs to be as early as possible. The earlier the practitioner can diagnose AMD (or the precursors to AMD), the more effectively the progression can be managed and slowed down. Ideally, management should begin well before symptoms or physical manifestations of the condition even appear. Yet the crucial subclinical stage of AMD is notoriously hard to diagnose with standard vision tests and diagnostic tools precisely because the patient still has no obvious symptoms and retains reasonable visual acuity, and no problematic drusen appear on scans. Alarmingly, the latest research indicates that typical screenings leave up to 25% of AMD cases undiagnosed.1 A startling statistic, since long before any drusen become visible, cholesterol deposits have already begun the process of wiping out photoreceptors and the drawn out and painful journey to blindness has started.

DARK ADAPTATION AND ADAPTDX

Alarmingly, the latest research indicates that typical screenings leave up to 25% of AMD cases undiagnosed.

for dark adaptation functionality is the AdaptDx from MacuLogix. The AdaptDx is fast and boasts reliable detection of AMD with impaired dark adaptation, which is proven to be highly sensitive (90.6%) and highly specific (90.5%) to AMD. While I’ll leave the exact mechanics of the test to medical experts, the gist is that the patient sits in a dark room and rests their head on the device.

A flash of light is emitted and the patient indicates with a response button each time they can see a stimulus light. The rod intercept (RI) is automatically calculated, indicating the patient’s speed of dark adaptation.

This process accurately measures dark adaptation speed. An RI greater than 6.5 is a proven indication of subclinical AMD, with data continuing to come in making the case for this stronger and stronger.2

high and slated to increase as the Baby Boomers age. Early subclinical detection allows for the best patient outcome precisely because early intervention is more effective—and that’s a longer period of time where the care you provide is generating revenue. The moment that dark adaptation time is impaired, you are recommending to your patient that they use blue light and UV protection, and hopefully selling that too.

You are also recommending and hopefully also selling AREDS2 supplements for this extended time period. All this will significantly slow down the progression of AMD while also increasing the revenue you are bringing in, for a longer period of time as you manage the condition.

Early detection isn’t just great for patients, it’s great for your practice too. O|O

EARLY DETECTION

Over the past few years, a great deal of solid research has gone into the early diagnosis of AMD. In particular, impaired dark adaptation has been a focus of research because it’s one of the first symptoms to manifest, potentially long before the appearance of drusen. The results have shown that functional testing for a dark adaptation impairment can help eyecare professionals diagnose subclinical AMD up to three years before any drusen show up on a screening.2 An early diagnosis allows for proactive treatment and monitoring of the disease to slow progression and identify choroidal neovascularization (CNV) before substantial vision loss occurs.

Obviously, patient outcomes are the primary focus, and the viability of your practice brand depends on providing the best care that you can.

Naturally, you don’t need me to tell you that the outcome for patients is proportional to how early AMD is detected, and it’s better for your practice too. Think about it like this.

When management is begun earlier, you establish yourself as an expert at the top of your field, and you’re also increasing your revenue. The patient with dark adaptation impairment now requires frequent testing and appointments to keep on top of the condition as it develops. Much of this testing, including the AdaptDx, is also reimbursable and covered by patient insurance.

Currently, the only effective, straightforward and automated testing tool

And there is a bigger piece here.

The rates of AMD occurrence are

The earlier the practitioner can diagnose AMD (or the precursors to AMD), the more effectively the progression can be managed and slowed down.

Zvi Pardes is an optometry marketing expert and head of content marketing at EyeCarePro. Focused exclusively on optometry and ophthalmology, EyeCarePro helps practices to achieve real, measurable growth with an increased online presence, content, and advanced SEO tools fine-tuned to eyecare.

References: 1. Neely DC, Bray KJ, Huisingh CE, et al.

Prevalence of undiagnosed age-related macular degeneration in primary eye care. JAMA Ophthalmol 2017 Jun 1;135(6):570-5 2. Owsley C, McGwin G, Clark ME, et al.

Delayed rod-mediated dark adaptation is a functional biomarker for incident early age-related macular degeneration.

Ophthalmology. 2016 Feb;123(2):344-51.

WHERE TO FIND IT MacuLogix 717.914.4067 | MacuLogix.com

O p tometr ic O ffic e. c om | May 2019

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CONTACT LENSES NEARLY 50% of contact lens wearers develop dry eye

NO MORE DRY EYE DROPOUTS Three lenses that challenge the statistics.

B y J o anne Marc hitelli From changes in vision (hello, presbyopia!) to developing dry eye disease (DED), the aging eye has a lot of surprises in store for your patients— especially those who wear contact lenses. While the risk of dry eye increases with age, with the majority of those over 65 experiencing some symptoms, younger patients and those who wear contact lenses are not immune. In fact, a study published in Optometry and Vision Science found nearly half of patients wearing contact lenses develop dry eye disease.

Additional risk factors include gender (females are more likely to develop DED), medications that may reduce tear production, exposure to smoke, wind and dry climates, digital eye strain and LASIK surgery.

patients, she said they first treat the underlying cause. “We take a detailed history from the patient, including medications and systemic diseases.

We take a careful look at the ocular surface and lids, and we also look at tear osmolarity with TearLab,” she said. “We determine a treatment plan based on this, including medications, such as Xiidra and Restasis, lid hygiene, artificial tears, addressing environmental causes (i.e., fans blowing directly on patients, etc), and patient education.

DAILIES TOTAL1

We asked our advisory board members what they recommend in their practice to keep their patients (and their eyes) happy, healthy, and hydrated.

“For patients with dry eye and contact lens intolerance DAILIES TOTAL1 from Alcon has a good reputation, and we have experienced success with this lens,” said Andrew Gurwood, OD, Philadelphia. “We also stress improved hygiene and decreased wearing time to help patients with DED or contact lens intolerance, and we recommend topical immunomodulators such as Restasis and Omega-3 oral supportives.”

MYDAY

BIOTRUE

It’s no surprise that the contact lens dropout rate is so high.

“For dry eye patients, my go-to lens is Coopervision’s MyDay,” said Jennifer Stewart Ellison, OD, Norwalk, CT. “The combination of comfort, breathability and sharp optics make this a winning lens in our practice.” To help dry eye 10 M a y 2 01 9 | O p to m e tri c O f f i c e .c o m

“For the contact lens patient with dry eyes, I will use the lens that works,” said Jeff Anshel, OD, FAAO, Encinitas, CA. His go-to lenses are usually monthly replacement lenses.

However, these are not the best option for patients with DED. “For dry eyes,

a daily disposable is preferred,” he said. Biotrue (Bausch + Lomb) and MyDay (CooperVision) are the preferred lenses for his patients. He also recommends a nutritional product, Biotears from Biosyntryx, to help reduce the symptoms of dry eyes.

“It’s a two-pill, twice-a-day product that usually shows an effect within 30 days and some people may not need more than that (depending on diet and lifestyle). If the condition requires it—often with the evaporative form—I’ll recommend hot compresses as well.”

In addition, he makes it a point to ask his patients about their work conditions. For office workers, this includes the height of their computer monitor, which he says is usually too high in their visual field.

Anshel also uses the TearScan 300 MicroAssay System from Advanced Tear Diagnostics to test for lactoferrin levels, which assess the dry eye or allergy conditions. O|O

WHERE TO FIND IT Alcon 800.451.3927 | Alcon.com Bausch + Lomb 800.828.9030 | Bausch.com CooperVision 800.341.2020 | CooperVision.com

PHARMACEUTICALS

NEW CORTICOSTEROIDS FOR CATARACT SURGERY B y J o anne Marchitelli Cataract surgery is one of the most successful surgeries performed in the U.S. with a healing time of about eight weeks. Knowing that, you are able to confidently recommend a surgeon to your patients as well as reassure them that the procedure is a common one with a high success rate.

Here’s what you need to know about the two latest corticosteroids for postsurgery care.

LOTEMAX SM Company: Bausch Generic: loteprednol etabonate ophthalmic gel 0.38% Dosage: One drop into the conjunctival sac of the affected eye three times daily beginning the day after surgery and continuing throughout the first two weeks of the postoperative period.

Indications: For the treatment of postoperative inflammation and pain following ocular surgeries, including cataract surgery.

Contraindications, Warnings and Precautions: • LOTEMAX SM, as with other ophthalmic corticosteroids, is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures.

• Prolonged use of corticosteroids may increase intraocular pressure

(IOP). If used for 10 days or longer, IOP should be monitored.

• Delayed healing.

• Use of corticosteroids may result in posterior subcapsular cataract formation.

• Infection exacerbation: monitor and treat for any exacerbations of bacterial, viral or fungal infections.

• The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation.

Possible side effects: Increase in IOP, corneal edema and iritis.

What Bausch wants you to know: • LOTEMAX SM uses SubMicron (SM) technology to adhere to the ocular surface and penetrate key ocular tissues to control pain and reduce inflammation after ocular surgeries.

• Compared to LOTEMAX GEL (loteprednol etabonate ophthalmic gel) 0.5%, LOTEMAX SM delivers a submicron particle size for faster drug dissolution in tears and provides two times greater penetration to the aqueous humor.

DEXYCU Company: EyePoint Pharmaceuticals Generic: dexamethasone intraocular suspension 9% Indications: For the treatment of postoperative inflammation; administered as a single dose at the end of cataract surgery.

Dosage: 0.005 ml of DEXYCU into the posterior chamber inferiorly behind the iris at the end of ocular surgery.

Warnings and Precautions: • Increase in IOP.

• Cataract development or progress in phakic patients.

What Eyepoint Pharmaceuticals wants you to know: • It is administered using the company’s Verisome sustained-release drug delivery technology to deliver a biodegradable extendedrelease formulation of the steroid dexamethasone into the posterior chamber of the eye via a single injection at the end of surgery.

• It is intended to replace the use of steroid eye drops, which have a dosing regimen that, depending on the brand, can require selfadministration for up to four times a day and titrating down over four weeks. This complicated dosing regimen can often lead to poor patient compliance.

• DEXYCU is the first long-acting intraocular steroid approved by the FDA for postoperative inflammation. O|O

WHERE TO FIND IT Bausch + Lomb, 800.828.9030 | Bausch.com/ECP EyePoint Pharmaceuticals, 833-EYE.POINT (833.393.7646) | EyePointPharma.com

O p tometr ic O ffic e. c om | May 2019

11

PATIENT CARE

DOCS | SPEAK OUT abo u t A l z he i m e r ’ s

A study published in the July 2018 issue of Alzheimer’s & Dementia found that glaucoma, age-related macular degeneration (AMD) and diabetic retinopathy were associated with an increased risk for Alzheimer’s. The study, however, did not find a link between developing cataracts and dementia. The researchers believe that may be due to the three diseases sharing a cardiovascular etiology with Alzheimer’s, while cataracts are simply a product of aging.

Researchers analyzed 3,800 people from the Adult Changes in Thought study, which began in 1994 and followed dementiafree adults until they died, developed dementia or opted to leave the study. Of those remaining participants, 792 developed dementia. Researchers noted that participants with AMD were 20% more likely to develop dementia than those without AMD; and those with diabetic retinopathy and those recently diagnosed with glaucoma were 44% more likely to develop the disease.

While an eye exam can’t predict future dementia and Alzheimer’s disease, early detection and treatment of these degenerative diseases can help patients focus on their cardiovascular health to control risk factors for Alzheimer’s.

In our “Docs Speak Out” survey this month we focused on Alzheimer’s disease and the optometrist’s role in early detection of these diseases. Here’s what you had to say about your role in early detection and caring for patients who have already been diagnosed with the disease.

Have you discussed the increased risk of Alzheimer’s with patients who have any of these three degenerative eye diseases?

YES

29%

NO

71%

For patients who are already diagnosed with Alzheimer’s, how do you adapt vision tests to their needs? What devices do you use to perform testing?

12 M a y 2 01 9 | O p to m e tri c O f f i c e .c o m

What do you (or would you) include in that doctor/patient discussion?

66%

(check all that apply)

10%

14% 10%

ha th e elp wit mer’s eal or e bov to h sease n i e h doct a o e y s e y e h n h tio e di ver Alz eir care of t ven of ey ot e elops e th ary all r r n e a t t v in sh prim ion tha de t to their tyle gress ce ease s n n e e a o i f s r i li ll pr pat with ss ssu e d the tion rea ive ey scu sta i e e d vid rat rag rma pro gene cou info n e e d

“Since Alzheimer’s comes in a spectrum of levels, I don’t have a ‘canned’ adaptation. Just like any other patient, I adapt to the patient. For those with Alzheimer’s, in general I provide more time, speak with them to preserve their dignity and then confirm with their guardian/POA who is with them for advanced stages. If they are

receiving regular assistance, then getting information ahead of time and communicating with the caretakers and PCP is critical. The key is really communication and being a part of the patient’s care team.”

“I perform both automated and subjective testing.”

“I use normal objective testing with lots of encouragement.”

“At present, if doing a comprehensive exam I would treat or refer any treatable disease of eye that required further treatment and communicate with the patient’s primary care provider.”

“Autorefraction, Optomap, OCT.” “I find Optos imaging and iCare tonometry helpful.”

“Autorefraction and VEP with BCVA, along with OCT and VF to monitor nerve functioning.”

“OCT-A, contrast sensitivity, MAIA, retinal imaging.”

cating with the care team and helping the patient.”

Are you aware that researchers linked glaucoma, age-related macular degeneration and diabetic retinopathy with an increased risk of Alzheimer’s disease?

21%

NO

79%

YES

“Mobile devices.”

“I recommend objective testing, OCT, trial lens and slowing down!”

“Rely more on objective, data gathering information than subjective responses.”

“Non-phoropter testing.”

“Start with cognitive recognition to establish a level of testing.”

“Earlier stage patients do fine with most standard testing. For more advanced cases, I slow down the exam and repeat my questions and/or instructions a lot. I also depend more on my objective findings.”

“OCT with ganglion cell analysis, Zeiss phoropter.”

“Understanding that presentation varies in patients and work from that perspective.”

“I do what it takes to follow their progress.”

“Genetic testing for ApOE, mTOR, and other genetic SNPs associated with chronic diseases.”

“Use visual clues.”

“It all depends on the level of Alzheimer’s.

I will adapt to the patient, not to the disease. In regards to adaptation, I will include more objective testing, frequently repeat and make good eye contact.”

“Give more time to decide. More compassion and be more firm to help gather information.”

“ARK, Optos imaging, and OCT. We also have and use RightEye technology.”

“I treat similarly to non-verbal patients and children.”

“Rely on objective testing when patient responses are non-supportive to diagnosis.”

“Genetic testing and Nutrigenomics testing.”

“OCT used in conjunction with perimetry.”

“OCT-A, full threshold visual fields, quantified ocular motor testing (RightEye Instrument).”

“I try to get them in early in the day, have a discussion with family before and after the exam and keep it short, if possible.”

“Slow, repetitive testing; not device oriented!”

“I’m not aware of any testing that I have that would benefit an Alzheimer’s diagnosis. If I did know of anything, I would be very willing to adapt my protocols in office.”

What do you do differently to help patients with Alzheimer’s treat their eye diseases?

“Communicate with their care team. If in memory care, then this is easy as they need doctor’s orders to carry out any care. If they are in early stages, it is about giving them written out instructions to help them remember. Ultimately, it is about communi-

“I might record instructions on their cell phones. Help them with reminders, etc.”

“Facilitate Rx dosing with family or other caregivers.

“Probably not enough.”

“More objective testing to determine correct diagnosis. Make sure staff and doctor care for patient with compassion and patience; and communicate with family about loved one and importance of future screening of family members.”

“Tailor to the patient’s needs and include family in discussions.”

“Work with caregivers and the patients themselves to devise plans that are understandable, manageable, and not complicated. ” “Advise their caretakers or significant others to monitor their meds and actions.”

“Make sure they are in a spectacle prescription that is simple to use. ” “Prescribe light therapy and cognitive work. ” “Write down everything recommended and discuss with caregiver in room. ” “I have no problem between autorefractor/retinoscopy and a children’s chart for those persons. ” “Talk to them about how a comprehensive eye exam is more than just an Rx for glasses or contacts, and lifestyle and nutrition can be preventative or slow down the disease in early stages.”

“Recommend genetic testing of ApOE, mTOR, and other genetic SNPs associated with chronic disease in the autophagy pathways. ” “No different; just consistent clear communication. ” “Always be friendly and calming.”

“Nothing yet, but I want to. I would love to turn them on to diet and lifestyle changes, and possibly a functional medicine practitioner that can reduce signs and symptoms of chronic disease and age-related neurodegeneration.”

O p tometr ic O ffic e. c om | M ay 2019

13

NEW PRODUCT | GALLERY OCTaVIA APP ASSISTS IN IDENTIFYING RETINAL DISORDERS OCT imaging requires training and expertise in order to provide a correct diagnosis.

Now, a new iOS app provides a resource for eyecare professionals and students in the diagnosis and management of retinal diseases. The OCTaVIA (Optical Coherence Tomography Visual Atlas) app provides images of normal OCT reference materials and corresponding OCT with fundus photography for multiple retinal diseases. The app also offers high-yield key considerations and links to aid in the differential diagnosis. Elena Z. Biffi, OD, MSc, FAAO, assistant professor, New England College of Optometry and attending optometrist at South Boston Community Health Center, created the app to help clinicians access an image library with notes to recognize different disorders. The OCTaVIA app was developed with financial support from the American Optometric Foundation and Johnson & Johnson Innovation in Education Grant and is available for free on the Apple App Store for iPhone and iPad users.

Go to NECO.edu

VMAX VISION DEBUTS NEW GLARE TEST Vmax offers its new brightness acuity test (BAT) as a stand-alone or optional accessory for its VASR and Perfectus instruments. By switching the normal piece with a Glare Tester eyepiece, the instrument can be used as a subjective refractor and a wavefront auto refractor with a BAT test being performed at the end of subjective refraction. The glare tester has three preset glare levels (low, medium, and high), which can be selected from a switch. The brightness levels at the entrance pupil are calibrated to 12 foot-lamberts (FL), 100 FL, and 400 FL, respectively, which is identical to a commercial BAT instrument. It has a USB charge port and a rechargeable battery.

The handheld unit can also be used with traditional phoropters. The slim design allows it to be used with the patient’s eye in close proximity to the phoropter, which is a significant advantage over the current BAT instrument.

Go to VmaxVision.com

EYEPROMISE RELEASES SCREEN SHIELD TEEN SUPPLEMENT EyePromise recently added Screen Shield Teen to its eye vitamin line. The ocular nutrition supplement is specially formulated to preserve and support visual comfort and wellness for children ages 4 to 17. Ingredients lutein and zeaxanthin have been shown to increase macular pigment optical density (MPOD) and, in turn, improved subjects’ headache frequency, eye strain, eye fatigue and other visual performance measures often associated with prolonged digital screen time. EyePromise’s scientific advisory board assisted in developing EyePromise Screen Shield Teen, an all-natural zeaxanthin (not synthetic) fruit-punch flavored chewable vitamin for children ages 4 and up. The supplement is GMO and gluten free and is manufactured in FDA cGMP and an NSF Certified for Sport facilities. EyePromise Screen Shield Teen was designed to complement a child’s current daily multi-vitamin and is not intended to treat, cure, or prevent any disease.

Go to EyePromise.com 14 M a y 2 01 9 | O p to m e tri c O f f i c e .c o m

ALCON EXPANDS PARAMETERS FOR DAILIES AQUACOMFORT PLUS TORIC Alcon introduced a broader range of parameters for its DAILIES AquaComfort Plus Toric contact lenses.

The new offering of 2,360 parameters includes -2.25D cylinder, around-the-clock axes in core parameters and expanded high-minus sphere powers. In addition, the lenses provide Dual Stability, which includes tear film and on-eye stability. This is achieved through the combination of Alcon’s Blink-Activated Moisture technology that releases polyvinyl alcohol (PVA) with every blink for outstanding tear film stability. It also includes the PRECISION CURVE Lens Design, which is a dual thin-zone design that allows both eyelids to apply equal pressure to keep the lens in the correct position.

Go to MyAlcon.com

ESCHENBACH INTRODUCES VARIO DIGITAL FHD DESKTOP VIDEO MAGNIFIER Eschenbach Optik of America, Inc. introduced the New Vario Digital FHD foldable desktop video magnifier. The unit features a 15.6-in. full HD monitor with optical digital zoom from 1.3x - 45x magnification and an FHD camera that provides a true color image with a large field of view. Tactile buttons and turn dials make it easy to operate, and it provides voice output when in menu mode (users can choose from five languages). Its bright LED illumination comes from lights on the arm and on the back of the monitor, which are adjustable to provide uniform, shadow-free viewing.

The widescreen format and tilting camera make it easier to read large documents, write under and see close-up while doing hobby work. Images can be captured and stored on a removable 8GB SD card and viewed either on the LCD screen or on a computer monitor when connected through the built-in type C USB port. An optional adjustable-height Video Magnifier Table is available to display the Vario Digital FHD in a waiting room to promote awareness of the product and increase patient interest.

Go to Eschenbach.com

AMPLEYE LAUNCHES INITIAL RX LENS CALCULATOR ONLINE Art Optical has launched a new online calculator to support fitting the Ampleye scleral lens. Developed in partnership with the KATT Design Group, the Ampleye Initial Rx Lens Calculator is intended to assist fitters in determining the patients’ initial Rx lens parameters based on input from the diagnostic assessment process. It also streamlines the diagnostic fitting and ordering process for Ampleye.

The required data for input into the calculator is collected from the on-eye assessment after the diagnostic lens has settled for 20 to 30 minutes. After noting which diagnostic lens was trialed on the patient, fitters assess the central and peripheral clearance zones, as well as the limbal and scleral landing zones, along with noting the over-refraction and cylinder for input into the calculator. The resultant Ampleye lens specifications can then be ordered quickly and efficiently via Art Optical’s online order form or by calling the company. The Ampleye Initial Rx Lens Calculator can also be used as a tutorial to help fitters learn the types and degrees of adjustment that are typically altered in each individual zone of the Ampleye lens based on the diagnostic results.

Go to ArtOptical.com/AmpleyeCalculator O p tometr ic O ffic e. c om | May 2019

15

AT-A- GLANCE LUBRICANT DROPS COMPANY

DOSAGE

KEY INGREDIENTS

Akorn Pharmaceuticals | 800.579.8327 | TheraTears.com carboxymethylTheraTears Dry Eye 1-2 drops as needed cellulose sodium 0.25% Therapy Lubricant Eye Drops

BENEFITS • hypotonic and electrolyte-balanced formula replicates healthy tears • available in nighttime, preservative-free and new Extra formula for extra moisturizing and rehydration for dry eyes

Alcon | 800.757-9195 | Systane.com SYSTANE Complete

1-2 drops as needed

propylene glycol 0.6%

• fast-acting hydration and lasting relief • tear evaporation protection • nano-droplets for better coverage

Allergan | 800.347.4500 | RefreshBrand.com

Refresh Optive

1-2 drops as needed

carboxymethylcellulose sodium 0.5% and glycerin 0.9%

• preservative free • for relief of burning irritation and discomfort due to dryness • available in advanced and gel formulas

Bausch + Lomb | 800.828.9030 | Bausch.com/ECP

Soothe XP

1-2 drops as needed

light mineral oil: 1.0% mineral oil: 4.5%

• contains Restoryl mineral oils to restore outer lipid layer • seals in moisture and helps to prevent further irritation • also available in preservative free, nighttime, and max hydration formulas

Johnson & Johnson Vision | 800.347.5005 | JustBlink.com Blink Tears Lubricating Eye Drops

1-2 drops as needed

polyethylene glycol 400 0.25%

• hypoosmolar, viscoelastic formula mimics tears to restore tear film • relieves mild to moderate dry eye symptoms • available in gel and preservative-free formulas

Natural Ophthalmics | 877.220.9710 | NaturalEyeDrops.com Tear Stimulation Forte Eye Drops

1-3 drops as needed

sulphur 6x nux v. 12x euphrasia (Eyebright) 5X alumina 10x arsenicum album 12x nux mosch. 6x zincum m. 10x

• preservative free • homeopathic formula designed to stimulate proper tear balance, produce a healthy tear film and maintain corneal health • special tear stimulation formula for women also available

OCuSOFT, Inc. | 800.233.5469 | OCuSOFT.com Retaine MGD

1-2 drops

light mineral oil mineral oil

• uses electrostatic attraction to stabilize tear film • replenishes lipid layer and reduces tear evaporation • preservative free

Prestige Brands | 877.274.1787 | ClearEyes.com Clear Eyes Pure Relief

1-2 drops

16 M a y 2 01 9 | O p to m e tri c O f f i c e .c o m

glycerin 0.25%

• contains a built-in purifying filter to prevent bacteria • preservative free • available in multi-symptom formula

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everyday Patients want multiple pairs of eyewear to enhance the way they live. Help make them easier to purchase from your practice with promotional financing options* available through the CareCredit credit card.

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