Optometric Office June 2017

OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

WIDER MARKET FOR DAILY DISPOSABLE CONTACT LENSES

CONNECT WITH YOUR PATIENTS ELECTRONICALLY

JUNE 2017

MORE CHOICES FOR IMPROVING LID HYGIENE

DIGITAL PHOTOGRAPHY FROM SMARTPHONE ADAPTERS TO STAND-ALONE CAMERAS

SUPPLEMENT TO VCPN JUNE 2017

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TABLE OF CONTENTS 10

ON THE COVER | DEPARTMENTS 6 | Views 10 | Buzz 11 | One-to-One: Scott Jens, CEO of RevolutionEHR and Rev360

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14 | Think About Your Eyes 28 | The Optometric Technician 30 | Punctal Plugs At-A-Glance 31 | New Product Gallery

22

32 | Docs Speak Out

FEATURES 16 | Get the Picture 18 | Daily Disposables Capture a Wider Audience 20 | Competing for Contact Lens Patients 22 | Connect to Your Patients Digitally 24 | Trouble Staying Current 26 | Put It on a Lid

31

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A whole lot of more.

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Thirty years ago, before we helped people with Lasik surgery and vision care, we started as a way to help them pay for dental implants.

When people had more options on how to pay for care, they got the care they wanted—without delay. They were healthier and felt better about themselves.

It made sense then. Today, it makes more sense than ever.

Because, today, our ten million cardholders can use CareCredit in more ways than ever.* For things like primary care, urgent care, lab and diagnostic testing, plus a wide range of healthcare specialties.

And that means one important thing for you. When more patients have more options to help them decide how to pay for care, that’s good for them, and good for you.

We’re making it easier for cardholders to use CareCredit in more ways to get more types of care.

When people can live healthier, they live happier. And we’ll keep giving them new ways to do it.

®

carecredit.com *Subject to credit approval.

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OPTOMETRIC OFFICE EDITORIAL STAFF VP, Editorial John Sailer | JS@VisionCareProducts.com Professional Editor Richard Clompus, OD | RC@OptometricOffice.com Editor-in-Chief Jeffrey Eisenberg | JE@VisionCareProducts.com Assistant Editor Cara Aidone Huzinec | CH@VisionCareProducts.com Vice President, Design Jane Kaplan | JK@VisionCareProducts.com Assistant Art Director Bruce Kenselaar | BK@VisionCareProducts.com Production and Web Manager Anthony Floreno | AF@VisionCareProducts.com Contributing Writers Roberta Beers, COPT • Mario Contaldi, OD • Jackie Garlich, OD, FAAO David H. Hettler, OD • Anar Maurya, OD • Mark Perry, OD Bradford Ripps, OD • Jennifer L. Stewart, OD

BUSINESS STAFF Executive Vice President/Publisher Shawn Mery | SM@VisionCareProducts.com President/Associate Publisher Frank Giammanco | FG@VisionCareProducts.com Director of Sales Janet Cunningham | JC@VisionCareProducts.com Vice President, Marketing Debby Corriveau | DC@VisionCareProducts.com Vice President, Operations Sharon O’Hanlon | SO@VisionCareProducts.com

The most advanced Phoroptor ® ever built.

Phoroptor® VRx Digital Refraction System Incredibly fast. Ultra-quiet. Effortless integration.

Made in the USA with premium components.

AOA 2017 - Booth #240 • reichert.com/vrx

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.

© 2017 AMETEK, Inc. & Reichert, Inc. (5-2017) · Made in USA Phoroptor is a registered trademark of Reichert, Inc. · www.reichert.com

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ScleralFil preservative free saline solution ™

NEW

Introducing a solution indicated for scleral lens insertion.

Offer your scleral lens patients a new option with ScleralFil™ preservative free saline solution.

From Bausch + Lomb Specialty Vision Products, ScleralFil™ is indicated as a scleral insertion solution — a new alternative for rinsing and inserting scleral lenses. It is a sterile, buffered isotonic saline solution that can be used to rinse soft and gas permeable lenses.

• Buffered to maintain pH • Travel-friendly, single-use, 10 mL vials stand upright • Each carton contains a 30-day supply • Indicated for soft and gas permeable lenses

Only available online at bauschSVPstore.com 800.253.3669 | info@bauschSVP.com

ScleralFil is a trademark of Bausch & Lomb Incorporated or its affiliates. © 2017 Bausch & Lomb Incorporated. SCFL.0017.USA.16

All-new!

VIEWS

Richard Clompus STATING THE OBVIOUS

Pixel-perfect acuity testing.

ClearChart® 4 · 4X · 4P Digital Acuity Systems Simple-to-use interface. 24-inch, LED backlit display.

Custom developed for acuity testing. Made in USA. AOA 2017 - Booth #240 • reichert.com/clearchart

© 2017 AMETEK, Inc. & Reichert, Inc. (5-2017) · Made in USA ClearChart is a registered trademark of Reichert, Inc. · www.reichert.com

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As an optometry student, my first time observing a healthy cornea with a biomicroscope was a breathtaking and humbling experience. How can there be living tissue that is so perfectly transparent? Yet, there it was in its entire splendor staring back at me.

As I observed the cycle of tears spreading across the surface and being replenished with the next blink, I felt as though I was watching a well-choreographed play. My amazement upon seeing this intricate structure continued throughout my clinical practice.

Optometry’s primary role is to help people optimize their visual potential while protecting their ocular health. Our role has been significant with the invention and development of contact lenses.

Decades of experience prescribing contact lenses have shown that they are not generic medical devices. Lenses made from the same material, base curve and diameter by two different manufacturers do not perform the same on human eyes.

And, patient compliance with the wear schedule and care regimen is critical for long-term success. There is no substitute for observing lenses on eyes and evaluating the ocular health.

New mobile apps permit consumers to purchase contact lenses prescribed by medical doctors without a physical exam. Wouldn’t it be great if a smartphone could provide a real-time microscopic view of the eye to permit prescribing contact lenses from any location at any time? Unfortunately, the technology doesn’t exist yet.

When mobile devices support services that have some resemblance to those ODs provide in their offices, I will happily embrace them. Meanwhile, I question the ethics of doctors who prescribe contact lenses through a mobile app without examining the patient. It places that individual’s health and welfare at risk for money. Not all revenue is good revenue. Not all profit is good profit.

Richard Clompus, OD, FAAO | Professional Editor | RC@OptometricOffice.com

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®

Superior Coverage for Complete Dry Eye Relief

Improves Tear Film Stability

For more information and to order, call (800) 233-5469 or visit www.ocusoft.com

© 2017 OCuSOFT, Inc., Rosenberg, TX 77471 USA

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Decreases Ocular Discomfort

Reduces Ocular Surface Staining

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VIEWS

Jeffrey Eisenberg MORE THAN JUST PRODUCTS

Corneal Hysteresis: His sight depends on your confidence.

Ocular Response Analyzer® G3 Add clarity to your glaucoma decision making.

Corneal Hysteresis: CPT code 92145 AOA 2017 - Booth #240 • reichert.com/glaucomaconfidence

People have asked what I liked about my former roles as managing editor of another eyecare magazine and as a freelance writer for various healthcare publications. One thing that immediately comes to mind: the possibility that an article I was involved with might have helped improve a patient’s care.

This took on new meaning in 2012. A bad headache I thought was a migraine became extremely severe over the next several days. Medications offered little more than an hour of relief. In addition, my right eye became extremely swollen, I couldn’t open it more than halfway, and it was bright red.

Eventually, my wife and I headed to the ER at our local hospital, where I spent the next 10 days. A few days later, I developed the telltale rash of herpes zoster ophthalmicus O.D. During the months of recovery, I had plenty of concerns: Would I ever not have bad headaches? Would I ever open my right eye completely? Would I ever again see beyond 20/100 in that eye? Five years later, my visual acuity fluctuates between 20/25 and 20/40 O.D., but I have severe dry eye O.U. and, at times, SPK and epithelial defects O.D. This experience gave me an even greater appreciation of the role eyecare providers play in their patients’ overall health.

It also has helped shape my perspective as the new editor-inchief of Optometric Office.

As I step into the shoes of Joanne Van Zuidam, I think about the importance of the products and technology you’ll read about in these pages. Consider my own situation: I use steroid drops, antibiotic ointment, Restasis and artificial tears. Punctal plugs? They’re in there.

These products enabled me to step into sunlight without agony, read to my son, and resume driving and work. They play a role in my everyday health and quality of life.

And, the products we cover help you provide the best care possible to your patients, often improving their own quality of life. I look forward to providing you with this information.

© 2017 AMETEK, Inc. & Reichert, Inc. (5-2017) · Made in USA Ocular Response Analyzer is a registered trademark of Reichert, Inc. · www.reichert.com

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Jeffrey Eisenberg | Editor-In-Chief | JE@VisionCareProducts.com

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Refractive

OPD-Scan III Wavefront

TRS Total Refraction Automation

EPIC Refraction Workstation

ARK Autorefraction Systems

ion Anterior Segment Imaging

SOLUTIONS

TRS-5100 Product/Model name: REFRACTOR RT-5100

AOA • 414

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Marco Refraction Systems – Advanced automated instrumentation includes the OPD-Scan III Integrated Wavefront Aberrometer, the TRS-3100/TRS-5100 and EPIC Digital Refraction Workstation, Autorefractors/Keratometers (with VA measurement, Subjective Sphere Refinement, Tonometry, Glare testing on certain models) and Lensmeters–all with EMR integration. And introducing ion IMAGINGSM System– a highly sophisticated slit lamp integrated anterior segment imaging system that emphasizes image quality, simplicity and efficiency.

Marc OPDDigita Subje Lens a hig emph

The D

The Difference is Marco.

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

STUDY FINDS CONSENSUS IN SCLERAL LENS RXES

COVERAGE ASSISTANCE FOR CROSS-LINKING

A reasonable degree of consensus exists among eyecare practitioners in prescribing scleral lenses and manageing patients, concluded the SCOPE Study in the April 6 issue of Eye & Contact Lens. In SCOPE, which stands for Scleral Lenses in Current Ophthalmic Practice: An Evaluation, the study group administered an online survey asking ECPs about prescription and management practices. Of 663 respondents, 65% prescribed lenses that were 15 to 17mm in diameter, 18% prescribed lenses that were smaller than 15mm, and 17% prescribed lenses that were larger than 18mm. Also, 651 respondents said that average daily wearing time was 11.8 hours, and 475 of those individuals (73%) recommended midday removal. Most respondents recommended nonpreserved saline to fill the bowl of the lens before application and a hydrogen peroxide-based disinfection system.

Avedro, Inc., will launch a comprehensive effort to help patients get coverage for Photrexa Viscous (riboflavin 5’-phosphate in 20% dextran solution), Photrexa (riboflavin 5’-phosphate dextran solution) and the KXL System used in corneal cross-linking for the treatment of progressive keratoconus and corneal ectasia following refractive surgery.

The initiative, known as the Avedro Reimbursement Customer Hub (ARCH) Program, will offer the following: a reimbursement support service with a hotline for questions and resources to assist with the commercial payer appeals process; a patient assistance program in which financially eligible, uninsured patients can receive Photrexa Viscous and Photrexa at no charge; and a prescription assistance program to minimize insured patients’ out-of-pocket expenses for Photrexa Viscous and Photrexa if their insurance plans deny coverage for the treatment.

Avedro.com

NASAL STIMULATION FOR DRY EYE PATIENTS Allergan plc has been granted marketing authorization from the U.S. Food and Drug Administration (FDA) for True-Tear Intranasal Tear Neurostimulator, which temporarily increases tear production during neurostimulation in adult patients. TrueTear is a handheld stimulator with daily disposable tips that are inserted into the nasal cavity to induce the production of tears. In clinical trials, True-Tear resulted in increased tear production upon stimulation of the nasal cavity. Allergan.com

POLAROID LAUNCHES INSTAGRAM CAMPAIGN Safilo Group’s Polaroid Eyewear, for its spring summer 2017 collection, has launched an Instagram campaign that will be carried out simultaneously in seven countries, reaching more than 15 million users, as the brand celebrates its 80th anniversary. As part of the campaign, more than 250 Instagram ambassadors in the fashion and lifestyle segments will post on their Instagram accounts the creative contributions they have made, sharing it with their communities. You can follow the project in real time at #InstantExperience and #PolaroidSun.

ADVANCED VERSION OF B+L’S RENU Bausch + Lomb has launched renu Advanced Formula multipurpose solution for soft and silicone hydrogel contact lenses. This new formula combines three disinfectants and two surfactants for lens cleaning and disinfection. The new renu Advanced Formula multipurpose solution will be the only renu solution on the market, replacing renu sensitive and renu fresh. Bausch. com/renuAdvancedFormula

News

First Insight Corp. announced that its MaximEyes software now integrates with GPN’s EDGE and EDGEPro data and metrics performance management software for optometry.

Eyefinity announced a formal partnership with Abyde, a technology start-up, to integrate Abyde’s HIPAA compliance management application into practice management and electronic health records software.

Opsis Therapeutics has formed a scientific advisory board to help develop and advance retinal cell therapies.

Heidelberg Engineering GmbH has acquired Medisoft Limited, a UKbased provider of electronic medical records software solutions.

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BOOTH 6 0 9 |

ONE-TO-ONE

Scott Jens

After being in practice for nearly 25 years, Scott Jens, OD, is now CEO of RevolutionEHR and Rev360. RevolutionEHR is a cloud-based electronic health record and practice-management software. Rev360 provides business services to Revolu-

AUTO REFRACTOR/ KERATOMETER HRK-----A

tionEHR customers.

Richard Clompus, OD, FAAO: I remember discussing software with you more than 10 years ago, and you were convinced that a cloud-based software management system was best for optometry.

What led you down this development path?

Scott Jens, OD: I preferred Apple computers through high school and college. When I started to practice in 1991, the options for optometric business software for Macs were minimal.

Our office used practice-management software for Mac during the 1990s. However, as modules for electronic health records (EHRs) became available, they weren’t on Mac. An OD colleague had a very close high school friend who was working on software that could be accessed through a browser on any type of computer. We connected and built the strategy for a fully hosted (cloud-based) software product for eyecare practitioners.

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CONTACT LENS FITTING GUIDE WITH COLOR CAMERA & EHR IMAGE EXPORT FUNCTION

DOWNLOAD THE FREE LAYAR APP

SCAN THIS PAGE

DISCOVER INTERACTIVE CONTENT

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RC: Practice efficiency is very dependent upon technology. How is RevolutionEHR improving the way eyecare practitioners (ECPs) deliver patient care?

SJ: RevolutionEHR is not modularized, so the entire system is centered on the patient encounter. This streamlines care because as a medication list is updated or a diagnosis added, those entries automatically become part of the EHR’s master lists.

Also, data views that provide compilations of data through the ongoing care of the patient and information about the patient’s progress (such as all IOP readings over time with graphical display) are available without the need to peruse through many pages of records.

This summer, RevolutionEHR users will have a unique dashboard, called Pulse, available as part of their system. This will reduce the effort of collecting and analyzing data reports and key performance indicators, allowing users to have practice performance available at their fingertips.

RC: Rev360 is a new software system designed to help practitioners become more profitable. What areas of practice can benefit with this software?

SJ: Rev360 is not software; it is a business services company that aims to deliver to RevolutionEHR practices a variety of optional software add-ons, as well as human-based services, to make the practice run more efficiently and profitably. These include new technologies that are embedded within RevolutionEHR for patient communication or image management, as well as offerings to outsource the practice’s billing/revenue cycle management to our in-house team of billing specialists. All these are available for low additional monthly fees and are only delivered as needed by the practice.

RC: With more technology based on mobile devices, where do you think the future of software management systems will take us?

SJ: Software and, more importantly, the data within its databases, needs to help us make better clinical and business decisions. With computing now available on lighter and more portable devices, software should enable these decisions and should be pushing notifications to the ECP and staff when concerns or opportunities arise. And, software should provide the conduit of communication to patients so they get information from their ECP when and where they want it. OO

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ADV ERTORIAL

Dry Eye, the ‘Bruder Mask’ and the Commoditization of Eyecare During the last five years, the incidence of dry eye and meibomian gland disease has all but revolutionized the eyecare profession. Consider: According to the Tear Film & Ocular Surface Society’s Dry Eye Workshop II report presented last month, dry eye disease affects more than 30 million people in the U.S. alone.

At the same time, a phenomenon is occurring not just in eyecare but in all healthcare fields: commoditization.

A CLOSER LOOK Most doctors believe their skill and a caring staff differentiate their practices from the competition and that their orientation as “professionals” has superseded all other factors in the delivery of their “product.”

During the last 15 to 20 years, however, we’ve seen a shift from “product value” to “service value.”

To patients, this trade-off between quality and service is somewhat an anomaly. Although the outcome depends on the skill of the medical professional and the appropriateness of the procedure, patients often make medical decisions based on non-medical factors.

Because of increased competition and strong cost-containment forces, the product value of medicine has begun to erode.

The average patient begins to view healthcare delivery as equal across the board.

Medicine, to that patient, becomes a commodity. For example, the choice of where to get LASIK or cataract surgery is often based on the location of the doctor and the cost.

IMPORTANCE OF SERVICE As we move toward commoditization, service becomes increasingly important.

But, what exactly is service excellence, particularly in an eyecare practitioner’s office? The answer is deceptively simple: customer satisfaction.

By putting patients first—that is, answering their specific needs, surveying their satisfaction and responding to their concerns—ECPs have left the comfort zone of pleasing peers, yet this new orientation is necessary for future success with patients.

What type of products or services you provide is an important component of patient satisfaction—immediate satisfaction, that is.

ENTER THE DRY EYE REVOLUTION Patients with dry eye may return to the office constantly in search of relief—relief that you can provide.

With the introduction of mass consumer advertising by the major pharma companies, these patients have a name for their problem. And they want relief (“Eye Love”) now!

THE BRUDER MASK Bruder Moist Heat Eye Compress, also known as the “Bruder Mask,” offers the same opportunity for immediate relief of symptoms for patients with dry eye syndrome, chronic dry eye, blepharitis and other eye irritations.

The moist heat compress contains patented MediBeads. They absorb water

molecules from the air to deliver an effective clean moist heat therapy treatment.

The patient simply microwaves the com02017-06_Bruder Half Page_Vertical.pdf 1 5/12/2017 press for 20 to 25 seconds and applies it for 10 minutes. The compress is reusable and can be used as often as prescribed.

For patients whose meibomian glands are obstructed, the moist heat opens the glands, allowing the natural oils to flow.

As a result, the compresses help stabilize the tear film and slow tear evaporation.

CONVENIENCE AND RELIEF The Bruder Mask is convenient for ECPs to recommend and easy for patients to use and see results. Not only is the routine easy for patients to comply with, but it can work in conjunction with other prescription and over-the-counter dry eye therapies. Some patients may benefit from starting treatment with the mask while making a decision about additional treatments.

It’s a great way to help patients get the relief they seek—and quickly.

And, they will credit you for providing them with a product that really works.

This is an enormous opportunity for some doctors. The playing field has suddenly been leveled. As you head toward parity with your strongest competitor, you can develop a leadership position by employing a strong proactive strategy with a powerful service differentiation. When treating dry eye patients, the Bruder Mask is better for your patients—and better for your practice.

For more information, visit Bruder.com/Moist-Heat-Eye-Compress/How-It-Works.

Also, you can register your practice on our professional ordering portal. Go to either Bruder.com or order.Bruder.com to order products online or to learn more.

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THINK ABOUT YOUR EYES

Communicating with Patients in the Digital Age At one time, optometrists had standard means of patient communications and marketing: an office phone line, an ad in the Yellow Pages and word of mouth. Now, patients turn to digital channels for everything, from finding a doctor to scheduling appointments and communicating with office staff.

So, we must embrace digital communications as well. In the Information Age, computers and mobile devices represent a treasure trove of opportunities for reaching out to patients. The checklist of tools for building relationships keeps expanding.

Office Website This starts with an office website. A website not only provides basic information that current patients need, but prospective patients can access it via search engines. So, a patient who may not have been looking for a specific office may end up in yours. You should also learn more about strategic search engine optimization, which will allow your website to being seen by more patients.

In the Information Age, computers and mobile devices represent a treasure trove of opportunities for reaching out to patients.

Think About Your Eyes Another way to improve your online presence is to buy a listing on Think About Your Eyes (ThinkAboutYourEyes.com). The online doctor locator can drive patients to your office website, and it can dramatically enhance your ranking in local Google or Bing searches. With more than three million visits to Think About Your Eyes, the doctor locator has proven to be a resource for patients and doctors alike.

Social Media A presence on social media, such as Facebook or Instagram, can be a powerful way to engage new patients and communicate with existing ones. Whether it’s a celebration of National Sunglasses Day on June 27 or a reminder to patients that “allergy eyes” could, in fact, be a

Mario Contaldi Mario Contaldi, OD, is a member of the Texas Optometric Association and among the 18,000 doctors listed on the Think About Your Eyes online locator. Think About Your Eyes is a nationwide public awareness initiative promoting the importance of an annual eye exam and overall vision health. First Vision Media Group supports Think About Your Eyes as a media partner.

sign of something more serious, social media is an easy way to reach patients where they are already spending time.

Digital tasks Patients have become used to performing daily tasks, from buying groceries to ordering lattes, through their computers or mobile devices. We need to offer similar options. For example, online appointment scheduling can improve your overall exam numbers, text reminders can reduce no-shows, and online payment options can reduce accounting overhead.

Patient communication will continue to evolve. As optometrists and business owners, we can use new technology to build relationships with patients. These relationships, of course, are the foundation for improving our patients’ eye health and vision care—and the success of our practices. OO

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INSTRUMENTATION

Get the Picture

By Mark Perry, OD From using your smartphone to a traditional stand-alone camera, here’s how you can make digital photography part of your practice.

In today’s world of dynamic technology, if your practice has not incorporated digital equipment into the day-to-day operations, you may find your patients leaving for a more “advanced” experience elsewhere. Updating or upgrading your practice to provide digital photography is simple, and the cost may be accomplished for far less than you’d expect.

RETINAL CAMERAS Digital retinal cameras have come a long way from the days of Polaroid or slide pictures. Full-size retinal cameras to smartphone-based adaptors allow you to have a large selection based upon your budget and the size of your practice. Most of these devices are non-mydriatic cameras that can come in handy at times.

The Pictor Plus handheld camera from Volk is an alternative to a smartphone adaptor.

The easiest and probably the simplest approach would be to add a handheld adaptor to your smartphone and then transfer the image to your electronic medical records or computer. Several examples of these adaptors are the Volk iNview iPhone Fundus Phone Camera, the D-Eye Portable Ophthalmosocpe from Digital Eye Center and the Welch Allyn iExaminer, which works with the company’s PanOptic Ophthalmoscope. To transfer the images, you would pair WiFi or Bluetooth with an app such as AirMore or Reflector, allowing all your images to be saved to a file on your desktop.

If you aren’t interested in a smartphone adapter, you might consider using a digital handheld retinal camera. These devices are more expensive than the smartphone adaptor, and the megapixels may not be as large. Examples of these devices are the VISUSCOUT 100 from Carl Zeiss Meditec, Inc., the GENESIS-D and GENESIS-Df from Kowa Company Ltd., the FC-40 from Digital Eye Center and the Pictor Plus from Volk. You transfer the images from these handheld cameras using a WiFi/app or a USB drive.

Moving up the ladder with respect to size and cost are the standalone digital retinal cameras. DRS from CenterVue; TRC-NW8, TRC-NW8F Plus and TRCNW400 from Topcon; the CR-2 AF and CR-2 PLUS AF digital non-mydriatic

Welch Allyn iExaminer is a retinal camera you attach to your smartphone.

retinal cameras from Canon USA, Inc.; and VISUCAM from Carl Zeiss Meditec are just a few examples.

Obviously, the footprint on these devices is larger and you would need to make space for them, but the quality and functionality of these instruments go well beyond what handheld devices can achieve. The quality of the megapixel can exceed 20 megapixels, and the images can get well beyond the 30- to 40-degree limit of handheld cameras. Also, in most instances, the ability to view images is simplified by using the manufacturer’s viewing software.

Several manufacturers have developed retinal cameras that include ocular coherence tomography. These instruments cost anywhere from $45,000 to $85,000, but they offer the ability to bill for both retinal photography and OCT when appropriate (but not on the same day). For this reason, I recommend them if you can afford them. Examples of these are the Topcon 3D OCT-1 Maestro, the Cirrus photo 600 and Cirrus photo 800 from Zeiss, and the iVue and iFusion from Optovue, Inc. In the case of the iVue and iFusion, the instruments can be on the same table sharing the same computer.

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VIEWING SOFTWARE Topcon’s IMAGEnet Connect software, Canon’s imageSPECTRUM and Zeiss’s FORUM allow you to view digital images, not only from your devices but from other devices as well. This allows you to view different images, such as a retinal image, a visual field report and an OCT of the same patient at the same time. Imagine the simplicity of explaining to a glaucoma patient the retinal image of nerve fiber layer (NFL) dropout with the corresponding visual defect and the depressed NFL on the OCT scan.

SLIT LAMP CAMERAS As with digital retinal cameras, the simplest and least expensive option for obtaining digital photographs of the anterior segment is to use a smartphone adaptor.

By simply attaching the adaptor/smartphone over the eyepiece, you are ready to take a picture or video.

There are many adaptors available on the market, such as EyePhotoDoc, Tiger Lens and the Canton Optics’ CTA-100 Digital Eyepiece Adapter. The price for these adaptors varies from less than $100 to more than $500. You can transfer the

The CR-2 AF is a digital non-mydriatic retinal camera from Canon U.S.A.

images from your smartphone to your electronic medical records/computer via an app and wireless connection. One highlight of this setup is portability; you can use these devices in any examination room.

If using a smartphone is out of the question, you can mount a digital single-lens reflex, or DSLR, camera to your slit lamp.

To achieve this, you would need to purchase a beam-splitter, camera adaptor, camera and preferably a foot-switch, which enables you to take a picture with the press of your foot. It is relatively easy to set up and easy to operate. This is the setup we currently use in our office. We view and store the digital images on the desktop in the exam rooms and show these to the patient as we explain our findings. We then transfer the selected images to the patient’s medical record and complete the interpretation and report. TTI Medical is the company we used to purchase this complete setup for a few thousand dollars.

The EyeRes-IS system from TelScreen is another slit lamp digital imaging system that can provide high resolution digital images and videos. However, instead of a DSLR it uses a Hitachi digital sensor along with a computer and 19-inch flat-screen monitor.

Most manufacturers of slit lamps, including Marco, Topcon, Zeiss, Haag-Streit and Veatch, have their own digital cameras or camera adaptors.

Many slit lamp cameras or adaptors allow you to obtain a retinal image as well.

Although the view will not be the same as that of many of the retinal cameras discussed above, you can get good quality digital images for an inexpensive price. OO Mark Perry, OD, practices with Vision Health Institute, Orlando, FL.

Topcon’s 3D OCT-1 Maestro offers both retinal photography and OCT.

WHERE TO FIND IT: Canon U.S.A. 800.970.7227 | USA.Canon.com/Eyecare Canton Optics 86.21.68555555 | ChinaCanton.com Carl Zeiss Meditec, Inc. 800.342.9821 | Meditec.Zeiss.com/USA CenterVue, Inc. 408.988.8404 | CenterVue.com Digital Eye Center 305-771-4562 | DigitalEyeCenter.com EyePhotoDoc 714.871.9221 | EyePhotoDoc.com Kowa American Corp.

800.966.5692 | Kowa-USA.com Optovue Inc. 866.344.8948 | Optovue.com TelScreen 800-769-4933 | TelScreen.com Topcon Medical Systems, Inc. 800.223.1130 | TopconMedical.com TTI Medical 800.322.7373 | TTIMedical.com Volk Optical, Inc. 800.345.8655 | Volk.com Welch Allyn 800.535.6663 | WelchAllyn.com

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CONTACT LENSES

Daily Disposables Capture a Wider Audience

By David H. Hettler, OD Whether patients are interested in full-time or part-time wear, the options have expanded.

During the last 30 years, advances in contact lens modalities have vastly increased the number of candidates eligible to wear them. Now, many former contact lens wearers and most new wearers in our practice choose daily disposable lenses for the obvious simplicity in wear and care and the less obvious decrease in complications.

We tell patients that what they used to spend on solutions, they can now spend on having fresh lenses every day. Giant papillary conjunctivitis and corneal abrasions as a result of contact lens wear are rare now, but at one time, I had this discussion with patients daily.

before with a standard daily disposable lens such as Alcon’s DAILIES AquaComfort Plus or 1-Day Acuvue Moist from Johnson & Johnson Vision Care. We find these lenses perform well for most patients who wear contact lenses part time or for most first-time wearers.

Lenses such as 1-Day Acuvue Moist tend to perform well For patients who have had past for part-time and first-time wearers. contact lens discomfort or report least and most expensive daily disposable symptoms of dryness, we usually move to lenses. We believe that patients need to be Alcon’s DAILIES TOTAL1 or Johnson & convinced of the necessity for a specific Johnson’s ACUVUE OASYS1-DAY. We’ve lens even if it costs several times more had success with all of these lenses. than the cheapest lenses.

The latest benefit of the newest crop It’s not that we cannot complete the iniof daily lenses is our ability to offer parttial fit. Without explanation, however, we PATIENT EXPERIENCE time wear to those who never thought that will lose the reorders and potential referWe choose the initial daily lens based on they were contact lens wearers. Patients rals of the patients’ family and friends if patient experience factors. We usually fit are delighted when we give them a free the patient thinks we were too expensive. patients who need spherical or toric lenses trial of daily lenses in the office while they This means that we try to thoroughly exor who have never worn contact lenses are looking at glasses. Getting a supply of plain not only the features and benefits of contact lenses to wear Biotrue ONEday lenses have improved our success rate with daily the lens modality fit but why we chose a on weekends or vacadisposable lenses for presbyopia. specific lens. tion is a smaller expense than many other discretionary items commonly used today.

PRICE DIFFERENCE Even so, we cannot ignore the large difference between the

PRESBYOPES In our practice, presbyopes represent the biggest untapped pool of patients to fit with contact lenses. Statistically, this is the group with the lowest penetration of contact lens use, yet we’ve found a huge potential pool of these patients who are

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interested in trying contact lenses. To them, the opportunity to take a break from wearing glasses every day is very appealing.

Managing expectations is the key to success. I normally tell patients that I can replace glasses for 90% to 95% of their day. Trying to get 100% patient happiness will drop your success rate dramatically and increase your frustration. By aiming for good enough, patients are much more likely to be happy. If patients push you for just a little better (distance, near) you are likely to fail.

We use Alcon’s DAILIES Total1 for patients who have had past contact lens discomfort.

I tell patients to think of their distance and near vision like a balloon. If we change (squeeze) one end, it changes the other. So, if they want better vision, something else will change. This understanding will usually yield more thoughtful requests at the first check-up.

DAILY DISPOSABLE CONTACT LENSES Alcon | 800.451.3937 | Alcon.com DAILIES AquaComfort Plus, DAILIES AquaComfort Plus Multifocal, and DAILIES AquaComfort Plus Toric DAILIES TOTAL1 and DAILIES TOTAL1 Multifocal FOCUS DAILIES, FOCUS DAILIES Progressives and FOCUS DAILIES Toric FreshLook ONE-DAY Bausch & Lomb | 800.828.9030 | Bausch.com/ecp Biotrue ONEday, Biotrue ONEday for Presbyopia, and Biotrue ONEday for Astigmatism SofLens Daily Disposable and SofLens Daily Disposable Toric for Astigmatism ClearLab | 888.777.7147 | ClearLabUSA.com eyedia fresh daily disposable CooperVision | 800.341.2020 | CooperVision.com/practitioner clariti 1 day, clariti 1 day multifocal and clariti 1 day toric MyDay Proclear 1 day and Proclear 1 day multifocal Menicon | Menicon.com/pro Miru 1 day Menicon Flat Pack Vistakon | 800.843.2020 | ACUVUEProfessional.com | eyesite@visus.jnj.com 1-DAY ACUVUE 1-Day ACUVUE Define 1-DAY ACUVUE MOIST, 1-DAY ACUVUE MOIST for ASTIGMATISM and 1-DAY ACUVUE MOIST

MULTIFOCAL 1-DAY ACUVUE TruEye ACUVUE OASYS 1-DAY with HydraLuxe Technology and ACUVUE OASYS 1-DAY with HydraLuxe

Technology for Astigmatism X-Cel Specialty Contact Lenses | 800.241.9312 | XCelSpecialtyContacts.com Extreme H2O Daily

I almost always use unequal adds when fitting daily bifocal contact lenses. I find this gives a good combination of distance, intermediate and near vision. Many guides recommend this, but this approach, when compared to monovision, improves both distance and near vision. It also improves the likelihood of acceptable night driving.

This method is especially good for either general purpose vision or social events. I have found that there is rarely success if the distance vision is not acceptable. A big improvement in our success rate with daily disposable lenses for presbyopia is a direct result of lenses having better optics and comfort. Lenses such as the J&J’s 1-DAY ACUVUE MOIST Brand MULTIFOCAL Contact Lenses and Bausch + Lomb’s Biotrue ONEday for Presbyopia have good comfort and, with careful fitting, can result in happy patients.

OVERCOMING PERCEPTIONS One of the biggest obstacles to success is still overcoming patient perceptions.

Proper staff training to at least suggest that contact lenses are an option is the only way to succeed.

Once there is interest, a hassle-free trial may lead to a full evaluation. If not, then perhaps it will just lead to a water cooler conversation and referral to someone even more motivated. OO David H. Hettler, OD, is principal partner in a seven-location practice in Virginia.

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CONTACT LENSES

Competing for Contact Lens Patients

By Anar Maurya, OD Online tools can help you to keep contact lens patients in your practice.

This era of online vendors and large retailers has left many eyecare practitioners facing new challenges, particularly in the contact lens arena. As practices try to compete with high-volume online vendors and “big-box” retailers, keeping contact lens dispensing in-house has become increasingly time-consuming.

Thankfully, new innovative methods of patient retention are becoming available to keep away competition, especially in the contact lens arena.

modalities. The practice can set its own prices, choose its own distributor, and personalize all reminder emails and texts.

My CL Reorder is integrated with several practice-management systems, enabling practices to place contact lens orders directly with the distributor.

It also provides valuable metrics and reporting for your practice, including your prescribing habits and pricing compared to the national average to help you better manage the contact lens side of your practice.

LensFerry S

YourLens.com

LensFerry S, a division of CooperVision, allows patients to spread out the cost of their contact lenses over time and enjoy the convenience of automatic lens deliveries shipped directly to them. In turn, optometrists keep patients connected to their practices. LensFerry S offers lenses from all major manufacturers and all modalities, enabling ECPs to utilize the service for a broad spectrum of patients.

ABB Optical Group’s ordering platform is YourLens.com. A link on your practice’s website takes patients to YourLens.com, where the patient sees information that is customized to your practice.

As with other platforms, you decide what lenses to offer patients and at what prices.

You also decide whether to place the first order while the patient is still in the office or whether to send the patient home with the prescription to enter. ABB Optical then ships the lenses directly to the patient.

My CL Reorder CLX System’s My CL Reorder identifies patients who are due to run out of lenses based on purchase history and automatically sends them emails and text messages containing a link from which they can reorder directly from the practice. CLX also provides practices with an ordering link to place on their websites.

With My CL Reorder, patients are able to purchase all different contact lens

pointment and coordinates regular contact lens deliveries to the member for a full year. The company says its standard vision plan supports all major manufacturers of soft disposable lenses, including torics, multifocals and color contacts.

Improved Efficiency Newer digital marketing services help practices increase patient retention, improve office efficiency and stay connected with their patients throughout the year.

Further, transactions between your practice and patient can occur outside normal business hours and are available 24-7.

This improved patient interaction drives practice growth and patient loyalty for years to come. OO Anar Maurya, OD, received her doctorate from UAB School of Optometry in 2004. She specializes in ocular disease, post-surgical management and fitting specialty contact lenses at Woodhams Eye Clinic in Atlanta, GA.

Sightbox

WHERE TO FIND IT:

Launched in January 2016, Sightbox is meant for individuals who don’t have a current contact lens prescription, or haven’t had it updated in at least one year.

For an annual membership fee, Sightbox schedules an eye exam and contact lens fitting for each member, pays the doctor directly for services at the time of the ap-

ABB Optical Group 800.852.8089 | ABBOptical.com My CL Reorder 314.995.9959 | CLXSystem.com LensFerry S 866.575.EYES (3937) | LensFerry.com Sightbox 844.503.9900 | SightBox.com

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S TA RT YO U R PAT I EN T S O N A

HEALTHY ROUTINE TODAY

ALCON DAILIES®

CH ICE PROGRAM

Now, you can upgrade your weekly and monthly replacement lens wearers with the ALCON DAILIES® CHOICE PROGRAM Recommend a healthy choice for your patients and practice

Reduce the price barrier with $200 savings* on a year’s supply

A convenient alternative to weekly and monthly replacement lenses

DAILIESCHOICE.com *Via mail-in or online rebate on an annual supply of DAILIES TOTAL1® or DAILIES ® AquaComfort Plus ® contact lenses. Rebate is in the form of an Alcon Visa Prepaid Card. Must be a new patient to DAILIES TOTAL1® or DAILIES ® AquaComfort Plus ® contact lenses and must purchase an annual supply of the lenses within 90 days of eye exam and/or contact lens fitting. Applies to purchases from participating retailers only.

Visit DAILIESCHOICE.COM for full terms and conditions. Offer ends 12-31-17.

See product instructions for complete wear, care and safety information. © 2016 Novartis

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PATIENT CARE

Connect to Your Patients Digitally

By Bradford Ripps, OD The world of instant connection lets you impress your patients even between appointments.

Thirty-four years of practice has let me see an evolution of communication that boggles the mind. My first mobile phone, which I used for emergency patient calls, had a bag with a receiver and a wire connecting it like your home phone.

When we wanted to have a successful growing practice, the best way was to reach out to patients four times a year.

Typically we would send a letter.

Today, if you don’t make a constant flow of impressions, someone else will.

Your patients are so connected through all forms of social media, so they are targets for your competition.

FIRST STEPS How do you start? First, let your patients know that the practice is going “green” by reducing paper use and mail.

Today, if you don’t make a constant flow of impressions, someone else will. Your patients are so connected through all forms of social media, so they are targets for your competition.

We don’t ask patients for a home phone number; we ask for their email addresses and cell phone numbers. We provide receipts by secure email, email reminders and text confirmation of appointments.

Make sure all your employees have email accounts associated with the office. That way, patients can directly reach the staff member who can help them. All this sets up your patients to see how your practice is keeping up with the future of communication.

GETTING STARTED Setting up your online community by opening accounts on Twitter, Facebook, Instagram, Pinterest, LinkedIn, and YouTube, as well as live streaming video, can seem daunting. But take one at a time. It always helps to assign this task to an employee who is a Millennial or who at least understands these media.

Once your accounts are set up, what do you do with them? Now, it’s time to spend some money. There are several companies that will help with your software needs.

You’ll need to look and determine which are the best match for your office, keeping in mind that no one company covers all the bases well.

We use software from 4PatientCare to manage online appointment schedul-

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ing, recalls and confirmations. All this is done with email and texts. Scheduler allows patients to book appointments automatically from our website, find-a-doctor locators, review sites such as Yelp and Google+, and social media such as Facebook and Twitter. 4PatientCare also helps with patient communications such as recalls and follow-ups for no-shows. And, there’s multi-channel, dual-language automated messaging that lets you communicate with patients in English and Spanish through email, text, voice and snail mail. It’s all about delivering the right message to the right patient at the right time, all automatically.

WebSystem3 software from EyeCare Prime, a subsidiary of CooperVision, also allows patients to book appointments on-

line. In addition, practices can send automatic appointment recalls, reminders and confirmations via text, email and phone.

It also encourages and enables patients to provide feedback by sending “thank-you” emails with a survey and an invitation to post a review on popular review sites. Our practice uses WebSystem3 to create newsletters for our patients and to post comical eyecare jokes, informational facts and fun visual illusions. (We get lots of likes for the jokes.)

Solutionreach also offers a patient relationship management platform that includes such features as automated eyeglasses pick-up notifications, appointment reminders, recall notifications, and payment reminders; targeted educational material; and targeted surveys.

VIDEO The world today is all about moving pictures.

You can create a YouTube channel for your office and post videos about the practice, for patient education or to let patients know of new offerings.

For even more fun, shoot a video of what’s happening now in your office. For example,

when I brought out the box of a new Vera Bradley product, I shot video of my employees picking out their favorite items.

WHAT TO REMEMBER When I walk into my exam room to see a patient, I try to remember something funny or a happy occurrence and I have a huge smile when I enter to see the patient. I watch that little thing change the demeanor of patients no matter how long they have been waiting or how bad their day is for them.

Our communication needs to be fun, unmasked, surprising and unexpected.

We want our patients to associate warmth, fun and entertainment with our offices as well as the quality of care we provide. It’s hard to put a dollar value on working in the new world of communications, but if you look at it as something new and fun, it will help you enjoy what you do with—and for—your patients. OO Bradford Ripps, OD, has three offices in northwestern New Jersey.

WHERE TO FIND IT: 4PatientCare 877.479.5484 | 4PatientCare.com HelpDesk@4PatientCare.com EyeCare Prime 866.575.3937 | EyeCarePrime.com EyeCarePrime@CooperVision.com Solutionreach 866-605-6867 | Solutionreach.com

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PATIENT CARE

Trouble Staying Current?

By Jackie Garlich, OD, FAAO To keep up with clinical news while maintaining a busy schedule, this OD launched a new blog.

Do you hit snooze or get up as soon as your alarm goes off? I’m a snoozer. I’ll eventually roll over, read a few emails and then, finally, accept that if I don’t get up immediately, I will not be able to stop for a coffee and still make it to work on time. And if I don’t get a coffee before my first patient, heaven help the patient who wants to try toric multifocal contact lenses.

So, here I am at work, said coffee in hand, and the first patient is an established 50-year-old with no complaints and who wears readers only. Sweet. An easy, uneventful first patient of the day.

Then, this once lovely patient blindsides me with one harmless question: “What’s that new procedure all over the news that said I won’t need to use my readers anymore?”(Crickets!)

This feels as if I’m playing a game of trivia in which no one knows the answer, and then someone shouts out that “even the doctor doesn’t know it.” And then you get all defensive and say, “Ask me an eye question, and I’ll knock your socks off, buddy.”

Except, in this situation, the patient is asking me an eye question, and I still don’t know. This is supposed to be my thing, but who has time to read all the optometry news?

Trouble Keeping Up? If you proudly read every piece of research and clinically relevant optometry news, you can stop reading this article and go take a nap because you can’t be sleeping enough. But, for the rest of you who have trouble finding time to keep

Look for Jackie Garlich’s new column in Optometric Office next month!

up with optometry news, I hear you.

It’s not your fault. You’re busy, and there is an incredible amount of optometry news to keep track of, and not all of it is pertinent to you. It’s overwhelming and you could spend a few hours a day trying to read it all. So at what point do you quit working, turn on Netflix, and binge watch the new season of Orange Is the New Black?

Before 2016, I felt the same, which is why I started writing “20/20 Glance.”

Delivered via email Monday morning, it contains a rundown on clinically relevant optometry news for the past week.

It has both headline news and a section on what your patients might ask you based on news during the past week.

It’s an easy way for the busy clinician to keep up-to-date. “20/20 Glance” distills clinically relevant news and presents it in an easy-to-read format. Once you start reading, you’ll be pleasantly surprised that you don’t feel as guilty as you walk past the stack of journals on your desk. OO Jackie Garlich, OD, FAAO, is founder of “20/20 Glance” and practices at Ophthalmology Associates in Milwaukee, WI. WHERE TO FIND IT: 20/20 Glance 2020glance.com

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Think About Your Eyes Advertising Has Driven

1,153,512

Incremental Eye Exams! and

$494.5 Million Total Additional Industry Revenue!

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PHARMACEUTICAL

Put It on a Lid

By Jennifer L. Stewart, OD We now have many choices of lid wipes and cleansers to offer patients with blepharitis and other eyelid conditions.

The treatment of conditions such as blepharitis, chronic dry eye, meibomian gland dysfunction, ocular rosacea and demodex has changed over the years. Previously, eyecare practitioners would recommend washing the eyes with baby, or no tears, shampoo. Today, we know that these conditions are microbial and inflammatory in nature, so a blanket treatment is no longer the proper course of action.

We must carefully assess these patients and prescribe a specific lid hygiene product just as we would prescribe treatment for conjunctivitis or glaucoma. These patients not only suffer from discomfort, irritation and cosmetic issues; their lid conditions can also adversely affect contact lens wear and ocular surgery outcomes.

Today, we have many options to offer our patients, including prescription and nonprescription wipes and cleansers. A specific recommendation to the patient is essential for proper treatment of these conditions.

AVENOVA WITH NEUTROX Avenova with Neutrox from NovaBay is a prescription, non-detergent-based eyelid and eyelash hygiene product. It is indicated for cleansing the lids and removing foreign material and skin debris, and it is non-toxic, non-sensitizing and non-irritating to the skin and eyes.

Avenova contains pure 0.01% hypochlorous acid (HClO), which has a fast antimicrobial time-kill, anti-biofilm activity and anti-toxin activity. In the body, hypochlorous acid also neutralizes inflammatory toxins and inflammatory mediators and deactivates enzymes. The product is indicated for twice daily usage and can be started one week prior to intraocular surgery.

As a non-antibiotic agent, Avenova helps to address concerns about bacterial resistance and has been shown to eradicate 20 species of pathogens, including Gram-positive bacteria and methicillinresistant Staphylococcus aureus (MRSA).

As it is formulated without surfactants, detergents and soaps, Avenova is very gentle and non-irritating. Avenova is a great addition to any lid hygiene routine, including patients suffering from dry eye or blepharitis, contact lens wearers and patients having ocular surgery.

OCUSOFT OCuSOFT offers a variety of lid scrub products for varying degrees of lid hygiene.

OCuSOFT Lid Scrub Original Premoistened Pads effectively remove makeup, oil, debris and pollen from the eyelids. This is ideal for daily lid hygiene for mild-tomoderate conditions. This formula is also available as a foaming cleanser.

Additional products include: • OCuSOFT Lid Scrub Plus, also available as pre-moistened wipes and a foaming cleanser, which is formulated to clean and remove contaminants for moderateto-severe eyelid conditions.

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• OCuSOFT Lid Scrub Plus Platinum, an extra strength, leave-on cleanser that has added anti-inflammatory properties.

• Oust Demodex Cleanser, which incorporates tea tree oil.

• OCuSOFT HypoChlor, available as a spray gel, which includes 0.02% hypochlorous acid to provide a mild, effective treatment for anterior blepharitis.

WE LOVE EYES We Love Eyes, founded by Tanya Gil, OD, focuses on products that are non-toxic, vegan, and paraben- and cruelty-free. The Tea Tree Eyelid Foaming Cleanser includes tea tree oil and is safe to use with eyelash extensions. The company’s Tea Tree Eyelid & Eyelash Makeup Remover Oil also safely removes waterproof mascara.

The Eyelid Scrub Kit consists of a cleansing oil that has a higher concentration of tea tree oil and the foaming cleanser. Indications include itchy eyelids, such as from demodex, blepharitis and dry eye.

BLINK Blink Lid Wipes, from Abbott Medical Optics, are preservative-free, alcohol-free and hypoallergenic. This makes them ideal for contact lens wearers, children and those with sensitive eyes. The addition of chamomile soothes the lid surface while cleaning and moisturizing. Individuals can use these wipes to remove makeup and treat lid disease. They are rinse-free and individually packaged.

CLIRADEX Cliradex, from Bio-Tissue (a business unit of TissueTech Inc.),which was commercially available starting in 2012, is a natural, preservative-free cleanser for the eyelids and face.

Cliradex consists of 4-Terpineol, or T4O, the ingredient in tea tree oil that has been identified as a highly effective cleanser for eradicating demodex mites, which may be infesting the eyelids.

Cliradex is appropriate for patients who suffer from ocular irritation due to blepharitis, demodex infestations or ocular surface diseases such as dry eye and meibomian gland disease linked to microbial activity. Cliradex should be used once or twice daily, and the patient should experience relief within two weeks of regular use.

The company also offers Cliradex Light, a foaming cleanser for managing the symptoms of ocular irritation and mild blepharitis.

SYSTANE Alcon has added SYSTANE Lid Wipes to its line of dry eye products. These premium, pre-moistened eyelid cleaning wipes can be used as part of a daily hygiene regimen. They remove debris and eye makeup that can cause irritation, and they are hypoallergenic. Each wipe is individually wrapped.

VISI-CLEANSE Visi-Cleanse wipes, by Life Wipes, are super-soft, thick, pre-moistened lid wipes that require no rinsing after use. These wipes are made in the U.S. and include ingredients such as aloe, cucumber, oat and chamomile.

One benefit is that these wipes are very gentle, and hypoallergenic, making them ideal for patients with sensitive skin or eyes. They are free of alcohol, phthalate, paraben, dye and fragrance.

Treatment of lid conditions, such as blepharitis, meibomian gland dysfunction, ocular rosacea and demodex, leads to overall better eye health, comfort, contact lens success, ocular surgery outcomes and patient retention.

By arming yourself with the knowledge of the prescription and non-prescription lid wipes and foamers available, you will be better able to prescribe the proper treatment to your patient. OO Jennifer L. Stewart, OD, is a partner at Norwalk Eye Care, in Norwalk, CT. She is also the co-founder and chief optometric officer at Performance 20/20, a sports and performance vision clinic, in Stamford, CT. WHERE TO FIND IT: Avenova 800-890-0329 | Avenova.com Blink JustBlink.com Cliradex 786-483-3054 | Cliradex.com OCuSOFT 800) 233-5469 | OCuSOFT.com Systane Systane.com Visi-Cleanse LifeWipes.com We Love Eyes WeLoveEyesXO.com

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THE | OPTOMETRIC TECHNICIAN

BY ROBERTA BEERS, CPOT DRY EYE REQUIRES LONG-TERM MANAGEMENT AND PATIENT EDUCATION. Dry eye is one of the most common diseases an optometric office will diagnose daily. It is important for the optometric technician to do a complete history during the pre-testing that will provide the doctor with information to make the diagnosis. For example, it is not enough to know that the patient has blurred vision; you need to determine how long the symptom has existed and how severe it is.

There are several ways to diagnose dry eyes (keratoconjunctivitis sicca), dysfunctional tear syndrome, lacrimal keratoconjunctivitis, evaporative tear deficiency, aqueous tear deficiency and LASIK-induced neurotrophic epitheliopathy (LNE).

A patient may present with symptoms such as burning, a sandy or gritty feeling, or even a foreign-body sensation. The doctor will evaluate the quality and quantity of the tear meniscus and tissue, using rose bengal, sodium fluorescein, or lissa-

mine green staining to determine the tear break-up time or using the Schirmer’s test to determine tear production.

CHRONIC CONDITION Dry eye can be temporary or chronic, with many possible causes. Patients usually require long-term therapy.

Dry eye occurs when the eye does not produce tears properly or when the tears are not of the correct consistency and evaporate too quickly. It can cause inflammation of the ocular surface and can be painful. Left untreated, dry eye can cause ulcers, or scars, on the cornea, and some loss of vision. However, permanent loss of vision from dry eye is uncommon.

Therefore, patient education is critical.

A patient must understand the need for regular—and often frequent—use of the prescribed lubricant. Dry eye syndrome can occur at any age and in people who

POSSIBLE CAUSES OF DRY EYE • use of certain medications, including antihistamines, nasal decongestants, tranquilizers, certain blood pressure medicines, Parkinson’s disease medications, birth control pills and antidepressants • skin disease on or around the eyelids • diseases of the glands in the eyelids, such as meibomian gland dysfunction • hormone replacement therapy • LASIK • chemical and thermal burns that scar the membrane lining the eyelids • allergies • infrequent blinking associated with staring at computer or video screens • long-term contact lens wear • autoimmune disorders such as Sjögren’s syndrome, lupus and rheumatoid arthritis • chronic inflammation of the conjunctiva or lacrimal gland • increased surface area of the eye, such as protrusion in patients with thyroid disease or following cosmetic surgery if the eyelids are opened too wide • exposure keratitis, in which the eyelids do not close completely during sleep

are otherwise healthy. It is more common with older age, when individuals produce fewer tears, and more common in women than in men.

For treatment of dry eyes to be successful, the patient must be willing to follow the doctor’s recommendations and use the products the doctor recommends consistently and as frequently as directed.

NUTRITION Studies have shown that omega-3s can help alleviate dry eye. Sources include cold-water fish, such as salmon, sardines, herring and cod. Some doctors recommend flaxseed oil for relief of dry eye.

Drinking more water can help, especially on hot, dry and windy days. Instructing the patient to simply drink more water can reduce the symptoms of dry eye syndrome.

If the patient has mild dry eye symptoms, the doctor might recommend a few things to do at home—remedies such as blinking more often, taking frequent breaks during computer use, removing eye makeup and cleaning eyelids to remove bacteria.

Remind patients to wear sunglasses when outside to protect their eyes.

ARTIFICIAL TEARS Most artificial tears are available without prescription. The challenge with using artificial tears is confusion about the brands and formulations available to choose from. Artificial tears and other overthe-counter (OTC) lubricating eye drops contain a wide variety of ingredients and have different viscosity.

Reiterate the instructions that the doctor has ordered. Explain to the patient that using different brands or multiple

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brands of artificial tears will make it difficult to assess the success of the dry eye treatment the doctor recommended.

WARM COMPRESSES The doctor may instruct the patient to apply warm compresses two to four times a day for five minutes to open clogged meibomian glands. One problem: Patients sometimes don’t have the time to perform the treatment correctly. Doing so less frequently and not using the compresses as directed makes the treatment less effective.

Xiidria received FDA approval in 2016 for the treatment of dry eye disease.

RESTASIS

dition, the doctor might recommend a prescription eye drop, namely Restasis (cyclosporine) from Allergan, Inc. Restasis does more than simply lubricate the surface of the eye; it reduces inflammation associated with dry eye syndrome and helps the body produce more of its natural tears to keep the eyes moist, comfortable and healthy.

When OTC artificial tears don’t make a difference in the patient’s dry eye con-

XIIDRA

SIGNS AND SYMPTOMS OF DRY EYE • a stinging or burning sensation • a feeling of dryness, grittiness and soreness in the eyes; a feeling like sand in the eye • eyelids that stick together upon awakening • stringy mucus in or around the eyes • redness • eye sensitivity to smoke or wind • difficulty keeping the eyes open, and blurred vision, especially toward the end of the day • difficulty performing some activities, such as using a computer or reading for an extended period of time • decreased tolerance for dry environments • sensitivity to light and tearing • discomfort when wearing contact lenses

In July 2016, the FDA approved Xiidra (lifitegrast ophthalmic solution) 5%, a prescription eye drop from Shire approved for the treatment of both signs and symptoms of dry eye disease in adults.

Xiidra is part of a new class of drugs, called lymphocyte function-associated antigen 1 (LFA-1) antagonist. Xiidra’s active ingredient, lifitegrast, is designed to specifically block the interaction of intercellular adhesion molecule-1 (ICAM-1) and LFA-1, which play important roles in the inflammation behind dry eye disease.

Xiidra is generally well tolerated. The most common adverse reactions reported include instillation site irritation, dysgeusia (an unusual taste) and reduced visual acuity.

STEROID EYE DROPS Steroid eye drops are generally used for a short term to quickly manage the dry eye symptoms. They are often used in combination with other treatments.

Steroid eye drops can increase the risk of elevated intraocular pressure or

cataracts if used for an extended period of time. It is important to make sure the patient is scheduled for an IOP check.

LACRISERT Lacrisert (hydroxypropyl cellulose) from Bausch + Lomb is a sterile, slow-release lubricant that is placed under the lower eye.

It is typically recommended for patients with moderate to severe dry eye symptoms, especially if dry eye treatments with artificial tears alone are unsuccessful.

PUNCTAL PLUGS A punctal plug is a small device that is inserted into one of the small openings (puncta) of tear drainage ducts located in the inner corner of the upper and lower eyelids.

After inserting the plugs the tears can no longer drain away from the eye through the ducts. It allows the tears to stay on the surface of the eye, relieving dry eye symptoms. OO Roberta Beers, CPOT, is an optometric assistant in Erie, PA. WHERE TO FIND IT: Lacrisert 800.828.9030 | Bausch.com Restasis 844.469.8327 | Restasis.com Xiidra 800.828.2088 | www.Xiidra-ECP.com MedInfoGlobal@shire.com

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AT-A- GLANCE PUNCTAL PLUGS NAME

SIZES

MATERIALS

SPECIFICATIONS

BENEFITS

• Permanent •A vailable in pre-loaded and bulk, non-sterile

• Easy to insert • Simple sizing • Guaranteed retention

• Sterile • Pre-loaded

• Tapered shaft • Pivoting wide-flex nose • Lowest profile rim

Polyvinylpyrrolidone (PVP) silicone

• Sterile • Pre-loaded

• Enhance drainage •P revent collection of debris on the surface of plugs • I ndicated for punctal stenosis or partial occlusion

Medical-grade silicone

• Sterile • Pre-loaded • Non-sterile bulk

•P roprietary shaft design for easy insertion and proper anatomical fit • Low profile dome

Medical-grade silicone

• Sterile •P re-mounted on an insertion tool

•R eservoir indentations trap tears and reduce foreign body sensation • I nsertion tool features a dilator on the end opposite the plug

Hydrophobic acrylic polymer

• Permanent •D ilation tool not needed

•T hin, rigid 6mm acrylic rod shrinks in length and expands in width to form a gel-like plug • J umbo plug available that will reach maximum diameter of 1.2mm

• Permanent •D ilation tool included • Pre-ioaded

•S ofter, more flexible silicone for comfort •A vailable in a 2-pack or 6-pack dispenser box •A vailable in a non-loaded economy pack

Beaver Visitec | Beaver-Visitec.com Parasol

XS (0.25 to 0.35mm) Sm. (0.35 to 0.65mm) Med. (0.65 to 0.85mm) Lg. (0.9mm+)

Silicone and titanium dioxide

Eagle Vision Inc., a Katena brand | DryEye.org SuperEagle

Sm. (0.4 to 0.6mm) Med. (0.6 to 0.8mm) Lg. (0.8mm and larger)

Soft silicone

FCI Ophthalmics Inc. | FCI-Ophthalmics.com PVP Perforated Plugs

Mini (0.7mm) Med. (0.9mm)

Lacrivera | Lacrivera.com VeraPlug

Sm, (0.4 to 0.6mm) Med, (0.6 to 0.7mm) Lg. (0.7 to 0.8mm) XL (0.8 to 1.0mm)

Lacrimedics Inc. | Lacrimedics.com LacriPro

XS (0.3mm) Sm (0.5mm) Med (0.7mm) Lg. (0.9mm)

Medennium Inc. | Medennium.com SmartPlug

One size

OASIS Medical Inc. | OasisMedical.com Soft Plug Silicone

Micro (0.4mm) Mini (0.5mm) Petite (0.6mm) Sm. (0.7mm) Med. (0.8mm)

Silicone

FOR AN EXPANDED LIST OF PUNCTAL PLUGS, GO TO OPTOMETRICOFFICE.COM 30 J un e 2 01 7 | O p to m e tri c O f f i c e .c o m

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NEW PRODUCT | GALLERY MEIBOMIAN GLAND TREATMENT WITH REUSABLE CABLE TearScience has released the LipiFlow Activator II for the treatment of meibomian gland dysfunction. The Activator consists of a scleral lens heating surface, shield structure and pulsation bladders, all of which directly interface with the patient oculus, and a separate, semi-permanent cable that remains connected to the LipiFlow Console. The LipiFlow System now includes a reusable cable that reduces waste.

For information, contact TearScience at 919.459.4880 or TearScience.com.

THREE NEW DIGITAL ACUITY SYSTEMS FROM REICHERT Reichert Technologies has launched the ClearChart 4 Digital Acuity System, ClearChart 4X Enhanced Digital Acuity System and ClearChart 4P Polarized Digital Acuity System. Optotypes include 17-letter set, eight-letter set, and Sloan, HOTV, Landolt C, Landolt C & O, Tumbling E, and children’s optotypes. Special test charts include astigmatic testing, fusion, phoria and binocular balance. For information, contact Reichert Technologies at 888.849.8955, Reichert.com/ClearChart or Reichert.Information@Ametek.com

CHEWABLE VITAMIN FOR INDIVIDUALS WITH AMD Alcon, a division of Novartis, has introduced SYSTANE ICAPS Chewable AREDS2 Eye Vitamin for individuals with intermediate to advanced age-related macular degeneration (AMD). The vitamin contains ingredients used in the Age-Related Eye Disease Study 2 (AREDS2), a clinical trial conducted by the National Eye Institute that evaluated the effects of various combinations of nutrients on the progression of AMD. The new SYSTANE vitamin contains 500mg vitamin C, 400IU of vitamin E, 25mg zinc, 2mg copper, 10mg lutein and 2mg zeaxanthin. For information, contact Alcon at 800.757.9785 or ICAPSVitamins.com.

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DOCS | SPEAK OUT CARING FOR LIDS AND LASHES Caring for dry eye disease and disorders of the lids and lashes has gone beyond recommending artificial tears and lid scrubs with baby shampoo. Some of the best products aren’t readily available in local pharmacies, however. Nearly three-quarters of doctors surveyed said they display lid hygiene products in their offices. See below for other ways doctors view specialty lid hygiene products in their practices.

Do you display and sell specialty lid/ lash products in your office?

Which products do you sell in your office to treat lid/lash conditions?

(Select all that apply.)

100

40 35 30 25 20 15 10 5

How do you promote lid/lash treatment to your patients? (Select all that apply.)

YES 69%

NO 31%

38% 38% 34% 9% 39%

0

) b b sed ANE cru cru pes dS d S ed wi oil-ba YST Wipes i i S L L T n e T Lid SOF SOF iste ea tre OCu T ipes OCure-mo w (p

YES 73%

NO 27%

80 60 40

20%

20 0

r

e Oth

e ffic

o

te

bsi

we

9% a

edi

al m

i soc

4% 36% 91% s ns ail ure cia ts t em broch hni e visi c e c ice ff/t ffi off sta ring o du

c dire

HOW THE VARIETY OF OVER-THE-COUNTER (OTC) LID/LASH PRODUCTS HAS IMPACTED PRACTICE GROWTH IN THE LAST THREE YEARS: “Very helpful. Lid cloths and baby shampoo are worthless and lead to undertreatment.”

“More options and more discussion for the patient. When they fail with one product, they have other options, which is nice.”

“Since certain products are not readily available, I have added them to the products I sell. I will get the initial sell, but it is rare when patients return for product. Thus, in my case, not a huge money maker.”

“Much better options than in the past.”

“I do not believe it has impacted growth as of yet, but I do believe it will. Lid disease is chronic, and these products treat the actual problem, not just the symptoms. Lid disease and dry eye are preventable in the majority of patients we see in our primary care offices.”

WHAT ODS WOULD LIKE TO SEE IMPROVED WITH THIS CATEGORY OF OTC PRODUCTS: “Addition to Medicaid formulary so all patients can have access to this product.”

“I think what is available is fine.”

“Manufacturer-sponsored public education (social media, TV ads).”

“Less detergent-based cleansers that strip the natural oil reserves, better ingredients promoting overall ocular health (i.e., no alcohols).”

“The product I order doesn’t have a way to order directly online from the

company. The orders have to be called in. Also, there is no patient portal so that they can order themselves online.”

“Better patient education nationally on the importance of good lid hygiene. It should be as important as oral hygiene.”

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INTRODUCING AIR OPTIX® PLUS HYDRAGLYDE CONTACT LENSES

2 1

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References: 1. Nash W, Gabriel M, Mowrey-Mckee M. A comparison of various silicone hydrogel lenses; lipid and protein deposition as a result of daily wear. Optom Vis Sci. 2010;87:E-abstract 105110.

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