Untitled-1 1
1/26/18 4:59 PM
OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE
FEBRUARY 2018
NEW
Oct 2017 OO CoverTip.indd 1
1/19/18 12:06 PM
OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE
ONE-DAY TORIC LENS OPTIONS
AN ECP’S GUIDE TO MENTORING
FEBRUARY 2018
GLANCE: 2017 IN REVIEW
DIABETES MANAGEMENT GOES WITH THE FLOW
SUPPLEMENT TO VCPN FEBRUARY 2018
OO-02FEB18-FINAL.indd 1
1/19/18 4:51 PM
NEW
Untitled-1 1
1/18/18 11:22 AM
OPTOMETRIC OFFICE EDITORIAL STAFF VP, Editorial John Sailer | JSailer@ FVMG.com Editor-in-Chief Jeffrey Eisenberg | JEisenberg@FVMG.com
Table of Contents 6
Assistant Editor Cara Aidone Huzinec | CHuzinec@FVMG.com Creative Director Megan LaSalla | MLaSalla@FVMG.com Production and Web Manager Anthony Floreno | AFloreno@FVMG.com
8
Contributing Writers Ed De Gennaro, Med, ABOM • Jackie Garlich, OD, FAAO • Carolyn Majcher, OD, FAAO
BUSINESS STAFF President/Publisher Terry Tanker | TTanker@FVMG.com Executive Vice President Shawn Mery | SMery@FVMG.com Director of Sales Janet Cunningham | JCunningham@FVMG.com Vice President, Marketing Debby Corriveau | DCorriveau@FVMG.com Vice President, Operations Sharon O’Hanlon | SOHanlon@FVMG.com
2 | From the Publisher 4 | Views 5 | Glance 6 | Buzz
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
10
DEPARTMENTS
12 | New Product Gallery
14
16 | Think About Your Eyes
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.
FEATURES 8 | Diabetes Management Goes With the Flow 10 | For Astigmatic Patients, It’s All in a Day
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.
OO-02FEB18-FINAL.indd 1
14 | An ECP’S Guide to Mentoring
1/19/18 4:10 PM
Terry Tanker
PLEASE LET ME INTRODUCE MYSELF
Many of the topics we cover would also be relevant for owners in the vision care industry, including strategy, leadership, finance, marketing, social media, hiring, sales and much more. This is my first column as the new owner of First Vision Media Group and publisher of VCPN, OLP and Optometric Office. However, I’ve written hundreds since 1999 when I first became a publisher. My passion has always been in the marketing communications field, and after college I worked for a B2B advertising agency for several years. However, an offer from a large trade publisher lured me away. I worked there for the next 20 years. In 2005, I saw an opportunity to start my own company and have been leading it ever since. For the last dozen years we’ve specialized in writing about business management topics for owners of small, medium and large mechanical systems companies. Many of the topics we cover would also be relevant for owners in the vision care industry, including strategy, leadership, finance, marketing, social media, hiring, sales and much more. And, I hope to incorporate some of those topics into what we do here at FVMG. We’ll also get back to our roots, “products and news.” We were founded on this category, and according to recent research we’ve conducted, this is the type of content you want more of—and we’ll deliver. Of course, your input is always welcome. In fact, we’ll be conducting readership studies over the course of the next year, inviting your comments about exactly the type of
content you are looking for in optical trade publications. The VCPN readership study will be conducted in February, and the Optometric Office readership study will be conducted in March. Frank, Shawn and I have been working on this deal for just over a year. That may seem like a long time, but when you stop to consider all that goes into a sale and acquisition, it’s difficult to imagine doing it any more quickly than that. I’ve acquired two companies and have learned there are several very important steps that need to be taken. Most notably, however, there has to be some chemistry between the buyer and seller or negotiations can easily get bogged down and go into stalemate. So, I’m thankful we had that working for us throughout the process. No matter the size of the company, the discovery and due diligence process is just that, a process. Neither side wants to get burned; as a result, it simply takes time. From a seller’s perspective, you’re hopeful to attract a buyer who will build upon the blood, sweat and tears you’ve poured into “your” company (in this case, for the last 17 years). From a buyer’s perspective, you look for a good company with a solid foundation you believe can go to the next level. I believe we all found what we were looking for. I’m looking forward to meeting our subscribers at the many upcoming industry events such as Vision Expo East and West as well numerous others. And, to our many advertisers, I’ll be seeing you soon—based on my itinerary I’ll be moving up a level on United’s frequent flier program. Should you like to reach out before we meet in person I would welcome your call or email and can be reached at 440.471.7810 and TTanker@FVMG.com.
Terry Tanker| Publisher | TTanker@FVMG.com
2 F e b r ua r y 2 0 1 8 | O p to m e tri c O f f i c e .c o m
OO-02FEB18-FINAL.indd 2
1/19/18 4:10 PM
TRS-5100 Product/Model name: REFRACTOR RT-5100
The TRS-5100 offers a split prism Jackson Cross cylinder with simultaneous target comparisons, for faster, more accurate and more positive exam experiences. Maximize exam efficiency, patient flow, and overall practice revenue.
AND DESIRED OUTCOMES Steve Chander, OD Chicago, Illinois
The Marco TRS systems enabled us to see 4 more patients a day and rapidly paid for themselves in efficiency cost savings, additional exam revenue, and sales of multiple eyewear. These workflow and profitability enhancements compelled us to purchase 3 additional TRS systems for our clinic.
April Jasper, OD West Palm Beach, Florida
I truly appreciate the seamless EMR integration of the Marco system. More than 50 mouse clicks are eliminated by this seamless data transfer with the push of one button. The time saved in the exam room is priceless.
Scot Morris, OD Conifer, Colorado
Our favorite refractor is the Marco TRS-5100. Because it is quiet, fast, efficient and comfortable, it also has earned the “cool” factor. Since patients can instantly compare their old and new Rx–and decide if they value the difference, satisfaction is greatly enhanced.
Dori Carlson, OD Park River, North Dakota
Our revenue per patient has risen- in part because the TRS-5100 allows me to show people the changes in the Rx with a push of a button. They can quickly see for themselves how minor shifts can impact their overall vision.
VISIT MARCO
March 1-3, 2018 • SECO • 1029 March 16-18, 2018 • VEE • MS4803
633 TRS Testiml-OD-OO.indd 1 Untitled-3 1
Designed and Manufactured by NIDEK - Represented by Marco 800-874-5274 • marco.com
1/18/18 3:11 2:51 PM PM 1/18/18
VIEWS
Jeffrey Eisenberg
21ST CENTURY DIAGNOSIS, OLD-FASHIONED WISDOM As primary health providers, you can educate yourself and your patients about what steps they can take—diet and exercise are two big ones—to prevent the onset of diabetes. Pay careful attention to at-risk populations. The leading cause of new cases of blindness among adults is diabetes. If that fact isn’t sobering enough, consider this: More than 30 million Americans have diabetes—with nearly one in four not diagnosed—and another 84 million adults 18 and older have prediabetes, according to the National Diabetes Statistics Report 2017 from the Centers for Disease Control and Prevention. As the CDC points out, that’s almost one in 10 individuals in the U.S. who have diabetes and one in three who are at risk of developing diabetes. The good news is that as the prevalence of diabetes continues to rise, technology evolves to help eyecare practitioners. This month, Carolyn Majcher, OD, FAAO, describes how optical coherence tomography angiography—OCT-A for short—allows for early detection of retinal vascular changes. This early detection, along with appropriate management and referral, may just save your patients’ vision. But care of patients who have or are at risk for diabetes requires even more than the latest technology. In some cases, it requires getting patients into the exam chair altogether. Nearly eight in 10 individuals don’t know diabetic eye diseases have no visible symptoms, according
to the American Optometric Association’s most recent American Eye-Q survey. Also, more than half do not know comprehensive eye examinations can detect diabetes. As primary health providers, you can educate yourself and your patients about what steps they can take—diet and exercise are two big ones—to prevent the onset of diabetes. Pay careful attention to at-risk populations. Remind individuals who have diabetes about the importance of monitoring their condition, making any necessary lifestyle changes, and seeking regular care not only from you but from their other providers as well. You might also steer your patients to additional resources, such as the American Diabetes Association (Diabetes.org), The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK.NIH.gov) and the CDC (CDC.gov/Diabetes). Knowing you played an important role in the care of your patients with diabetes and helped them preserve their vision will no doubt be extremely gratifying.
*** Speaking of gratitude, I’d like to thank, Richard Clompus, OD, who served as professional editor for Optometric Office and is now returning to his role as a consultant for industry. When I first entered the world of optometric publishing nearly 25 years ago, I turned to Richard for knowledge about the profession and honest feedback about whether the articles I wrote and edited might truly benefit ODs. Seven months ago, when I became editor-in-chief of Optometric Office, I had a lot to learn about the advances in products and technology. Richard once again shared his knowledge, providing valuable insight about what topics would be of interest to you, our readers, and helped me expand my network of go-to sources. To quote Richard’s email signoff, “be well.” Jeffrey Eisenberg | Editor-In-Chief | JEisenberg@FVMG.com
4 F e br ua r y 20 1 8 | O p to m e tri c O f f i c e .c o m
OO-02FEB18-FINAL.indd 4
1/19/18 4:10 PM
GIVING YOU A QUICK RUNDOWN ON THE TOP NEWS AND RESEARCH FROM THE PAST MONTH. CONSIDER THIS THE MOST PRODUCTIVE FIVE MINUTES OF YOUR DAY. READY?
Now that 2018 is here, it’s only natural to do the obligatory recap of advances in eyecare in 2017. A lot happened actually. Here’s the rundown.
IF YOU SEE DRY EYE PATIENTS ... The U.S. Food and Drug Administration approved Restasis Multidose (cyclosporine 0.05%) in March. The new bottle design offers an alternative to single-use vials. Then in April, the FDA approved TrueTear, a handheld intranasal neurostimulator that provides a temporary increase in tear production for up to four hours. How do you use TrueTear? TrueTear emits micro-electric pulses to stimulate the lacrimal gland and trigeminal nerve. The intensity can be adjusted, but the desired effect is a “tingling sensation” in the nose. The neurostimulation should be no longer than three minutes at a time and no more than 10 times a day.
IF YOU SEE ALLERGY PATIENTS … In May, the FDA approved Zerviate (ceterizine 0.24%), a second-generation antihistamine drop from Nicox Vision Science. Cetirizine is the active ingredient in Zyrtec. Dosing is b.i.d.
IF YOU SEE GLAUCOMA PATIENTS … Right before the ball dropped on 2017, the FDA approved two new glaucoma drops: VYZULTA (latanoprostene bunod 0.024%) and Rhopressa (netarsudil 0.02%). How does VYZULTA work? According to Bausch + Lomb, it is “a nitric oxide-donating prostaglandin F2-alpha analog.” I can feel your attention fading so let me say that a different way. VYZULTA has two mechanisms of action. It’s a prostaglandin analogue that increases aqueous
GLANCE
Jackie Garlich outflow via the uveoscleral pathway. It also acts as a nitric oxide donor, which increases outflow throughout the trabecular meshwork and Schlemm’s canal. What is the dosing? One drop once a day. What are the side effects? The most common are conjunctival hyperemia, eye irritation, eye pain, and instillation site pain. Increased pigmentation of the iris and periorbital tissue and growth of eyelashes also may occur.
IF YOU SEE VISINE ADDICTS … In December, the FDA approved Lumify (brimonidine tartrate, 0.025%), an over-the-counter eye drop to help treat red eyes. Brimonidine tartrate (brand name Alphagan) was approved in 1996 to lower IOP. It does so by reducing aqueous production and increasing uveoscleral outflow.
How much IOP reduction are we talking? In the APOLLO and LUNAR studies, there was an average of 32% diurnal IOP reduction. When can I prescribe it? Now! Go forth and prescribe. What is Rhopressa? A once daily eyedrop from Aerie Pharmaceuticals to lower IOP for patients with open-angle glaucoma or ocular hypertension. How does it work? The main buzzword you will hear is that it’s a ROCK inhibitor. It increases outflow through the trabecular meshwork by inhibiting Rho Kinase (ROCK). Rhopressa is also presumed to work via two other mechanisms. It reduces fluid production in the eye by inhibiting the norepinephrine transporter, and it lowers episcleral venous pressure.
What is the difference between Alphagan and LUMIFY? LUMIFY contains a lower concentration of brimonidine compared to Alphagan, which is available in 0.2%, 0.15%, and 0.1%. In other words, Alphagan 2% is eight times stronger than Lumify. Why is this better than Visine? Visine use can lead to loss of efficacy and rebound redness when stopped. Brimonidine specifically targets, namely the alpha receptors on blood vessels, which reduces the other side effects. When will I see this on the shelves? Second quarter of 2018.
IF YOU SEE RETINAL DEGENERATION PATIENTS ...
What are the side effects? The biggest one was conjunctival hyperemia, reported in 53% of patients. Others were vortex keratopathy, instillation site pain, and conjunctival hemorrhage.
The FDA approved Luxterna (voretigene neparvovec), a one-time gene therapy treatment for patients with vision loss due to biallelic RPE65mediated inherited retinal disease (Leber’s congenital amaurosis as well as autosomal-recessive retinitis pigmentosa).The estimated cost for this one time treatment is nearly $1 million.
When can I prescribe it? Likely by the second quarter of 2018, but you’ll start seeing reps soon.
That’s your short and sweet recap of 2017. Here’s to hoping you have a productive and successful 2018!
Jackie Garlich, OD, FAAO | 20/20 Glance | 2020Glance.com
O p tometr ic O ffic e. c om | February 2018 5
OO-02FEB18-FINAL.indd 5
1/19/18 5:15 PM
PRODUCT | BUZZ LAUNCHES, PROMOTIONS, MERCHANDISING, EVENTS AND OTHER THINGS TO KEEP YOU IN THE KNOW.
NEW OCT SYSTEM SHOWS ENTIRE EYE
Researchers have developed an optical coherence tomography system that can provide a detailed image of the entire eye by incorporating a lens that changes optical parameters in response to an electric current. The researchers from Nicolaus Copernicus University in Poland and the Universidad de Murcia in Spain say the technology can produce higher quality images than currently available and could make eye examinations faster and more comfortable for patients by avoiding the need to undergo imaging with multiple instruments to look at different areas of the eye. In Optica, The Optical Society’s journal for high-impact research, the researchers show that their new OCT can image the front and the back of the eye and image the interfaces of the eye’s vitreous gel with the retina and lens in great detail. This new imaging capability could allow scientists to better understand how the vitreous gel that fills the eye interacts with the retina and why it can sometimes become detached with aging. Go to UMK.pl/en/.
FDA APPROVES RHOPRESSA FOR LOWERING IOP
The U.S. Food and Drug Administration has approved Rhopressa (netarsudil 0.02%) Aerie Pharmaceuticals’ eyedrop for lowering elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension. The once-aday eyedrop increases the outflow of aqueous humor through the trabecular meshwork. Call 949.526.8700, or go to AeriePharma.com.
Pablo Artal (pictured) led the Universidad de Murcia research group that developed a new OCT instrument, which can provide a detailed image of the entire eye. Courtesy: Pablo Artal, Universidad de Murcia.
I-PEN TEAR OSMOLARITY SYSTEM COMES TO THE U.S.
A new distribution agreement between OCuSOFT Inc. and I-MED Pharma Inc., a Montreal-based biotechnology company, will make the I-PEN Osmolarity System available in the U.S., pending anticipated FDA 510(k) clearance
in the first quarter of 2018. The I-PEN Tear Osmolarity system, used with the I-PEN Single Use Sensors, measures the tear-soaked palpebral conjunctiva and displays a numerical tear osmolarity test result on the liquid crystal display. Call 800.233.5469, or go to OCuSOFT.com.
6 F e br ua r y 2 0 1 8 | O p to m e tri c O f f i c e .c o m
OO-02FEB18-FINAL.indd 6
1/19/18 4:11 PM
BIO-TISSUE ANNOUNCES AMNIOTIC MEMBRANE RESULTS
Use of cryopreserved amniotic membrane and intraoperative mitomycin C reduces recurrence rates after pterygium surgery, according to study findings in the February 2018 issue of Cornea. In this retrospective review, 556 eyes of 535 patients who underwent pterygium excision were treated with Bio-Tissue Inc.’s AmnioGraft cryopreserved amniotic membrane. After an average follow-up period of 17.3 months, corneal recurrence occurred in only 20 eyes (3.6%) and conjunctival recurrence in 12 (2.2%) eyes, for a total recurrence rate of 5.8%. Call 888.296.8858 or go to BioTissue.com.
AMPLEYE SCLERAL LENS AVAILABLE IN TWO MORE DIAMETERS
With the addition of 15.0mm and 15.5mm diameters, Art Optical’s Ampleye scleral lens is now available in diameters from 15.0mm to 17.0mm. The reduced diameter Ampleye does not require additional diagnostic lenses—a simple sagittal depth conversion calculation from the 16.5mm Dx lens will produce
the same initial fitting results—but for those who prefer to work with smaller scleral lenses, Art Optical offers nine-lens diagnostic sets in the 15.0mm and 15.5mm diameter. Ampleye lenses also feature anterior surface toric and multifocal optics, quadrant-specific control technology, and Tangible Hydra-Peg surface coating on lenses made in Optimum materials. Call 800.253.9364, or go to ArtOptical.com/Ampleye.
PHASE 2 DRY EYE TRIAL NOW UNDER WAY
Novaliq GmbH has begun randomization of patients in its multicenter SEECASE Phase 2 clinical trial for the treatment of dry eye disease. The SEECASE clinical trial, a randomized, double-masked, salinecontrolled study, will evaluate the effect of using NOV03 either twice daily or four times daily to treat signs and symptoms of dry eye disease. NOV03 is designed to immediately stabilize the lipid layer and possibly dissolve lipids in the meibomian glands to improve their functionality. Go to Novaliq.com.
News CooperVision, Inc., acquired Paragon Vision Sciences, a manufacturer of orthokeratology (ortho-k) and specialty contact lenses and gaspermeable contact lens materials. The Centene Charitable Foundation, St. Louis, has provided a $150,000 grant to Optometry Cares— The Foundation’s InfantSEE program in which nearly 4,000 optometrists examine thousands of infants annually for normal eye development and to intervene early if necessary. Shire plc announced that Xiidra (lifitegrast ophthalmic solution 5%), a twice-daily eyedrop solution indicated for treating the signs and symptoms of dry eye disease in adults, has been approved in Canada. Momenta Pharmaceuticals, Inc. and Mylan N.V. announced plans for a randomized, double-blind, active-control, multi-center study to compare the safety, efficacy and immunogenicity of M710, a proposed biosimilar to EYLEA (aflibercept) injection, in patients with diabetic macular edema during the first half of 2018. Glaukos Corp. announced that its Travoprost Intraocular Implant with the iDose delivery system continued to provide sustained reduction in intraocular pressure (IOP) in a 12month interim cohort of patients in its U.S. Investigational New Drug (IND) Phase II clinical trial.
Ampleye is now available in diameters of 15.0mm to 17.0mm.
O p tometr ic O ffic e. c om | February 2018 7
OO-02FEB18-FINAL.indd 7
1/19/18 4:11 PM
*
INSTRUMENTATION
DIABETES | MANAGEMENT
GOES WITH THE FLOW
OCT angiography allows early detection and more accurate staging of retinal vascular changes. By Caro l yn M ajcher, OD , FAAO VITREORETINAL INTERFACE
Even though the prevalence of diabetic retinopathy (DR), a leading cause of new cases of blindness among adults, is on the rise, new technology can improve the way we manage patients who have diabetes. Optical coherence tomography angiography, or OCT-A, allows for earlier detection and more accurate staging of retinal vascular changes.
NONINVASIVE AND DYELESS
OCT-A is a noninvasive, dyeless system that provides volumetric data about the integrity and blood flow of the retinal and choroidal vasculature. This technology creates 3D maps that show the motion of intravascular red blood cells at one particular point in time. By contrast, fluorescein angiography defines phases based on where dye transverses.
SUPERFICIAL
DEEP
A 3mm x 3mm OCT-A macular scan taken with ZEISS Angioplex depicts the three en-face views that are most useful for assessing the inner retinal circulation. The vitreoretinal interface includes the vitreous anterior to the retina. In a healthy eye, the VRI should be void of signal. The VRI is particularly useful for detecting preretinal neovascularization. The superficial retina contains the larger branches and the superficial capillary plexus of the central retinal artery. The FAZ is of normal size and shape. The deep retina contains the deep capillary plexus of the central retinal artery.
The most common way to view OCT-A information involves pre-set en-face displays from the manufacturer. Each en-face display is generated by compressing a slab consisting of multiple retinal layers into a 2D planar surface. Two systems with OCT-A capability currently are available: the ZEISS CIRRUS OCT with AngioPlex and the AngioVue Imaging System from Optovue. Others, such as the Nidek RS-3000 Advance with AngioScan, are awaiting FDA approval. These devices come with advanced eye-tracking technologies that are essential for generating high-
resolution OCT-A images.
RAPID ACQUISITION
Benefits of OCT-A include easy and rapid acquisition, short-term repeatability, excellent safety profile and high-resolution microvascular imaging. OCT-A generates volumetric data, allowing you to use depth to localize abnormal vascularization. This is important in differentiating intraretinal microvascular abnormalities (IRMA) from preretinal neovascularization, which is located anterior to the internal limiting membrane. Even normal vasculature can be separated out for viewing and analysis.
8 F e br ua r y 2 0 1 8 | O p to m e tri c O f f i c e .c o m
OO-02FEB18-FINAL.indd 8
1/19/18 4:23 PM
OCT-A also lets you correlate vascular and structural abnormalities. OCT-A provides both a conventional 3D macular cube of structural data that allows for visualization of edema and thickening as well as a superimposed 3D map of the retinal vasculature. Microaneurysms and/ or IRMA are often adjacent to fluid cysts, and vascular nonperfusion may correspond to areas of retinal cellular disorganization and atrophy.
VAST APPLICATIONS
OCT-A has vast clinical applications when evaluating diabetic eyes. When present, vascular abnormalities are typically in the superficial capillary plexus and the deep capillary plexus en-face displays. The high-resolution microvascular imaging of OCT-A highlights and allows for precise delineation of the foveal avascular zone (FAZ), areas of inner retinal nonperfusion, neovascular complexes and IRMA. Studies suggest that microvascular abnormalities detected by OCT-A precede the onset of clinically detectable DR. Anomalies found in diabetic eyes without clinical retinopathy include enlargement and an irregular shape of the FAZ, decreased macular vessel density, focal areas of capillary nonperfusion, and microaneurysms.
PROGRESSIVE CAPILLARY CLOSURE
The pathophysiology of DR involves progressive capillary closure with mounting ischemia. Retinal ischemia is typically invisible on funduscopy unless it is acute and accompanied by retinal whitening or is extensive enough to cause large vessel sclerosis. With OCT-A, however, we can easily visualize nnonperfusion. The degree of macular perfusion compromise, particularly of the deep plexus, directly correlates with the severity staging of retinopathy. Extensive retinal nonperfusion in an eye thought to have nonproliferative DR (NPDR) should raise suspicion for budding neovascularization, which typically
In my own experience, OCT-A has confirmed neovascularization that was questionable or was not apparent via ophthalmoscopy. occurs at the border of perfused and nonperfused zones. Eyes with extensive nonperfusion and severe NPDR require close monitoring given the risk of progression to proliferative DR. These patients may benefit from early anti-vascular endothelial growth factor (anti-VEGF) treatment even in the absence of diabetic macular edema (DME). Enlargement of the FAZ and macular ischemia, which may contribute to or be the sole cause of decreased vision in diabetic eyes, are invisible clinically but readily apparent with OCT-A imaging. Studies have shown a correlation between enlargement of the FAZ and worsening visual acuity. Confirmation of macular ischemia is advantageous when the patient experiences decreased vision, even though no macular edema is present. Also, OCT-A is useful for determining the prognosis in eyes that will undergo anti-VEGF treatment for DME. Poor responders often exhibit significant macular ischemia with large FAZs and numerous microaneurysms within the deep capillary plexus. In these eyes, decreased vision may persist even when the edema resolves.
EARLY PROLIFERATION
Perhaps the greatest clinical utility of OCT-A in DR evaluation is the ability to detect early proliferation and differentiate IRMA from true preretinal neovascularization using depth localization. In contrast to IRMAs, which are dilated telangiectasias confined to the retina, preretinal neovascularization is characterized by new blood vessel growth anterior to the internal limiting membrane that often clings to the posterior hyaloid of the vitreous. The ZEISS Angioplex has a preset en-face display, the vitreoretinal
interface (VRI), that corresponds to a segmentation slab of vitreous just anterior to the retina. This was designed to detect and visualize preretinal neovascularization. In diabetic eyes, vascular lesions that are present on the VRI display represent neovascular complexes, not IRMA. The distinction is important, as neovascularization carries a risk for severe vision loss from vitreous hemorrhage and/or tractional retinal detachment. In my experience, OCT-A has confirmed neovascularization that was questionable or was not apparent via ophthalmoscopy. The high-resolution microvascular detail makes OCT-A an ideal choice for monitoring and ensuring regression of neovascular tissue following treatment.
IMPROVED CARE
OCT-A can improve the quality of care you provide individuals with diabetes. As software continues to advance, allowing for automated quantitative analysis of neovascular area, nonperfused zones, FAZ, and macular vessel density, the clinical utility of OCT-A in diabetic evaluation will increase further. O|O Carolyn Majcher, OD, FAAO, is chief of the Retina Clinic and assistant clinical professor of the Rosenberg School of Optometry University of the Incarnate Word in San Antonio, TX.
WHERE TO FIND IT Carl Zeiss Meditec, Inc. 800.342.9821 | Meditec.Zeiss.com/USA NIDEK Inc. 800.223.9044 | USA.Nidek.com Optovue Inc. 866.344.8948 | Optovue.com You can find this article fully referenced on our website at OptometricOffice.com.
O p tometr ic O ffic e. c om | Fe bruary 2018 9
OO-02FEB18-FINAL.indd 9
1/19/18 4:11 PM
*
CONTACT LENSES
FOR ASTIGMATIC PATIENTS, IT’S ALL IN A DAY Daily disposable toric lenses offer patients the visual benefits of correcting astigmatism and improved comfort and eye health.
By J ef f rey S . Eisenberg As a millennial herself, Jennifer Lyerly, OD, of Cary, NC, is very familiar with visual demands, especially on younger generations. After all, she says, individuals often spend eight-hour workdays staring at computer screens, playing video games, and simultaneously watching television and looking at smartphones. In April, U.S. Time Spent with Media, a report from eMarketer Inc., estimated that digital usage for 2017 would total nearly six hours a day. Indeed, individuals spend an average of more than three hours daily using mobile devices for purposes other than telephone calls. “That means even small imperfections in vision can be a huge detriment to our daily performance,” Lyerly said. “While in the past it may have been acceptable to ignore astigmatism when writing a contact lens prescription, our patients expect and deserve the sharpest 20/20 vision (or even 20/15) they can achieve.” Thanks to the advent of daily dis-
posable toric lenses, it’s possible to offer patients this vision as well as improved eye health benefits.
COMFORT AND CLARITY
But, are they getting that vision? According to Bausch + Lomb, approximately 73.2 million people in the U.S. have astigmatism, yet only 8.8 million, or 12% of them, currently wear toric contact lenses. “Approximately 42% of vision corrected teens and adults in the U.S. have been diagnosed with astigmatism, and it is often a challenge to fit them with a lens that has the right combination of visual clarity and comfort to meet their unique vision correction needs,” said Mile Brujic, OD, of Bowling Green, OH. Brujic described himself as “delighted” to offer patients with astigmatism “the comfort and clarity they need in the convenient form of a daily disposable lens” when Bausch + Lomb introduced its Biotrue ONEday for Astigmatism daily disposable
contact lenses in March. Biotrue ONEday for Astigmatism features Surface Active Technology, which uses a large volume of hydrophilic polyvinylpyrrolidone (PVP), a water-loving molecule, and Poloxamer 407, a surface-active macromer, to form a unique dehydration barrier that helps the lens maintain 98% of its moisture for up to 16 hours. B+L engineers also created an evolved peri-ballast design that employs spherical aberration control in both axes to help reduce halos and glare, even in low-light conditions.
HEALTH BENEFITS
Besides the visual advantages, ODs say that the health factors shouldn’t be overlooked. “Any one-day lens, toric or otherwise, should be seriously looked at by eye doctors,” said John McIntyre, OD, of Corpus Christi, TX. For example, he said, patients wearing monthly replacement torics might report no comfort issues during the first two weeks of wear but less
10 F e br ua r y 20 1 8 | O p to m e tri c O f f i c e .c o m
OO-02FEB18-FINAL.indd 10
1/19/18 4:11 PM
comfort by the third and fourth week, and he may observe corneal edema on the exam. “I tell them they need to consider switching to the one-day modality,” McIntyre said. McIntyre also likes using daily disposable lenses with teenagers not only because of the eye health benefit but because he is concerned about whether they will comply with the care regimen.
TEST SITE
McIntyre’s practice tested MyDay toric daily disposable contact lenses from CooperVision Inc. before it launched last month. This latest entry into the daily disposable toric segment offers the same Optimized Toric Lens Geometry found in CooperVision’s Biofinity toric, which the company says provides uniform horizontal ISO thickness, an optimized ballast band design, large toric optic zone, and a smooth, continuous surface to make it an easy-to-fit, stable toric lens. The lens also features Smart Silicone chemistry, which optimizes oxygen permeability. The lens consists of just 4.4% silicon, leaving more room in the lens for hydrophilic material, resulting in improved surface wettability, higher water content, and lower modulus for a softer, more comfortable lens-wearing experience. It also enables a modulus of only 0.4 MPa to make MyDay CooperVision’s softest ever one-day silicone hydrogel contact lens. While the lens provides the optimal softness of a hydrogel, it remains strong enough to ensure the exceptional handling of a silicone hydrogel lens. “The MyDay specifically just hits all cylinders. It’s good Dk, it’s good water, it handles well, and the vision is excellent,” McIntyre said. (For more on this new lens, see “New Product Gallery,” page 12.)
CONVENIENCE AND STABILITY
Besides the health benefits of using a new lens each day, Stephen Pullen,
OD, of Jacksonville, FL, says daily disposable lenses have become standard in his practice because this modality “offers the convenience of no solutions, cases or cleaning regimen and provides consistent vision due to state-of-the-art technology in production.” Pullen says he offers Johnson & Johnson Vision’s ACUVUE OASYS Brand Contact Lenses 1-Day for ASTIGMATISM for anyone with -0.75D or greater cylinder. ACUVUE OASYS combines HydraLuxe Technology, which includes tearlike molecules and highly breathable hydrated silicone that integrate with the patient’s own tear film, and BLINK STABILIZED Design, which harnesses the natural power of the eyelids, to help keep the lens in the correct position even with head and eye movements. “Patients are able to discern the improvement in acuity immediately,” Pullen said. “The BLINK STABILIZED Design provides consistent vision and holds its orientation throughout the day very well.” In addition, he said, the lens features a stiffer modulus for easier handling and ease of insertion, and the thinness of the lens makes for more comfortable lens wear. “In my experience, patients who have handling difficulty with many single use toric lenses find the OASYS 1-Day for ASTIGMATISM to handle very well and to be extremely comfortable all day,” he said. “The Hydralux technology used on the OASYS 1-Day for ASTIGMATISM is a great wetting and ‘slick’ lens all day.”
EASE OF HANDLING
Lyerle says DAILIES AquaComfort Plus Toric from Alcon Laboratories has become her go-to lens due to its ease of handling. The lens combines dual thin zone Precision Curve lens design, which
the company says supports excellent visual acuity, and Blink-Activated Moisture, in which moisturizing agents are released with every blink for all-day comfort. Lyerle also points out the convenience of clearly visible alignment markings, which allow patients to self-align their lenses for immediate clarity and determine whether the lens is inside out before insertion. “In an era where we expect technology to respond immediately, waiting even just a few minutes for visual clarity is a drawback for patients with astigmatism lenses,” she said. “They love seeing that green ‘OK’ to be able to easily insert their lenses in the perfect location for immediate vision performance.”
COST CONCERNS
One final piece of advice these doctors offer is not to let cost discourage you from offering daily disposable lenses. “Asking an existing toric patient if they experience visual fluctuation during the day or during the life of the lens can often provide an opportunity to discuss single use as a better alternative,” Pullen said. “Clean lenses tend to stay aligned, and that is a natural segue to offer a single-use option.” “As eye doctors we just need to overcome our own fear of prescribing something that we think is expensive,” McIntyre said of daily disposable toric lenses. “I think they’re the present and the future. We’ve embraced it in my office, and we’ve been quite pleased at the result.” O|O
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 800.843.2020 | ACUVUEProfessional.com
O p tometr ic O ffic e. c om | Fe bruary 2018 11
OO-02FEB18-FINAL.indd 11
1/19/18 4:12 PM
NEW PRODUCT | GALLERY COOPERVISION INTRODUCES NEW DAILY DISPOSABLE TORIC
CooperVision, Inc. has introduced MyDay toric daily disposable contact lenses, which combine the company’s Optimized Toric Lens Geometry for easy fit and stability and Smart Silicone chemistry for optimal oxygen permeability, improved surface wettability, higher water content and lower modulus. The lenses also feature built-in UV protection that filters 85% of UVA and 96% of UVB rays. MyDay toric lenses have a base curve of 8.6mm and a diameter of 14.5mm and are available in sphere powers from plano to -6.00D (0.25D steps), and -6.00 to -10.00D (0.50D steps); plus powers will be available in the future. Available cylinder powers are -0.75D, -1.25D, and -1.75D (in axes of 10°, 20°, 70°, 80°, 90°, 100°, 110°, 160°, 170°, and 180°) and -2.25D (in axes of 10°, 20°, 90°, 160°, 170°, and 180°). For more information, visit PrescribeMyDay.com/Toric.
ART OPTICAL BRINGS KERASOFT THIN TO U.S. MARKETPLACE
Under license from UltraVision CLPL, Art Optical is now manufacturing and supplying KeraSoft Thin, a quarterly replacement silicone hydrogel contact lens, in the U.S. KeraSoft Thin, manufactured in Contamac’s Definitive silicone hydrogel material, offers an ultrathin design for improved wearing comfort, increased oxygen transmission and increased lens flexibility for improved drape over the cornea. An eight-lens diagnostic set is available, as are additional fitting resources, training aids and a practitioner locator at KeraSoftLens.com. Call 800.253.9364 or visit ArtOptical.com.
SAFILENS LAUNCHES CONTACT LENS FOR ASTHENOPIA
Safilens launched its fusion 1day vista daily contact lens for asthenopia. The lenses feature D-Stress geometry, which the company says, provides enhanced depth of field to reduce eye strain associated with daily activities such as prolonged use of digital devices. The controlled release of natural substitutes for the tear film from the lens to the eye surface ensures long-lasting comfort in dry environments, such as air-conditioned offices or when blinking is reduced in frequency or is incomplete. Go to Safilens.com/en. 12 F e b r ua r y 20 1 8 | O p to m e tri c O f f i c e .c o m
OO-02FEB18-FINAL.indd 12
1/19/18 4:12 PM
LUXEXCEL INTRODUCES 3D LENS INSERTS
Luxexcel has introduced 3D-printed prescription lens inserts. The Luxexcel VisionPlatform enables 3D printing of ophthalmic lenses for specialty applications, including augmented reality, for which the Belgian company received an equity investment of $4.7 million from Netherlands-based venture capital fund Innovation Industries. Hans Streng, CEO of Luxexcel, said: “60% of the U.S. population needs eye correction. Without custom prescription inserts, those people will not be able to fully enjoy the most advanced new augmented reality products.” For information, call 800.350.4138 or go to Luxexcel.com
NEW OTC DROP TARGETS OCULAR REDNESS
The U.S. Food and Drug Administration has approved LUMIFY (brimonidine tartrate 0.025%), Bausch + Lomb’s over-the-counter eyedrop for the treatment of ocular redness. The low dose of brimonidine selectively constricts veins in the eye, making more oxygen available to surrounding tissue. B+L, a wholly owned subsidiary of Valeant Pharmaceuticals International, Inc., licensed the product from Eye Therapies, Inc. and expects LUMIFY to be available for purchase at major retailers in the second quarter of 2018. Go to Bausch.com.
NEW RESOURCE EDUCATES PATIENTS ABOUT EYEDROPS
The Mentholatum Company, distributors of ROHTO DRY-AID, in conjunction with the Intrepid Eye Society and CEDARS/ASPENS, a not-for-profit society of anterior segment surgeon educators, has developed “Before You Buy Eye Drops: What You Need to Know.” This new educational resource helps you educate patients about when and how to properly use over-thecounter eyedrops. “Before You Buy Eye Drops: What You Need to Know” offers information about different types of eyedrops and what they are most commonly used for, helpful “Do’s and Don’ts” to follow when using eyedrops, step-by-step instructions on how to properly instill eyedrops and links to additional eye health information resources. To download copies, go to the Resources section at the ROHTO DRY-AID Professional website at ROHTOEyedrops.com/ wp-content/uploads/2017/12/Before-You-Buy-Eye-Drops-What-You-Need-to-Know.pdf.
O p tometr ic O ffic e. c om | Fe bruary 2018 13
OO-02FEB18-FINAL.indd 13
1/19/18 4:12 PM
*
BUSINESS
AN ECP’S GUIDE | TO MENTORING Training should occur in every practice, and every practice needs to prepare for it. By Ed De Gennaro, MEd, AB OM Mentoring is highly important in an ophthalmic office. Given that many non-doctor employees don’t have a college education, there’s a huge need for training. After all, how does someone learn on the job if there’s no training program? While many offices will tell you they have a training program, the fact is most don’t. Why? It’s probably because they aren’t prepared for it. After all, techs are hired to help the doctor, not to be teachers. Opticians and others in the office will sing a similar lament. If the turnover of the non-doctor staff in an office is about five years, then an office will be hiring a new office staff every five years (on average). Sure, there are offices that have had the same staff for years, but there are those who turn them over quickly, too. The point to take away here is that training should occur in every office, which means that every practice needs to prepare for it.
AN UNSTRUCTURED APPROACH
There are two basic types of mentoring: structured and unstructured. The latter is the most common type. It involves a more experienced person responsibile for training a less experienced person, usually a recent hire or new employee. The mentor orients the new hire to the tasks and responsibilities of the position and provides some hands-on training for an unspecified period of time. Even when the mentee seems capable of handling things at a fundamental level, the mentor still keeps a watchful eye on the mentee and provides follow-up help or additional instruction as needed. This kind of arrangement is common with opticians and techs. Either the doctor or a knowledgeable and skilled employee will provide the training and supervision. Some offices find it convenient and effective to have representatives of optical laboratories or instrument companies
to do the training. Some vendors have highly qualified trainers who do this often. Because this can be an expensive proposition regarding time spent in an office, this arrangement usually is provided for optical offices that are good customers of the lab/vendor.
A STRUCTURED APPROACH
Structured mentoring involves a curriculum created for training and an appointed mentor (trainer/ supervisor). The Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) has such a program for ophthalmic techs. This program has three levels: • Certified Ophthalmic Assistant, an entry level core designation that confirms an assistant’s knowledge in 19 specific content areas. • Certified Ophthalmic Technician, the second core designation level confirming knowledge in 19 specific content areas specifically designed to test the Certified
14 F e br ua r y 2 0 1 8 | O p to m e tri c O f f i c e .c o m
OO-02FEB18-FINAL.indd 14
1/19/18 4:12 PM
Ophthalmic Assistant or program graduate who intends to advance their career in the eyecare field. • Certified Ophthalmic Medical Technologist, a designation that recognizes those individuals who have progressed through the COA and COT levels or are training program graduates as accomplished eyecare professionals. The COMT designation confirms knowledge in 17 content areas that the ophthalmic professional seeking the COMT designation performs on a daily basis. For each level, there’s a curricular workbook and a checklist of tasks that must be done to the doctor’s satisfaction over a specified period of time. There’s a similar program for optometric techs and opticians. Although techs do not have to be certified, anyone who wishes to demonstrate their knowledge and skills in the ophthalmic tech world may enroll in the JCAHPO program. More information on the examinations, required coursework, required work experience and specific tasks can be found on the JCAHPO website. The American Optometric Association has a similar training program for paraoptometric techs. It also has three levels: • Certified Paraoptometric (CPO), who demonstrates an understanding of the concepts used in optometric care • Certified
Paraoptometric Assistant (CPOA), who demon-
strates the ability to apply the concepts used in optometric care. • Certified
Paraoptometric Technician (CPOT), who demon-
strates the ability to understand, apply, and interrelate the concepts used in optometric care.
• P a r a o p t o m e t r i c Coding Certification (CPOC), demonstrating proficiency, expertise, and validating superior knowledge in an optometric coding environment. While no mentor is required for paraoptometric certification, it’s reasonable to assume that nearly everyone will want to have a designated supervisor and trainer because the material can get pretty rigorous. You’ll find requirements for each certification, a self-study course, sample tests and a host of other preparation resources on the American Optometric Association (AOA) Paraoptometric website.
SYSTEM FOR OPTICIANS
Opticians also have a structured system. The American Board of Opticianry certifies opticians at three levels, ABOC (Certified), ABOC-AC (Advanced Certified) and ABOM (Masters in Ophthalmic Optics). There is no work experience requirement for the ABOC level; anyone 18 or older may take it at any time. For the ABOC-AC, you’ll need to hold an ABOC and have taken a select number of courses to take this test. Once you’ve received your ABOC-AC, you can apply for the Masters level. A research paper on a topic approved
by the Board provides access to this level. The National Contact Lens Examiners (NCLE) has a similar process for contact lens fitters. The National Academy of Opticianry created the Career Progression Program in the 1980s. This self-study program attempts to provide a full spectrum of information to help applicants prepare in a self-study way. The program requires an on-site mentor for the student. The Academy also produces a variety of study materials. The Contact Lens Society of America (CLSA) has similar materials for contact lens trainees.
INVALUABLE RESOURCES
These programs can be invaluable resources when training a new or current staff member. They have all been constructed by knowledgeable professionals and have withstood the test of time for their relevance. Consider using one of them for your training needs. Every office needs to have a good idea of how it is going to train new employees before they need to provide that training. Hiring someone without knowing how that person will be trained is not a good strategy. Invest time up front to determine the training options you have and which one is best suited to your potential needs so that you’ll be ready when the time comes. O|O Ed De Gennaro, MEd, ABOM, is editor emeritus of First Vision Media Group.
TRAINING PROGRAMS American Board of Opticianry/National Contact Lens Examiners: ABO-NCLE.org American Optometric Association, Paraoptometric Center: AOA.org/Paraoptometrics Contact Lens Society of America: CLSA.info Joint Commission on Allied Health Personnel in Ophthalmology: JCAHPO.org/Certification-Recertification National Academy of Opticianry: NAO.org/CCP
O p tometr ic O ffic e. c om | Fe bruary 2018 15
OO-02FEB18-FINAL.indd 15
1/19/18 4:40 PM
*
THINK ABOUT YOUR EYES
GIVE PATIENTS THE GIFT OF SIGHT Today’s average consumer is inundated with advertisements, reminders and suggestions for “lifehacks” to simplify everyday tasks. It seems like the last thing the public needs is another “to-do” on the list. However, these same people confess to being worried about their vision health and consider it a priority. Indeed, 56% of adults recently surveyed by Think About Your Eyes (TAYE) say they should visit the eye doctor more.
NEW CAMPAIGN
In 2017, TAYE launched “Seeing is a Gift,” a campaign to celebrate the gift of sight and all it allows us to experience. Our mission: to continue reminding the public of the importance of sight and to schedule an annual eye exam.
Jon Torrey
Our doctor locator currently lists more than 19,000 practices, so patients are very likely to find practices near them. For many practices, a patient can book an appointment directly through our doctor locator or call the office from the mobile site. Simplifying the task of booking this annual health check-up makes this much more likely to occur.
Jon Torrey is the executive director of Think About Your Eyes. First Vision Media Group is a Think About Your Eyes media partner.
We find consumers where they spend most of their time: online, on their phones, in their cars and on their favorite TV channels. We spread our messaging through online ads, streaming radio and cable TV. Our Facebook page currently has more than 50,000 likes and reached more than five million people in 2017. Our campaign and message was mentioned in USA Today, Sirius XM radio and ReadersDigest.com.
The campaign could do so much more with more support and funding. And, it could continue to move the needle on eye exam rates, making an eye exam as routine as a dental check-up.
We’re reaching consumers with our message everywhere they turn. And it’s working; more than 1 million exams in 2016 are the result of TAYE advertising.
MORE WORK NEEDED
There’s still work to be done. Currently, 41 state optometric associations support the campaign and place their members on our doctor locator. Is your state one of them? The campaign is funded by 24 ophthalmic companies, few of whom benefit from TAYE advertising. Still, the campaign could do so much more with more support and funding. And, it could continue to move the needle on eye exam rates, mak-
ing an eye exam as routine as a dental check-up. So what can you do? If you’re a doctor with a locator listing, make sure the information is still correct. Consider upgrading to premium level to gain additional features, such as an appointment-booking button, space for a photo and preferential placement. If you have a social media page, consider sharing Think About Your Eyes posts. And, as always, let us know what you think of the campaign, when you see or hear a commercial, and any ideas you have. Let’s make 2018 a landmark year for Think About Your Eyes. O|O
16 F e br ua r y 20 1 8 | O p to m e tri c O f f i c e .c o m
OO-02FEB18-FINAL.indd 16
1/19/18 4:12 PM
8.4 base curve now available!
Hello Miru.
Bye, bye blister pack. Introducing Miru 1day, the world’s thinnest package for daily disposable contact lenses. Miru’s ultra lightweight 1mm thin package is about 1/8th the thickness of a traditional blister pack and was specifically developed to reduce the risk of microbial contamination. When opened, the lens is presented on a special disk, oriented correctly for proper insertion. To learn more, please visit: www.meniconamerica.com Š2018 Menicon America, Inc. Miru is a registered trademark of Menicon Company Ltd.
Untitled-1 1
1/18/18 11:26 AM
For dad For mom For the whole family From premium lenses and designer frames to prescription sunwear or an annual supply of contact lenses — families need eyewear that fit a wide range of activities in their lifestyle. You can help make it easier for them to purchase all the products they want right from your practice with promotional financing options* available through the CareCredit credit card. Visit booth #1600 at SECO. Or call for more information and enroll at no cost today^.
866.853.8432
www.carecredit.com
visioninfo@carecredit.com
* Subject to credit approval. Minimum monthly payments required. See carecredit.com for details. ^ Subject to change. OO0218OA
Untitled-6 1
1/19/18 4:15 PM