CONTACT LENSES:
PHARMACEUTICALS:
AT-A-GLANCE:
A FRESH LOOK AT DAILY DISPOSABLES p 10
HELPING PATIENTS WITH LID HYGIENE p 12
PUNCTAL PLUGS p 16
THE SECRET TO INCREASING ACCEPTANCE OF VISUAL FIELD TESTING, RETINAL SCANS, AND MORE
p8
SUPPLEMENT TO VCPN JUNE 2019
OPTOMETRIC OFFICE EDITORIAL STAFF VP, Editorial John Sailer | JSailer@ FVMG.com Editor Joanne Marchitelli | JMarchitelli@FVMG.com
Table of Contents
5
Creative Director Production and Web Manager Megan LaSalla | MLaSalla@FVMG.com Contributing Writers
Jennifer L. Stewart, OD
BUSINESS STAFF President/Publisher Terry Tanker | TTanker@FVMG.com Vice President, Marketing Debby Corriveau | DCorriveau@FVMG.com Regional Sales Manager Eric Hagerman | EHagerman@FVMG.com
2 | Views
Cover photo courtesy of Optos.
3 | One-to-One: Alex Andrich, OD, International Sports Vision Association 4 | Think About Your Eyes: Using Technology to Show You Care 5 | Product Buzz 15 | New Product Gallery
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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.
What are your goals in patient communication? (select all that apply)
100
94%
88%
80%
80
16 | At-A-Glance: Punctal Plugs
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
8
FEATURES
60 40 20
43%
0
staff efficiency (reduce phone time)
Alan G. Kabat, OD, FAAO
DEPARTMENTS
reduce no shows
Evan Kestenbaum
patient education
Janice Holly Booth
confirm appointments
Ann M. Hoscheit, OD, FAAO
8 | INSTRUMENTS: Lights, (Retinal) Camera, Action! 10 | CONTACT LENSES: A Fresh Look at Daily Disposables 12 | PHARMACEUTICALS: A Clinical Guide to Lid and Lash Products 14 | PATIENT CARE: DOCS SPEAK OUT About Digital Patient Communication
www.Facebook.com/OptometricOffice www.Twitter.com/OO_Magazine www.Linkedin.com/showcase/Optometric-Office-Magazine
VIEWS
DISPOSABLE OR RECYCLABLE?
Joanne Marchitelli Daily disposable contact lenses have become the darling of the contact lens world. Both doctors and patients love them. A clean lens each day means no build-up, no germs, no dryness, no scratches. What’s more, the price of daily disposables are now somewhat comparable to other modalities when you consider the cost of solutions and cases making them an increasingly popular choice.
Terracycle, a recycling company, is known for recycling items that are not commonly known to be recyclable (i.e., juice pouches, chip bags, toothpaste tubes, coffee capsules, razors and even cigarette butts). TerraCycle partners with brands, manufacturers and retailers to collect and recycle such items free for the consumer. After processing, the contact lens and blister packs components are remolded to make recycled products. (The contact lens packaging may be recycled through municipal recycling programs.) To recycle contact lenses, it’s as easy as placing the empty blister packs, top foil and used contact lenses in a small box. Once filled, print out a free shipping label and send to TerraCycle (you can drop off at a local UPS store or ship from home). In addition, patients can also opt to drop the used lenses at a participating retailer for recycling. Bausch + Lomb’s ONE by
SO, WHAT’S NOT TO LOVE ABOUT DISPOSABLE CONTACT LENSES? WASTE. Twenty percent of contact lens wearers flush their disposable
ONE program partners with TerraCycle to accept any brand’s disposable contacts at participating locations, including optical retailers and optometric practices.
contact lenses down the toilet, according to a 2018 Arizona State University (ASU) study. “This is a pretty large number, considering roughly 45 million people in the U.S. alone wear contact lenses, amounting to 1.8 to 3.36 billion lenses flushed per year, or about 20 to 23 metric tons of wastewater-borne plastics annually,” said Charles Rolsky, a PhD student who was part of the ASU research team. It gets worse. They believe those lenses break down into microplastics at treatment plants, posing a risk to marine organisms and food supply. What about the other 80% of used contact lenses? Most end
THE PROGRAM HAS RECYCLED MORE THAN 5 MILLION UNITS OF LENS MATERIALS (THAT’S 31,000 POUNDS!) IN THE PAST TWO YEARS. For participating doctors’ offices or to register your office as a recycling drop-off site, visit BauschRecycles.com. As a thank you for being a member, TerraCycle donates $1 for every qualifying shipment of 2 pounds or more to Optometry Giving Sight. As you’ve seen, this waste quickly adds up!
up in the trash, as they should be disposed of. But, there is one
I know I’m late with the Earth Day column, but as Mother Earth
other option: Recycle them. When prescribing disposable lenses
would say, every day is Earth Day.
to patients it’s worth noting that the lenses can be recycled.
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Joanne Marchitelli | Editor | JMarchitelli@FVMG.com
AA: Sports vision is an excellent specialty niche that can be easily incorporated into an eyecare professional’s primary care practice. According to the Physical Activity Council’s 2017 Participation Report, 72% of the U.S. population ages six and older are active. The Sporting Goods Manufacturing Association reports that about 90 million Americans of all ages avidly participate in at least one sport. Building a sports vision specialty provides optometrists with a great opportunity to better serve the needs of patients, generate increased revenue through ophthalmic and contact lens sales, and draw in new clients who are highly motivated to achieve peak athletic performance. JM: How can an OD develop a specialty in sports vision or include sports vision training in their practice?
ONE-TO-ONE Alex Andrich, OD Alex Andrich, OD, is the president of the International Sports Vision Association. Andrich is a graduate of The Ohio State University College of Optometry and is in private practice in Cleveland, OH. He is a vision coach for the Cleveland Indians, Cleveland Monsters hockey team and Cleveland Gladiators arena football team. Joanne Marchitelli: What is the International Sports Vision Association’s mission? Alex Andrich: The International Sports Vision Association (ISVA) was formed in 2014 to provide a professional association for those interested in advancing the field of vision training for athletes of all ages and levels to help them achieve peak athletic performance. Today, ISVA is a multi-disciplinary organization that includes optometrists, ophthalmologists, athletic trainers, vision therapists, coaches, athletes and other sports professionals. ISVA is dedicated to increasing public and professional awareness of the positive impact that vision training and enhancement of vision skills can have on athletic performance; advancing the quality and delivery of optometric sports vision care through ongoing education, training and sharing of research; encouraging coaches, trainers, and others who work with athletes to include optometrists and ophthalmologists with expertise in sports/ performance vision as a part of a performance enhancement team; and reducing the risk of traumatic vision and headrelated injuries (i.e., concussions) through education about protective devices and equipment. JM: What should an eyecare professional in private practice know about sports vision?
AA: For some practitioners, a sports vision specialty may mean participating in a limited way, such as offering sports-specific eyewear and conducting basic sports-vision screening tests. For others, it might mean building and growing a specialty that can expand into providing detailed visual performance evaluations or testing, along with visualperformance enhancement training. No matter what your level of interest is, just as you would do for any other specialty, becoming well versed in the concepts of sports vision is an important first step. Associations such as The College of Optometrists in Vision Development (COVD. org), The Optometric Extension Program Foundation (OEPF. org), and Neuro-Optometric Rehabilitation Association (NORAVisionRehab.org) are all excellent resources. In addition to the education component, attendance at our ISVA Annual Conference also offers an opportunity to interact, exchange ideas and learn from colleagues practicing sports vision. JM: What are some things optometrists can do now to get started? AA: Almost every patient that walks into a primary care optometry office participates in a sport at some level. Here are a few tips: • Include a question or two about sports participation on your patient case history form. It offers an opportunity to begin a dialogue during the exam about how their visual system is currently working and how it can be improved to help make them more successful in their sport. • Continue the dialogue by discussing specific lens and tint options at the conclusion of the vision examination that relate to a patient’s sport. Depending on the sport, a special tint may make a significant difference in performance. It is also very important to discuss eye safety and offer a great selection of sports frames in your optical dispensary. • Consider adding a few additional testing procedures to the exam protocol to give the athlete an understanding of how their visual system impacts performance. • Last, but certainly not least, become a member of ISVA!
To read full interview, go to OptometricOffice.com. O|O
O p tometr ic O ffic e. c om | J une 2019
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THINK ABOUT YOUR EYES
USING TECHNOLOGY TO SHOW YOU CARE Software programs make it easy to stay connected and top-of-mind with your patients between office visits. While grocery shopping a few years ago, I had a chance encounter with a patient of 20 years. During our chat, it dawned on me that I hadn’t seen her in the office for a while. Had she seen one of my partners instead? Had she switched providers? The patient answered my unspoken questions by announcing, “I’m pretty sure it’s time for my eye exam, but I haven’t received a reminder card.” This got me thinking: as an eyecare provider, should it be my responsibility to shepherd my patients? Shouldn’t there be individual accountability around something as important as one’s eyesight? The answer is irrelevant: we live in an age and a culture where patients expect to be reminded that it’s time for their yearly check-up, whether that’s with the dentist or the eye doctor. What might seem like one more thing to do turns out to be an opportunity to engage with patients and retain them over time. Think About Your Eyes (TAYE) has been doing this work for us—reminding patients to schedule an annual eye exam and prioritize their vision health. TAYE has taken up the mantle for educating the public about the very thing we live for—eyecare health! Are we doing our part to support this important initiative?
THE TECHNOLOGY CONNECTION Patient relationship management (PRM) programs have made the work of connecting to and communicating with our patients easier than ever and in ways that improve operational efficiencies. Just look at how much time doing it “by hand” actually takes: • An appointment-reminder call takes three minutes. • A reminder call about a contact lens follow-up appointment takes three minutes. • A call making your patient aware that his or her contact lenses or eyeglasses have arrived takes three minutes. That’s almost 10 minutes. Multiply that by the number of patients you see in a week and the number is startling.
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Ann M. Hoscheit OD, FAAO, and Janice Holly Booth Ann M. Hoscheit, OD, FAAO, is president of EyeBridge Consulting Associates, an associate of Cherryville Eye Care, and one of the 22,000 doctors on the Think About Your Eyes doctor locator. Janice Holly Booth is a best-selling author, freelance writer and business consultant. Both frequently partner with the eyecare industry and private practices. First Vision Media Group supports Think About Your Eyes as a media partner. Important PRM services available through companies that offer automated customizable solutions via email and/or text communications include recalls, reminders, thank you messages, follow-ups, recare, e-blasts, two-way texting and text to pay. Using technology to gather patient satisfaction data is a wonderful tool for gauging your patients’ feelings about their care and, when the reviews are positive, drive practice growth. Finally, don’t forget the importance of “relationship” in PRM! The ways we connect shows we care about our patients, beyond their eye health or office experience, beyond knowing their name when running into them at the store. The way we remain connected between visits says to the patient, “We are thinking about you, we value you, and you are part of our family.” O|O
PRODUCT | BUZZ LAUNCHES, PROMOTIONS, MERCHANDISING, EVENTS AND OTHER THINGS TO KEEP YOU IN THE KNOW.
Coburn Technologies has named Ezequiel Lukin as national sales manager for diagnostic instruments.
FOCUS ON EYE HEALTH NATIONAL SUMMIT CELEBRATES EIGHT YEARS Prevent Blindness will hold its eighth annual Focus on Eye Health National Summit on July 17, 2019, at the National Press Club in Washington, DC. This year’s theme is “A Lifetime of Vision.” Expected attendees include patient advocates, community-based organizations, national vision and eye health organizations, government agencies and legislative staff. Those unable to attend in person will have an opportunity to watch a live video stream of event presentations as well as follow the event on Twitter at #eyesummit. Bill Barkley, a visually impaired adventurer, advocate, and author will be the keynote speaker. Barkley will inspire attendees by reflecting on building a life without limits and overcoming barriers as he shares tales of his accomplishments, including being the first deaf-blind individual to climb Mount Kilimanjaro in Africa in 2008, leading expeditions for deaf teenagers to the Amazon jungle and the Grand Canyon, and being the first deafblind person to complete the Boston Marathon. In addition, Prevent Blindness will for-
mally present the 2019 Jenny Pomeroy Award for Excellence in Vision and Public Health during the summit. This year’s recipient is Cynthia Owsley, PhD, MSPH, Nathan E. Miles chair of ophthalmology, and director of the clinical research unit at the University of Alabama at Birmingham (UAB) School of Medicine, Department of Ophthalmology and Visual Sciences. Prevent Blindness will also hold its annual Eyes on Capitol Hill event, providing volunteer patient advocates with the opportunity to meet with their government representatives on Tuesday, July 16. A reception for the Congressional Vision Caucus will be held the evening of this Capitol Hill event.
New England College of Optometry (NECO) has selected two alumni to receive honorary degrees and one alumnus for the Presidential Medal. Mitchell Scheiman, OD, FCOVD; Guang-Ji Wang, OD; and Alan Glazier, OD, FAAO, received their honors during NECO’s 125th commencement ceremony on May 19, 2019, at Boston Symphony Hall. The AOA received a Gold Circle Award for its United in Possibilities campaign. The American Society of Association Executives recognized the AOA’s new membership initiative with an award in the Membership Recruitment Campaign category. Eyefinity has announced the highly anticipated integration of EDGEPro and Eyefinity Practice Management (EPM). Genetic Disease Investigators, LLC received their second patent addressing dry eye treatment via the autonomic nervous system. This patent is in addition to one for treatment of autonomic dysfunction. Galimedix Therapeutics announced the appointment of Thomas Hohman, PhD, to
“Every year, the Prevent Blindness Focus on Eye Health National Summit brings dedicated leaders in the vision and eye health field together with those in public health and community outreach to discuss the best ways to improve vision for children, adults, and seniors,” said Jeff Todd, president and CEO of Prevent Blindness. “We especially thank all of our sponsors for their instrumental role and making this important event so successful.”
its board of directors.
Go to PreventBlindness.org/EyeSummit
the treatment of progressive keratoconus.
BVI Medical, Inc. has named Shervin Korangy as president and chief executive officer. Atia Vision, Inc. has announced initial closing of its committed $20M Series D preferred stock financing. Avedro, Inc. completed patient enrollment in a pivotal Phase 3 clinical trial to evaluate the safety and efficacy of an epithelium-on (Epi-On) corneal cross-linking procedure for
O p tometr ic O ffic e. c om | J u ne 2019
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PRODUCT | BUZZ organizations are joining forces to help provide children across the country with eyeglasses as part of their mutual goal of ensuring every child has clear vision.
COOPERVISION CONVERTS TO 100% RENEWABLE ELECTRICITY IN ROCHESTER Taking yet another step to succeed with sustainability in mind, CooperVision has converted its three Rochester, NY-area sites—the Scottsville contact lens manufacturing plant, the West Henrietta global packaging and distribution operation, and the Victor commercial center—to 100% renewable electricity usage. The company began moving to electrical power using renewable energy certificates (RECs) two years ago in Rochester. The sites now completely rely on wind-derived electricity via RECs, a choice made by the company because of wind generation’s prominence in New York State. “Making the switch to 100% renewable electricity was the right thing to do as we continue to invest in upgrading our Rochester facilities,” said Myles Ott, environmental, health and safety engineer at CooperVision. “It reflects our commitment to the environment, health and well-being of our employees and the local community, as well as complementing many of our customers’ and partners’ sustainability efforts.” CooperVision worked with consultant Power Management and Constellation, an Exelon company, for the Rochesterarea renewable electricity supply. 6 J un e 2 01 9 | Op to m e tri c O f f i c e .c o m
Progress in Rochester reflects only a portion of CooperVision sustainability initiatives focused on saving water, conserving energy; reducing, reusing and recycling resources; and empowering people within the company and the communities in which it operates. Go to CooperVision.com/Sustainability
ESSILOR VISION FOUNDATION AND LIONS KIDSIGHT USA FOUNDATION COLLABORATE FOR KIDS VISION HEALTH
A new partnership between Essilor Vision Foundation and the Lions KidSight USA Foundation, a charitable foundation of Lions Clubs International, will ensure more children have access to vision care. The
“Essilor Vision Foundation refers to vision impairment as an invisible problem because unlike hunger or tooth decay, children often do not even know they cannot see clearly. To them, blurry eyesight is normal,” said Becky Palm, president and executive director of Essilor Vision Foundation. “We are very enthusiastic about our collaboration with Lions KidSight USA Foundation, which enables us to work together to provide vision care for underserved children. Through this partnership, we are offering the Changing Life through Lenses program to Lions KidSight USA Foundation’s members and charitable eye doctor network and expanding the availability of vision services across the country. Changing Life through Lenses is Essilor Vision Foundation’s online platform, which provides charitable eye doctors and non-profits access to no-cost glasses for patients in need. Lions KidSight USA Foundation is a nationwide program that screens children ages six months through six years, and provides screening through 12th grade where possible. “Regional Lions Clubs have been working with Essilor Vision Foundation since 2007, and we are proud to broaden our relationship with the inclusion of the Changing Life through Lenses program. Lions KidSight USA Foundation has been a strong advocate of providing vision screening to more than 1.5 million children annually, and this exciting initiative helps to ensure that no child will go without glasses,” said Edward V. Cordes, OD, FAAO, past international director, Lions Clubs International and chair, Lions KidSight USA Foundation. Go to EVFUSA.org
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INSTRUMENTS
Photo courtesy of Optovue Inc.
LIGHTS, (RETINAL) CAMERA, ACTION!
A well-scripted approach to introducing new technology helps increase patient acceptance of screenings. B y Evan Kestenbaum I took a film class in high school. I have always loved the movies and liked the idea of earning credits for watching them. I remember stepping into the classroom and seeing movie posters hung in marquee frames, Casablanca, The Godfather, Pulp Fiction, old set pieces and props from former film students strewn about the room. The discussion prompt on the board was simple: What are your favorite movies, and what makes them good? By the end of class, we had concluded that the very “bones” of a good movie boil down to six simple elements: script, character, acting, timing, sound and visuals. Those same bones build the skeleton of some of what we do in the eyecare industry. While not every interaction 8 J un e 2 01 9 | Op to m e tri c O f f i c e .c o m
While nobody enjoys a dilation, it’s what they know. So how can we help our patients choose one of these other screening tests over what’s been tried and true?
between patients and employees is scripted, everybody is most definitely playing a part, and how well those parts are played affect the success of our businesses. Think about it. Some patients are certainly characters, and I’ve definitely seen employees put on Oscar-worthy performances. But where do the lights, the camera, and the action come in? We are in the midst of a technological-industrial revolution, and as such, the medical eyecare world is shifting along with it. There’s likely a whirring Optos or Optovue machine sitting in some corner of your
office—probably in a pre-screening room, possibly in an exam room, next to a visual field test and retinal scanner—all of which can be intimidating to your patients. But these machines literally bring the lights and the camera into this scenario. If visuals are integral to any movie, these screening tests bring them to the table in a way that patients can see and try to understand, with a doctor’s guidance, what is going on with the health of their eyes. So now we’ve got our characters, our actors, our visuals, that whirring sound and less time than a dilation would take. All we need now is the script and the action.
COACHING PATIENTS THROUGH NEW INSTRUMENT EXPERIENCES New technology can be intimidating. While nobody enjoys a dilation, it’s what they know. So how can we help our patients choose one of these other screening tests over what’s been tried and true? Anytime a new product is introduced to your practice, the way it’s marketed and discussed should be standardized. However, there’s a fine line between a patient feeling like someone is trying to sell them a used car and them feeling confident and informed about the options being offered. The more informed your staff are, the more educated your patients will be.
BOOSTING SCREENING ACCEPTANCE When we first introduced the Optos at our practice, Optix Family Eyecare, we needed to make sure it was a worthwhile investment, and the only way to do that was to watch the numbers. As a staff, we met and set a S.M.A.R.T. goal. That is, a goal that is Specific, Measurable, Achievable, Repeatable and Timely. We wanted to see 65% of our patients screened within one month’s time. We weren’t far off. Our excitement over this new piece of technology was catching, and we only missed our goal by 10%. However, after a month, as our excitement waned, so too did patient interest and that gap between our target and where we were became wider and wider. By the end of the second month, just 40% of our patients were opting for Optos, but why? When a patient walks into your practice, they should be given enough information to make informed decisions regarding their health. “Selling” screenings shouldn’t be the objective; educating should. Everyone on your team should be an authority on the screening tests offered in your office. They should be confident in their delivery and prepared to answer any questions the patient may have. The information should come easily to them, well-rehearsed without
missing a beat. It should also be conveyed in a way that is easy to follow for patients. At Optix, we’ve even designed a visual sheet that is given to patients and shows the full scope and spectrum of what a machine like Optos can do (Figure 1).
Figure 1. The Optomap Retinal Exam displays over 80% of the retina at one time.
Once we changed the words on the form and practiced the way we educate patients, we saw an increase in screenings from that initial dip to 40% back up to 50%. Since then, we’ve continued to practice and refine and have remained at a stable 65% to 70% of patients opting in for Optos. We’ve had similar successes with scripting our visual field testing, retinal scans and even saw a 10% increase in Optovue iWellness scans.
in hopes of seeing a trend that means happy, healthy patients and a happy, healthy practice. While your practice is no film set, and your staff aren’t really actors, there’s still a thing or two that can be learned from the silver screen. When Humphrey Bogart convinced Ingrid Bergman to get on that plane at the end of Casablanca, not only did she do as he asked, but she did it knowing it was right. If we take our cues from a legend, we can see that a combination of great scripting, confidence, and genuine care on his part made for a meaningful ending, and that’s what you should expect of your staff— great scripting, flawless delivery and genuine care. With those elements in place, you’ll have a blockbuster on your hands and the metrics will reflect it. O|O
Evan Kestanbaum, MBA, is chief operating officer of GPN Technologies and coowner and business manager of Optix Family Eyecare in Plainview, NY.
While I’m sure none of us are going to have our own stars on the Hollywood Walk of Fame anytime soon, I am certain that the importance of carefully crafting the way we interact with and educate our patients has everything to do with the success of our practice. Your staff should be well informed on not only what they are offering their patients but why they are offering it—and the metrics should be measured. No movie goes to the theaters without publishing its box-office rankings. Similarly, you should be pulling the metrics on your goals and publishing them somewhere for your staff to see and analyze. Looking at the increased or decreased percentage of patients opting for screening tests prior to an exam can let you know if the script, actors and visuals are working for your patients. If they’re not, you can adjust, set a new goal, and re-measure
Optos Daytona Plus
WHERE TO FIND IT Optos 800.854.3039 | Optos.com Optovue Inc. 866.223.1130 | Optovue.com
O p tometr ic O ffic e. c om | J une 2019
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CONTACT LENSES
A FRESH LOOK AT DAILY DISPOSABLE LENSES Giving patients a fresh start with new lenses B y J enni fer L . S tewart , OD From new contact lens wearers to those who are having a hard time staying in their current lenses to those who never thought they were an option, these problem-solving lenses give most of your patients the opportunity to be free of their eyeglasses.
WHO IS A GOOD CANDIDATE? Everyone. Our practice consistently fits 85% to 90% of our patients in daily disposables. I prescribe daily disposable contact lenses to every patient that falls within the parameters. They are my go-to for full-time wear as well as part-time wear, patients of every age and even those who need specialty lenses, such as multifocal and toric lenses. They are also great for anyone with a history of dry eye and allergies. Our workhorse lenses (Alcon DAILIES AquaComfort Plus and Clariti 1 Day from CooperVision) give patients clear, crisp vision at all distances, and have a wide range of powers available. For patients with dry eye, I found DAILIES Total 1 (Alcon) and MyDay (CooperVision) to be great problem-solving lenses. A clean lens every day eliminates the build-up of allergens, debris and makeup and helps with overall comfort and vision.
WHO IS NOT A GOOD CANDIDATE? Patients who have complex prescriptions or those who may be better suited for a specialty lens (ie, gas permeable, scleral). However, there are lenses that are available in different base curves, such as ACUVUE OASYS 1-Day and 1-day 10 J un e 2 01 9 | O p to m e tri c O f f i c e .c o m
ACUVUE MOIST Brand Contact Lenses, both from Johnson & Johnson Vision Care, Inc., and Extreme H20 (X-Cel Specialty Contacts) is available in larger diameters to fit those populations of your patients.
WHO THOUGHT THEY WEREN’T A CANDIDATE BUT REALLY ARE? New patients. Many will remark that they were always curious about daily disposables but their previous doctor never brought them up (and they were afraid to ask). I break down the cost of daily disposables (along with insurance and manufacturers’ rebates) compared to monthly lenses, solutions and cases, and most are surprised at how comparable they are. I send new patients home with trial lenses and have my office follow-up in 3 days to see how they are doing. It is rare to have a patient who wants to go back to their reusable lenses! Presbyopes. We have a large multifocal practice and have very high success rates. In fact, these patients are often my largest referral source! We now have DAILIES AquaComfort Plus Multifocal and DAILIES Total1 Multifocal from Alcon, Proclear 1 day Multifocal and clariti 1 day multifocal from CooperVision, Biotrue ONEday for Presbyopia from Bausch + Lomb and many more. Astigmats. I also fit a lot of daily disposable torics. Astigmatic patients in general often have the misconception that they cannot wear contacts, or they are limited in what is available. But the availability is only increas-
ing. Case in point: Alcon recently expanded the parameters DAILIES AquaComfort Plus Toric lens. I always like to offer my patients the newest technology, and that is usually in a daily disposable material. The latest lens, SimplifEyes 1Day contact lenses, from SynergEyes is enhanced by Tangible coating, a new polymer formulation that has been used in scerals and hybrids for more wettable surfaces, less debris buildup and increased comfort. Isn’t it time for your patients to get excited about contact lenses again? Daily disposables can help. O|O
Jennifer L. Stewart, OD, is a partner at Norwalk Eye Care, in Norwalk, CT, and, co-founder and chief optometric officer at Performance 20/20, in Stamford, CT.
WHERE TO FIND IT Alcon Laboratories 800.451.3937 | Alcon.com Bausch + Lomb 800.828.9030 | Bausch.com CooperVision, Inc. 800.341.2020 | CooperVision.com Johnson & Johnson Vision Care, Inc. 800.843.2020 | JnJVisionPro.com SynergEyes. 877.733.2012 | SynergEyes.com X-Cel Specialty Contacts. 800.241.9312 | xcelspecialtycontacts.com
PHARMACEUTICALS
A CLINICAL GUIDE TO LID AND LASH PRODUCTS Indications, clarifications and recommendations for effectively managing lid margin disease. B y Al an G. Kabat , OD , FAAO Blepharitis, a variable but common source of chronic eyelid margin irritation, has long been recognized as a contributory element of ocular surface disease. Likewise, we have acknowledged the value of routine lid hygiene in managing this condition for well over 30 years. Cleaning of the lashes and their follicles helps to promote better overall ocular health, diminish potentially pathogenic bacterial reservoirs on the eyelid margins, and remove excess sebum (which can be irritating to the eye) along with trapped debris, foreign matter and microscopic organisms. The indications for use of a lid hygiene product are varied, but in general we tend to employ these agents as first line therapy for red, irritated eyelid margins and/or visible buildup of debris at the base of the lashes, commonly referred to as crusts, collarettes, scales or scurf. Of course, there are several recognized forms of blepharitis, and it is important to understand that all commercial eyelid cleansing products are not intended for the same purpose, nor are they equally effective in addressing the underlying etiologies of the disease. In order to better understand this concept, let’s first look at the prevailing types of eyelid cleansers. Surfactants. Detergent surfactants (which are the type found in lid cleansers) possess both a hydrophobic and a hydrophilic component; hence, these agents can attach to both water and oil, allowing for the 12 J un e 2 01 9 | O p to m e tri c O f f i c e .c o m
encapsulation and removal of lipid and lipid-laden debris by an aqueous solution. The oldest and still most commonly used lid cleansers—including dilute baby shampoo—are surfactant cleansers. Table 1 lists some of the more common, commercially available surfactant lid cleansers. When applied to the eyelashes and margins with mechanical action, these products help to separate accumulated sebum from the tissue and, as previously mentioned, wash away the debris, foreign matter and microscopic organisms that are associated with these excess lipids. Hypochlorous acid (HOCl). This chemical agent is produced naturally by white blood cells as an element of the human immune response to pathogens, where it helps to neutralize bacteria through protein and lipid peroxidation. However, HOCl can also be formulated with relative ease in large quantities under controlled laboratory conditions. Studies have shown that HOCl in very low concentrations (e.g. 0.01% to 0.02%) can
effectively diminish some bacterial pathogens by more than 90%, with Staphylococcus being particularly susceptible. Table 2 lists some common HOCl eyelid cleaners. It should be noted however that none of these products incorporates a surfactant cleanser; rather, all contain primarily saline with a very small amount of HOCl as a preservative. Hence, while these agents can be helpful in addressing bacterial-induced lid margin disease, they have no mechanism by which to remove the excess sebum or other debris associated with various forms of blepharitis. Tea tree oil (TTO). The oil, obtained from the leaves of the Melaleuca alternifolia is known to have numerous medicinal benefits, including bactericidal, virucidal, fungicidal and acaracidal properties. Additionally, studies have shown that the water-soluble fraction of TTO (terpinen-4-ol or T4O) has anti-inflammatory properties as well. Shampoos and skin care products containing TTO are widely available as over-the-counter prepa-
Table 1 : SURFACTANT AGENTS OCuSOFT Lid Scrub Original OCuSOFT Lid Scrub Plus OCuSOFT Lid Scrub Plus Platinum
OCuSOFT | 800.233.5469 | OCuSOFT.com
TheraTears SteriLid
Akorn Consumer Health | 800.579.8327 | TheraTears.com
LidHygenix Foam
LidHygenix | 888.471.0555 | LidHygenix.com
ComfortClear Lid Wipes
Focus Laboratories | 866.752.6006 | ShopFocusLabs.com
Blink Lid Wipes
Johnson & Johnson Vision | 800.347.5005 | JustBlink.com
Systane Lid Wipes
Alcon |800.757.9780 | Systane.com
Table 2 : HYPOCHLOROUS ACID SOLUTIONS Avenova
NovaBay, Inc. | 800.890.0329 | Avenova.com
OCuSOFT HypoChlor
OCuSOFT | 800.233.5469 | OCuSOFT.com
Acuicyn Antimicrobial Eyelid & Eyelash Hygiene
Sonoma Pharmaceuticals | 800. 759.9305 | SonomaPharma.com
Zenoptiq 0.01% Hypochlorous Acid Spray
Focus Laboratories | 866.752.6006 | ShopFocusLabs.com
Bruder Hygienic Eyelid Solution
Bruder Healthcare | 800.827.8337 | Bruder.com
HyClear
HyClear | 833.266.8262 | GetHyClear.com
Heyedrate Lid & Lash Cleanser
Eye Love | 888.EYE.LUV9 | EyeLoveTheSun.com
Hypochlorous Eyelid Cleansing Spray
We Love Eyes | 855.687.3279 | ODs.WeLoveEyesXO.com
Table 3 : TEA TREE OIL FORMULATIONS Cliradex, Cliradex Light
Bio-Tissue | 844.425.4723 | Cliradex.com
OCuSOFT OUST Demodex Cleanser
OCuSOFT | 800.233.5469 | OCuSOFT.com
Blephadex
Lunovus | 800.980.6551 | Lunovus.com
Gentle Formula 1% Tea Tree Eyelid & Facial Cleanser Advanced Formula 2% Tea Tree Eyelid & Facial Cleanser Anti-Aging Formula 1% Tea Tree Eyelid & Facial Cleanser
EyeEco | 888.730.7999 | EyeEco.com
Ovante Demodex Control
NAAMA, Inc. | 484.525.6787 | StopDemodex.com
Tea Tree Eyelid Foaming Cleanser Tea Tree Eyelid Cleansing Oil
We Love Eyes | 855.687.3279 | ODs.WeLoveEyesXO.com
rations. But with the recognition that TTO is effective against Demodex species—a common but poorly recognized skin mite associated with blepharitis—a number of lid hygiene products containing TTO or T4O have entered the eyecare space. The main disadvantage of these formulas is their tendency to cause irritation, particularly at higher concentrations. TTO produces a menthol-like effect when applied to the skin. While some patients tolerate and even enjoy this feeling, others may find it difficult to endure. A listing of these products can be found in Table 3. In terms of use, all of the aforementioned products have a place; but, not all are interchangeable. In order to understand the applications, it is best to examine the different forms of blepharitis. “Staph” or bacterial-associated blepharitis. The goal in treating Staph blepharitis is to diminish the bioburden caused by lid bacteria. Excessive populations of bacteria destroy the delicate homeostasis of the eyelid ecosystem and can incite a pathogenic response. Surfactant
cleansers are very effective in addressing this condition. In addition to helping clean the lid margins of oil and debris that harbor bacteria, some surfactants also have microbicidal properties, disrupting bacteria by altering the permeability of their lipid membranes. For more severe or recalcitrant cases, HOCl can be extremely effective, but it should be used in conjunction with rather than in place of surfactants. In other words, think of HOCl as an adjunctive therapy. TTO solutions can be of value in Staph blepharitis as well, because this unique ingredient has inherent antimicrobial properties. Seborrheic blepharitis. Surfactant cleansers are most useful in cases of seborrheic blepharitis, where the primary pathology is simply an overabundance of sebum production. Twice-daily cleansing is often sufficient to help control the greasy scales and minor lid inflammation that accompanies this form of blepharitis. HOCl is generally ineffective for seborrheic blepharitis, since there is no bacterial component. Tea tree
oil products, while not technically contraindicated, are generally unnecessary. Meibomian gland dysfunction (MGD). MGD is primarily an obstructive disorder of the meibomian glands, caused by changes to the consistency of the meibum secretions and resulting in atrophy of the glands. While studies have shown that the bacteriological profile in patients with MGD is altered, there is little consensus on how to address this clinically. Most experts agree that the best course of therapy for MGD is application of heat combined with or followed immediately by lid massage and expression of compromised glands. One recent report demonstrated a benefit to the use of surfactant cleansers in MGD, however it is unknown if the effect was generated by the mechanical action of the cleaning process, the surfactant properties of the cleanser, an antimicrobial effect, or something else entirely. For these reasons, it is advised that lid cleansers of all types be used judiciously in MGD, as they best represent an adjunctive therapy. Demodex-associated blepharitis. As mentioned earlier, the primary indication for TTO-derived lid cleansers is Demodex. Typical surfactant cleansers may be helpful in removing excess sebum, which is the primary food source of Demodex mites, but these agents have little impact on the mites themselves. Likewise, HOCl is ineffective in curtailing mite activity and reproduction. Products with higher concentrations of TTO or T4O possess the greatest efficacy in terms of alleviating Demodex infestation. O|O
Alan G. Kabat, OD, FAAO, is professor, Southern College of Optometry in Memphis, TN. Disclosure: Dr. Kabat is a member of the Eyelid Hygiene Advisory Board for OCuSOFT and a former consultant and clinical researcher for Bio-Tissue.
O p tometr ic O ffic e. c om | J u ne 2019
13
PATIENT CARE
DOCS | SPEAK OUT
Di g i t a l P a t i e n t C o mmunic ation
Sure, your chairside manner is second to none, but what happens when patients leave the office? We wanted to know how you communicate with current patients and prospective ones through digital technology. So, in our “Docs Speak Out” survey this month we asked how digital patient communication has helped improve your practice as well as patient experience. While most of you have had good experience using digital communications, one OD mentioned an example of overuse: “When corporate sends messages using my name, especially for pre-appointments, it pisses people off and confuses them!” While that’s something that you may not be able to control, the software does offer the features to help streamline staff time while staying in touch with patients. Here’s what you had to say about your current system and what you would look for in your next one.
Which digital tools do you use for patient management? (select all that apply)
(select all that apply)
online appointment scheduling patient billing and online payments
86
YES
22%
60
69%
20
53%
two-way texting
20
40
80%
recall messages
0
“Automatic recall reminders and batch notifications that glasses/contacts are in.”
80
patient engagement (surveys, feedback)
%
If you currently use patient communication software, what feature(s) do you find really made a difference for your practice?
51%
40
60
0 80
“None.” “The recalls took a lot of time out of our staff’s hands, and patients seem to like the ability to receive confirmation and reminders even the day of.” “I like confirming my appointments.” 14 J un e 2 01 9 | O p to m e tri c O f f i c e .c o m
80% 43%
100
“Two-way TALK.” “Text and email plus opt out.” “Online scheduling.” “Appointment reminders to reduce no shows. Also the surveys we receive.” “All of it!”
“Text messaging patients.” “Text confirmations.”
94%
88%
staff efficiency (reduce phone time)
%
100
reduce no shows
88%
appointment reminders
patient education
NO 14
What are your goals in patient communication?
confirm appointments
Does your office use digital patient communication software?
If you are considering new or updated software for your practice, which one and why? “I am happy with mine, but I would consider software that had the recall system as part of the system to ensure compatibility between EHR and recall software.”
“I want an easy-to-use software that integrates fully with my EHR that can data mine and send out reminders to patients who have not yet purchased.” “An updated version of Officemate.” “4PatientCare. It will be more compliant with our EHR system (FoxFire) and provide more communication opportunities.” “Our group just moved all practices to Solutionreach.” “Compulink.” “We just switched to Weave. We chose it for the phone integration and two-way texting.” “One that is built into our software so no extra cost.”
NEW PRODUCT | GALLERY ZEISS LAUNCHES DUAL-SPEED SWEPT-SOURCE OCT/OCTA ZEISS Medical Technology Segment launched the first dual-speed Swept-Source OCT/ OCTA at the Association for Research in Vision and Ophthalmology (ARVO). The PLEX Elite 2.0 will now scan at 200kHz, in addition to 100kHz, providing a deeper and more detailed view into the retina, enabling visualization options for various diseases. The varying speeds of the instrument can be applied to different disease states in the eye and expand possibilities of research. For example, clinicians can fully image conditions such as posterior staphylomas, retinal detachments, high myopia and choroidal tumors. The technology provides faster scans to visualize from the retinal vitreous interface all the way down to the choroid to assess highly curved myopic eyes in an unprecedented way. Go to Zeiss.com/med
EYLEA APPROVED FOR DIABETIC RETINOPATHY Regeneron Pharmaceuticals, Inc. has announced that the U.S. Food and Drug Administration (FDA) has approved EYLEA (aflibercept) Injection to treat all stages of diabetic retinopathy (DR). The approval was based on six-month and one-year results from PANORAMA, a randomized, multi-center, controlled Phase 3 trial that investigated EYLEA for the improvement of moderately severe to severe non-proliferative DR without diabetic macular edema, compared to sham injection. “The PANORAMA trial showed that by one year 20% of untreated patients developed proliferative diabetic eye disease, and EYLEA reduced this risk by 85% to 88% when administered using an every 16-week or eight-week dosing regimen, respectively,” said George D. Yancopoulos, MD, PhD, president and chief scientific officer at Regeneron. Go to Regeneron.com
LKC TECHNOLOGIES PRESENTS UPDATED UTAS SYSTEM The new SunBurst, a small, lightweight and easy-to-use system, is capable of conducting full ISCEV-complaint electroretinograms (ERGs), visual evoked potential (VEPs) tests, and electro-oculogram (EOGs) tests. It also features a light, bright and most capable ganzfeld. Updated features include a high-quality LCD Monitor; the MGIT, or Isolation Transformer, and the UTAS Interface are now combined into one unit requiring half the space; and a completely redesigned UBA amplifier with six differential channels with 24 bit A-to-D conversion using a native USB connection. The enhanced UTAS system is now fully Windows 10 based for the latest PC technology and associated security enhancements. Go to LKC.com
SIGHT SCIENCES INTRODUCES TEARCARE TearCare is a wearable device that allows a patient’s eyes to remain open and blinking during localized heat application procedures that treat meibomian gland dysfunction, dry eye and blepharitis. Soft, flexible thermal devices conform to the eyelids to deliver a therapeutic level of heat to soften and liquefy meibum, preventing tear film evaporation. Patients purchase their own personal product for use with in-office heated treatments. A single center, prospective pilot study published in Clinical Ophthalmology provided preliminary evidence that an initial treatment with the TearCare System as well as a re-treatment after six months delivered a sustained and statistically significant improvement in the signs and symptoms of dry eye disease at four weeks and at each follow-up visit through 12 months. Go to SightSciences.com
O p tometr ic O ffic e. c om | J u ne 2019
15
AT-A- GLANCE PUNCTAL PLUGS COMPANY
SIZES
MATERIALS
Beaver Visitec | 866.906.8080 | BVIMedical.com Extend 180 0.3 x 2.0mm polydioxanone Absorbable 0.4 x 2.0mm Synthetic Implants 0.5 x 2.0mm
SPECIFICATIONS
BENEFITS
• available in single pack or • provides occlusion for six full months 10-pack box • indications: post-ocular surgery, • also available in Extend seasonal dry eye, contact lens 180 Absorbable Synthetic intolerance, dry eye associated with Implant Variety Pack: two digital eye strain pairs 0.3mm x 2.0mm, five pairs 0.4mm x 2.0mm, three pairs 0.5mm x 2.0mm
EagleVision | A Katena Brand | 800.225.1195 | Katena.com Eagle Flexplug 0.4mm silicone • two individually packaged 0.5mm sterile plugs with inserter/ 0.6mm dilator per twin pack 0.7mm 0.8mm 0.9mm
FCI Ophthalmics Inc. | 800-932-4202 | FCI-Ophthalmics.com one size medical-grade Snug Plug • pre-loaded silicone
• tapered shaft • ribbed interior and exterior shaft, with about 30% more surface area • compresses, elongates and bends at both shaft and rim • super thin rim for reduced corneal contact
• expanded shape assures snug fit to prevent pop-out • prestretched shape on the inserter avoids need for dilation • permanent yet removable
Lacrimedics, Inc. | 800-367-8327 | Lacrimedics.com
LacriPro
XS (0.6mm) small (0.7mm) medium (0.8mm) large (0.9mm)
medical-grade silicone
• sterile • proven occlusion therapy • pre-mounted on an insertion tool
medical-grade silicone
• sterile • pre-loaded • non-sterile bulk
• proprietary shaft design for easy insertion and proper anatomical fit • low profile dome
• permanent • dilation tool not needed
• thin rigid 6mm acrylic rod shrinks in length and expands in width to form a gel-like plug
• • • • •
• gelatinous canalicular plug • no foreign-body sensation removed by irrigation • available in a two-pack or 10-pack dispenser box
Lacrivera | 855.857.0518 | Lacrivera.com
VeraPlug
small (0.4 to 0.6mm) medium (0.6 to 0.7mm) large (0.7 to 0.8mm) XL (0.8 to 1.0mm)
Medennium | 888.727.6100 | Medennium.com SmartPlug
one size
hydrophobic acrylic polymer
OASIS Medical Inc. | 844.820.8940 | OasisMedical.com Form Fit one size fits all hydrogel
long-term fully hydrates in 10 min. dilation tool included pre-loaded on inserter sterile
For a longer listing of Punctal Plugs, go to OptometricOffice.com. O|O 16 J un e 2 01 9 | O p to m e tri c O f f i c e .c o m
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