Optometric Office November 2018

OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

NOVEMBER 2018

ONE-TO-ONE:

CONTACT LENSES:

INSTRUMENTS:

SUSAN DANIEL, OD, ON NEURO-OPTOMETRY

PRESBYOPIC LENS FOR MYOPIC KIDS

DOCS SPEAK OUT ON BUYING EQUIPMENT

WALKING A FINE LINE | TOWARD EFFICIENCY USE TECHNOLOGY TO YOUR ADVANTAGE SUPPLEMENT TO VCPN NOVEMBER 2018

Healthy Eyes Start with Healthy Eyelids The root cause of anterior blepharitis is the overproduction of oils. Surfactants in OCuSOFT® Lid Scrub® Eyelid Cleanser dissolve and remove oil, debris and desquamated skin. When the most severe conditions occur, the combination of OCuSOFT® Lid Scrub® and OCuSOFT® HypoChlor® (0.02% Hypochlorous acid) is ideal.

To achieve optimum results, CLEAN all oil, debris and other contaminants associated with eyelid irritations using OCuSOFT® Lid Scrub® Eyelid Cleanser and then SPRAY OCuSOFT® HypoChlor® for fast action against microorganisms.

Clean ‘n Spray™ For more information and to order, call (800) 233-5469 or visit www.ocusoft.com © 2018 OCuSOFT Inc., Rosenberg, TX 77471

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OPTOMETRIC OFFICE EDITORIAL STAFF VP, Editorial John Sailer | JSailer@ FVMG.com Editor-in-Chief Jeffrey Eisenberg | JEisenberg@FVMG.com

Table of Contents 6

Editor Cara Aidone Huzinec | CHuzinec@FVMG.com Creative Director Megan LaSalla | MLaSalla@FVMG.com Production and Web Manager Anthony Floreno | AFloreno@FVMG.com Contributing Writers Sharokh Kapadia, OD, FAAO Steve Loomis, OD

BUSINESS STAFF President/Publisher Terry Tanker | TTanker@FVMG.com Executive Vice President Shawn Mery | SMery@FVMG.com Vice President, Marketing Debby Corriveau | DCorriveau@FVMG.com Regional Sales Manager Eric Hagerman | EHagerman@FVMG.com

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

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

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

DEPARTMENTS

8

2 | Views

15

3 | One-to-One: Susan Daniel, OD 4 | Think About Your Eyes: The Future is Bright 6 | Product Buzz 12 | At-A-Glance: Contact Lens Care Products 15 | New Product Gallery

FEATURES 8 | INSTRUMENTS: Docs Speak Out: Equipment Purchases 10 | PATIENT CARE: Improving Office Efficiency 14 | CONTACT LENSES: Using NaturalVue Multifocal for Myopia Control

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

VIEWS

Jeffrey Eisenberg

THE GOOD NEWS:

YOUR PATIENTS NEED YOU There are often stories about machines doing jobs once done solely by human beings. Robots have taken over certain jobs in the manufacturing arena. Computer programs can write articles (though I like to think not as good as humans). The web and various apps claim to provide eye exams. So, does this mean patients will look for automated procedures and place a lower value on the care you deliver in your offices?

The good news, however, is that this seems less likely than you might expect. Advances in technology don’t replace the doctor patient relationship. They enhance it, and patients still value their in-person experience. This is according to findings from CooperVision’s Best Practices EYEdea Lab. A panel at the Global Contact Lens Forum at Vision Expo West presented findings from the inaugural EYEdea Lab, which combined qualitative research on the floor of Optometry’s Meeting in June with follow-on quantitative research among consumers and ECPs. When asked which sources they most trust to recommend and explain the best options for their eye health and vision correction needs, the overwhelming majority (87%) of consumer respondents selected their ECPs, not online medical sites and news reports. Also, the research found that they choose to visit their practices for something different than what’s available online, meaning you don’t have to try to duplicate what’s advertised on the web.

Still, technology is important. Quantitative survey results showed that 92% of ECPs believe that their patients perceive more value when there is more technology incorporated into the exam process, but 82% of ECPs consider online refraction a threat to their practices. However, 66% of

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consumers surveyed believe online testing is less accurate, and 20% are unsure.

The other thing about technology, as Sharokh Kapadia, OD, FAAO, tells us in this month’s cover story, is it lets you practice more efficiently without sacrificing patient care or even interaction with your patient.

GOOD-BYE TO A FAVORITE UNCLE Last month, Frank Fontana, OD, better known as “Uncle Frank,” passed away at age 96. By now, you’ve no doubt read about his many accomplishments. He served in the army during World War II, opened an optometric practice (and practiced into his 90s), founded the American Optometric Association’s Contact Lens & Cornea Section, co-founded the Heart of America Contact Lens Society, served on various AOA committees, consulted, and lectured, received various honors … the list goes on.

He was also a husband, father, grandfather and great grandfather—and, of course, everbody’s uncle. In 1993, when I heard a colleague talking to “Uncle Frank,” I then learned that Uncle Frank was actually an optometrist in St. Louis and that we were all his nieces and nephews.

Sure enough, when I met him a few months later, he immediately told me to call him Uncle Frank. It was official; I was his nephew. He not only mentored many ODs but a newbie optometric editor who was trying to understand the world of eyecare, especially contact lenses. I could always count on Uncle Frank to explain things to me, to point out up-andcoming ODs, and to steer me to the right resources in industry.

Most of all, though, seeing him became a favorite part of every optometric conference I attended. His energy exceeded that of many younger people. He was in his element as an emcee on the exhibit hall floor. He told great stories. And, he had a kind word to say about pretty much anybody. He was just a kind person in general.

Optometric Office extends condolences to his immediate family and to his many nieces and nephews for their loss. Rest in piece, amico. *** Jeffrey Eisenberg | Editor-In-Chief | JEisenberg@FVMG.com

JE: Can you further explain the concept of neuro-optometric rehabilitation?

SD: Neuro-optometric rehabilitation is an individualized treatment regimen for patients with visual deficits as a direct result of physical disabilities, TBI and other neurological insults. In addition to visual issues, a neurooptometric rehabilitation optometrist examines other subtle factors involved in the complex visual process, such as posture, spatial awareness, visual memory and motor output—all areas that can have wide-ranging effects on daily activities and quality of life.

Clinical experience and research studies have documented the improved performance of patients who have completed a vision rehabilitation program.

ONE-TO-ONE

Susan Daniel, OD

Susan Daniel, OD, is the president of the Neuro-Optometric Rehabilitation Association (NORA). Daniel is in private practice with her husband, Christopher Davis, OD, in Carlsbad, CA. She also serves as a consultant for the North Coastal Consortium for Special Education and the Tri-City Medical Center Acute Rehabilitation Services in the visual rehabilitation treatment for brain-injured patients and stroke victims.

Jeffrey Eisenberg: Can you describe the Neuro-Optometric Rehabilitation Association, International, and explain how it has evolved in these last 27 years?

Susan Daniel, OD: NORA is an interdisciplinary group of professionals dedicated to providing patients who have physical or cognitive disabilities as a result of an acquired brain injury with a complete ocular health evaluation and optimum visual rehabilitation education and services to improve their quality of life.

NORA’s origin can be traced back to 1990, when a small group of optometrists met in Chicago to share their experiences in diagnosing and treating patients with neurological/ cognitive injuries and disabilities.

Over the years, our mission has focused on advancing public and professional knowledge and understanding of neurooptometric care and encouraging an interdisciplinary team approach among all professionals who provide rehabilitative services to individuals who have suffered a traumatic brain injury (TBI).

JE: Besides optometrists, what other types of professionals are part of NORA, and how do the professions work together to care for patients?

SD: An interdisciplinary, integrated team approach can play a vital role in the rehabilitation of patients with concussions, stroke or other neurological deficits. Neuro-optometric rehabilitation optometrists regularly work with physical and occupational therapists, vision therapists, speech-language pathologists, physical medicine and rehab physicians, neurologists, ophthalmologists and others involved in treating individuals with physical disabilities or TBI to ensure patients get the care they need.

JE: How great a need is there for neuro-optometric rehabilitation?

SD: An estimated 1.7 million people in the United States sustain a TBI each year. About 75% of them are the result of concussions or other forms of mild TBI. Studies show that at least 50% of patients with TBI suffer from visual dysfunctions, with one such study finding a 90% incidence of post-trauma visual complications. About two-thirds of stroke survivors have visual impairment that typically relates to diminished central or peripheral vision, eye movement abnormalities or visual perceptual defects.

JE: How can ODs develop a specialty in neuro-optometric rehabilitation?

SD: Optometrists skilled in neuro-optometric rehabilitation therapy have pursued extended education and training.

NORA’s clinical skills/fellowship program was developed to provide professionals with the highest level of clinical abilities and scientific knowledge in the field of neurooptometric rehabilitation. This process leads to a fellowship within NORA. Information about the program and its requirements can be found on our website at NORAVisionRehab.org. The NORA website also features information about brain injuries and vision for patients and caregivers as well as ODs and other health professionals, including downloadable educational resources.

For the complete interview, go to OptometricOffice.com.

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THINK ABOUT YOUR EYES

THE FUTURE IS

BRIGHT This year marked the 10th year since the initial inception of Think About Your Eyes and five years since the campaign’s national launch. In that time, the campaign has grown tremendously to become the campaign supporting the entire eyecare profession and ophthalmic industry by encouraging the public to get an annual eye exam.

SIGNIFICANT IMPACT

The impact of Think About Your Eyes is significant. This year alone, 95% of the target audience was exposed to Think About Your Eyes advertising through TV commercials, radio ads, online banner ads and paid searches. In 2017, the efforts resulted in 3.4 million eye exams, with estimated industry revenue of more than $750 million from exam fees and follow-on purchases.

Last year also saw the first new creative elements to the campaign since 2008. There were new commercials themed around “Seeing is a Gift,” celebrating the inspirational aspect of sight.

Forty-five state optometric associations currently support the campaign, resulting in more than 20,000 listings on the TAYE online locator (ThinkAboutYourEyes.com). This means that patients around the country are likely to find an eye doctor near them after being directed to the TAYE website through an ad, article or social media post.

INDUSTRY PARTNERS

Today, 93% of the campaign’s funding comes from 21 industry partners. These partners essentially are shouldering the financial cost of something that helps the whole industry.

By having additional partners supporting the campaign, we can reach more people more often with the TAYE message.

We can air more commercials on the most-watched TV shows and channels, more radio ads, and more media relations efforts to keep the message about annual eye exams

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Steve Loomis, OD

Steve Loomis, OD, is past president of the American Optometric Association and outgoing chairman of Think About Your Eyes. He practices in Littleton, CO. First Vision Media Group is a media partner of Think About Your Eyes. in the news. The result: more visitors to the doctor locator through paid search and more people being exposed to TAYE Facebook posts and becoming invested in their vision health.

The 2018 partners are: American Optometric Association, The Vision Council, Alcon, Essilor, Johnson & Johnson Vision, Luxottica, All About Vision, Compliancy Group, Eschenbach, First Vision Media Group, GUNNAR, Hilco Vision, Jobson Media Group, National Vision, Optolec, Shamir, SpecialEyes, Transitions, Vision Expo, Walman, and WestGroupe.

AN EXCITING PROSPECT

TAYE will continue to have significant impact on American’s eyes and lives, and we’re excited about that prospect. When additional support is provided from industry players who have yet to take advantage of the opportunity, I can only imagine the lives we will enhance. I can’t stress enough the opportunity before us today for industry and our profession to join together to make a real difference in improved healthcare and industry. O|O

WORLD S I

G LEN E AL

T DAY CH H G

A child should never be limited by poor vision Help a child to see.

Take the Challenge DONATE today Every $100 can provide eye care for up to 20 children!

To learn more or to donate today visit givingsight.org or call 303-526-0430

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

J&J LAUNCHES MYACUVUE SUBSCRIPTION PROGRAM

Johnson & Johnson Vision developed its new MyACUVUE Subscription Program to provide contact lens wearers with greater access and convenience when purchasing an annual supply of ACUVUE Brand contact lenses. Following a comprehensive eye exam and contact lens fitting with an ECP, patients can purchase an annual supply of lenses while in the doctor’s office. They can use MyACUVUE Rewards for savings or spread out the cost of an annual supply into affordable payments with MyACUVUE Subscription.

Orders through MyACUVUE Subscription Program are placed through the ECP’s practice and shipped directly from J&J. There are no fees for ECPs to participate, and ECPs set pricing for their patients.

Shipping is free, and the program will allow for contact lens wearers to use their full insurance benefit.

Go to JJVision.com.

COOPERVISION WEB TRAINING TEACHES HOW TO UPGRADE

CooperVision’s new web-based training and on-demand webinar focus

on teaching ECPs and staff how to successfully upgrade monthly and two-week contact lens wearers to benefit patients’ health and wearing experience and increase practice growth. The module, “Upgrade Your Monthly/2-Week Contact Lens Patients to SiHy 1-Day Lenses,” walks you through the five stages of a patient interaction with an eyecare practice, identifying opportunities to educate that patient about the benefits of silicone hydrogel one-day contact lenses.

In other news from CooperVision, the company has launched its fourth annual search for the nation’s “Best Practices.” Applications will be accepted through November 21, 2018, and will be reviewed by a panel of judges, including past Best Practices honorees, industry experts, and CooperVision leaders. The 2019 Best Practices will be announced early next year.

For information about the web-based training go to Learning.CooperVision. com. To apply for Best Practices, go to EyeCareBestPractices.com/applying.

go backstage at New York Fashion Week. Individuals who want to be Alcon’s guest need to follow @AIROPTIXCOLORS on Instagram, snap a photo while wearing AIR OPTIX COLORS contact lenses and post the photo on Instagram with two hashtags: #Sweepstakes and #ReadyToPlay. In addition, Alcon has enlisted Laura Sanchez and Raye Boyce, two social media influencers, to spread the word about the AIR OPTIX COLORS sweepstakes.

Go to AirOptixColors.com.

UPRISE, GLIMPSE OFFER PERFORMANCE DASHBOARDS

Uprise by VisionWeb, a cloudbased practice management and electronic health records (EHR) system designed for optometrists, integrated with Glimpse, a healthcare analytics provider acquired by ABB OPTICAL GROUP earlier this year, to offer ECPs performance dashboards that measure business success and help improve growth.

Glimpse securely integrates with EHR and practice-management systems to provide in-depth analytics, live benchmarking, employee productivity tracking, monthly SWOT reports and daily metrics in an easyto-understand, snapshot format.

Go to GlimpseLive.com.

ESSILOR LAUNCHES MYOPIA CAMPAIGN ALCON SWEEPSTAKES TAKES PATIENTS TO FASHION WEEK

Alcon is inviting individuals to play with their eye color as part of the AIR OPTIX COLORS contact lenses sweepstakes for a chance to

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Nearly half the children who have myopia experience difficulty in the classroom, but only 41% of parents noticed their children were struggling with myopia, according to research of more than 1,000 parents of children

ages 7 to 17 who have myopia and more than 600 children who have myopia.

The survey, conducted by MetrixLab on behalf of Essilor of America, also found that 41% of parents of myopic children claim their children struggle with everyday activities, 35% of myopic children say they do not enjoy school and 38% of parents of myopic children say their children have difficulty playing sports The Essilor Group launched an integrated campaign aimed at consumers and ECPs to educate them about the increasing prevalence of myopia.

Essilor also is using social media and trade media and partnering with ophthalmic thought leaders to create a recommended path to becoming a myopia expert. Go to EssilorUSA.com.

COMPULINK SOFTWARE USES ARTIFICIAL INTELLIGENCE

Compulink Healthcare Solutions demonstrated Advantage SMART Practice, the latest enhancement to its Eyecare Advantage software at Vision Expo West. Advantage SMART Practice uses artificial intelligence technology and real-time data from the clinic to completely automate tasks and improve patient flow. Enhancements include: • Advantage SMART Workflow, which automatically displays the patient’s record when needed and lets you know which patients are waiting and where to go next.

• SMART Automated Billing, Eligibility and ERA Posting, a task automation engine that lets you schedule eligibility, claims submission and remittance posting to run unattended.

• Advantage SMART Patient Engagement, which automatically communicates personalized content directly to the patient’s mobile device.

Go to CompulinkAdvantage.com.

News Davis Corley, a co-founder and president of neurolens, has been named chief executive officer.

scleral contact lens through the

Carol Alexander, OD, has been appointed Head, North America Vision Care Professional Relations for Johnson & Johnson Vision, with a focus on partnering with national optometric associations and organizations to advance eye health and patient care and to continue supporting J&J’s advocacy efforts.

510(k) clearance from the FDA for

Jonathan Mish has joined ABB OPTICAL GROUP as chief information officer, responsible for overseeing the company’s information technology department.

Think About Your Eyes has hired Jane Balek, who has more than 20 years of experience at nonprofits, as executive director.

Prevent Blindness has chosen Glenn Ellisor, OD, executive chairman and founder of Vision Source, and Jim Greenwood, president and CEO of Vision Source, as the recipients of the 2019 Prevent Blindness Persons of Vision Award.

Canadian scientist Dr. Andras Nagy, senior investigator at Mount Sinai’s Lunenfeld-Tanenbaum Research Institute, is the inaugural recipient of the Cedric Ritchie Fund to Cure Blindness, a $1.5 million initiative made possible by the Foundation Fighting Blindness.

company’s strategic partnership with Contamac, which received Optimum Extra and Optimum Extreme contact lens materials to treat dry eye conditions.

Eyevance Pharmaceuticals announced a worldwide licensing agreement with OcuNexus Therapeutics for NEXAGON, which is being developed for persistent corneal epithelial defects that are nonresponsive to standard-of-care treatment.

Web Vision Technologies is working closely with National Aeronautical Space Administration (NASA) to develop an “All-in-One” vision testing (diagnostic) device that can be deployed on spacecraft to do comprehensive vision testing and evaluation, and to guide medical interventions of astronauts experiencing vision problems on future long-duration, deep space missions.

20/20NOW recently announced its use of artificial intelligence to enhance retinal images, allowing for the early detection of retinal disease such as diabetic retinopathy.

EyePoint Pharmaceuticals, Inc.

SynergEyes, Inc. now offers its Tangible Hydra-PEG coating Duette and UltraHealth hybrid lenses to ECPs in Canada.

has received FDA approval for YUTIQ

TruForm Optics announced the therapeutic use of its DigiForm

fecting the posterior segment of

(fluocinolone acetonide intravitreal implant) for the treatment of chronic non-infectious uveitis afthe eye.

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INSTRUMENTS

DOCS | SPEAK OUT Eq u i p m e n t P ur c has es

With Vision Expo West and the American Academy of Optometry meeting behind, you’ve no doubt been hearing about and seeing the latest advances in ophthalmic technology. At the same time, you might be doing your year-end tax planning.

One consideration, for example: The Tax Cuts and Jobs Act of 2017 expanded Section 179 of the tax code, allowing you to deduct the full purchase price of qualifying equipment and software. In this month’s “Docs Speak Out” survey, we ask ODs about their equipment purchasing decisions.

If you could buy/receive any one piece of equipment, what would it be and why?

“OCT. It gives the most objective clinically useful information for disease diagnosis, monitoring and treatment.”

“Anterior segment camera. I see so many eyelid and anterior segment lesions that would be great to quickly document and monitor. Pictures are always better than my drawings or descriptions.”

“YAG laser.”

“Edger. Just don’t understand why they cost so much.”

“OCT with angiography technology.

Cutting edge. Better for treating AMD and diabetic changes in retina.”

“I am already upgrading my OCT, so in addition, I would purchase a digital phoroptor.”

“Vision therapy technology because we have VT/Rehab practice.”

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“Digital refactor. Speed and accuracy.”

“OCT because of technological advances in diagnostic ability. Too expensive, though.”

“Computerized/digital refraction system.

To have the latest in state-of-the-art equipment.”

“Combo auto-K-ref that does some meibomian gland imaging. Need the K’s and refraction info. Would appreciate the gland images.”

“Camera (anterior and posterior) to better follow conditions and discuss with patients about their conditions.”

“Automated lensometer to speed up pretesting.”

“Optos. Need a good accessible imaging device for primary care and diabetic imaging.”

“Autorefractor. Never had one and never used it yet. But I have every other equipment except that and the Optos. I have two fundus cameras, including the Eidon, which has better resolution than the Optos but small field.”

“Have all I want for now.”

What are the two most important factors in your decision to purchase a particular piece of equipment?

“Is it beneficial to the patient? Is it beneficial to the practice?”

“Cost and reimbursement.”

“ROI and tax advantages.”

“Quality and reliability. Ability to generate results or capital.”

“Cost and ability to bill for.”

“Can it provide more information or can it do something better than what I currently have?”

“How does it improve patient care? What is cost/benefit ratio? Can I pay for it in a reasonable time with patient fees?”

Do you prefer to purchase or lease new instruments?

“Reliability and ease of use.”

“Price. Quality.”

“Cost/benefit. Do I have enough cash to pay for it?”

“Practice need for delivering patient care is primary. Disease state detection and monitoring.”

“Will it help me provide better care to my patients? Will it pay for itself, either in additional reimbursements or improved efficiency?”

“Quality equipment: Useful in diagnosis, appealing aesthetically to patients with high-tech appearance, value to practice and, of course, ease of use requiring minimal staff time or learning process and durability. I like things to last at least five years or more.”

It depends on the particular piece of equipment I haven’t considered this

26% 7

%

PURCHASE

57%

10%

LEASE

Do you prefer to purchase or lease new instruments?

O p tometr ic O ffic e. c om | November 2018 9

PATIENT CARE

WALKING A FINE LINE |

TOWARD EFFICIENCY

By using technology to our advantage, we can see more patients without sacrificing care.

By Sharo kh Kapadia, OD , FAAO Many of us find ourselves walking a fine line as far as how many patients we see each day and for how long.

Consider: To compensate for reduced reimbursements from managed-care plans, we want to be more efficient so that we can see more patients to make up for lost revenues. Also, I’ve found that many of my patients, who have busy schedules themselves, don’t want to be in the office for more than one hour. But, if you trim the exam time too much, patients may start to feel as though they aren’t getting the care they deserve.

My associates and I try to perform 18 complete exams a day as well as see patients whose visit is for a specific issue or a contact lens check. That means we had to become more efficient. Fortunately, technology has enabled us to do so in several ways.

AUTOMATED REFRACTION

In my practice, we use the CV-5000S Computerized Vision Tester (shown above) from Topcon Medical Systems to perform refractions.

The CV-5000S provides a complete 21-point refraction and includes such features as a high-speed fully enclosed lens chamber, a one-dial controller with color 10.4-inch LCD touch screen, simultaneous colorcoded cross cylinder and up to five user-defined personalized refraction programs to ensure ease of use. Also, Topcon and M&S Technologies embedded M&S Smart System charts and tests, including LEA SYMBOLS, color testing and sine wave.

Some major advantages I’ve found when using this system: The lens disc rotation speed is more rapid with the CV-5000S than with manual

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phoropters. The CV-5000S shows the patient’s current prescription and the recommended one side by side, saving us from having to repeatedly ask, “Which is better: one or two?” Also, the exam results go directly into the patient’s electronic health record, reducing the risk of transcription errors.

Overall, we’ve found that automated refraction shaves the exam time by about four minutes, which adds up over the course of the day.

One note: While I try to delegate many tasks to my technicians, refraction isn’t one of them. As optometrists, this is an important skill that we bring to the exam room, and I believe there’s an art associated with refracting patients.

practice has used electronic health records since we opened in May 2003; we use Revolution EHR. That way, we can converse with our patients without having to constantly turn away to enter information into the computer. (An additional advantage: Revolution EHR allows us to link both our offices together in the cloud.)

DIAGNOSTIC TECHNOLOGY PAGING SYSTEM

We use the Optometry/Ophthalmology Office Paging Software from Comlite Systems, which tells us where patients are and which room the doctor needs to go to next.

The Comlite software uses light buttons and audible chimes to show which exam room patients are in and what tasks need to be done. The Comlite system lets you view eight messages at a glance, and dropdown messages are available. In the image shown above, for example, the screen to the left shows that doctor 1 (the white DR 1 button) has a patient waiting up front, is in exam room 1 (the red light on the Ex 1 button) and has a patient waiting in exam room 4 (the green light on the Ex 4 button).

Doctor 1 has paged a tech to exam room (the red light on the white tech button).

Doctor 2, meanwhile, has three patients (the red light on the blue DR 2 button) waiting up front, is in exam room 2 with a patient (the red light on the blue Ex 2 button) and has paged an optician to exam room 2 (the blue OPT button with a red light). Dr. 2 also has a patient who is dilating and is in the dispensary.

We use diagnostic technology to provide optimal patient care without sacrificing efficiency. (We charge a nominal annual technology fee but incorporate these instruments in the patients prescreening.) Some examples: • Optical coherence tomography.

Since 2009, we have offered optical coherence tomography at each location, using the CIRRUS 5000 HD-OCT from Zeiss at one office and Topcon’s 3-D OCT Maestro at the other. We do retinal imaging on every patient, particularly those older than 40. For example, I recently saw a patient in his late 70s who had not had an eye exam in 10 years. With the OCT images in hand at the start of the exam, I could already tell that he had glaucoma—which I found saved time rather than order OCT after the exam.

• Meibography. We take a similar approach with our dry eye patients.

We use Johnson & Johnson’s

Besides delegating testing, we use scribes in the exam room. Our

• Retinal photography. We use Daytona ultra-widefield imaging from Optos, Inc. at one of our offices. This allows us to capture a 200° view, or 82% of the retina, in a single, high-resolution optomap image. Besides the time savings, it’s easy for the patient, as there is no flash of light.

In addition to these, we use largescreen televisions in the room so that we can show patients images as part of our patient education rather than have them look at the computer monitor. All these devices have indeed made that fine line easier to walk. O|O

Sharokh Kapadia, OD, FAAO, graduated from Michigan College of Optometry and did a residency in ocular disease at Bascom Palmer Eye Institute.

He is in private practice in the Greater Jacksonville, FL, area.

WHERE TO FIND IT Carl Zeiss 1 (800) 341-6968 | Zeiss.com Comlite Systems 800.426.5271 | ComliteInfo.com Johnson & Johnson Vision 800.843.2020 | JJVIsion.com

SCRIBES

Other than refraction, we delegate many tasks to our technicians, allowing the doctor to focus on providing good care for our patients.

LipiView II Ocular Surface Interferometer with Dynamic Meibomian Imaging at each location and test patients who are contact lens wearers or who have a score of six or higher on the Standardized Patient Evaluation of Eye Dryness, or SPEED.

Optos, Inc. 800.854.3039 | Optos.com A large screen television on the wall helps us educate patients without them having to look at a computer screen.

RevolutionEHR 877.738.3471 | RevolutionEHR.com Topcon Medical Systems, Inc. 800.223.1130 | TopconMedical.com

tometr ic O ffic e. c om | Nove mber 2018 11 OOpptom

AT-A- GLANCE

CONTACT LENS CARE PRODUCTS SOLUTION

TYPE

INDICATION

CARE REGIMEN

Alcon Laboratories | 800.451.3937 | Alcon.com CLEAR CARE 3% hydrogen soft contact lenses, PLUS with peroxide including silicone HydraGlyde solution hydrogel lenses; Moisture Matrix rigid gas permeable contact lenses

OPTI-FREE PUREMOIST

multipurpose solution

1. Place lenses into domed lens holder, and thoroughly rinse with solution for five seconds.

2. Fill the lens cup to the fill line with solution, place the lens holder in the lens cup, and store lenses for at least six hours to neutralize the solution. Do not shake the lens case.

3. Discard used solution, rinse the lens cup and lens holder with sterile saline or fresh CLEAR CARE PLUS, and allow to air dry cap side down. silicone hydrogel and 1. Wet lenses with solution and rub for soft lenses 20 seconds.

2. Rinse each side of the lens for 10 seconds with a steady stream of the solution.

3. Store lenses in the solution for at least six hours. Rinse any remaining debris with solution.

BENEFITS • Biocompatible deep cleaning and disinfection • Triple action cleaning: deep cleans, loosens dirt and enhances protein removal • Preservative-free

• Contains HydraGlyde Moisture Matrix for comfort and to help keep moisture on the lenses • The POLYQUAD and ALDOX dual-disinfectant system reduces harmful microorganisms • Reduces lipid deposition and removes protein deposits for fresh, clean lenses

Bausch + Lomb | 800.828.9030 | Bausch.com multipurpose solution

soft contact lenses, including silicone hydrogel lenses

1. Place at least three drops of solution on each side of lens surface and gently rub for 20 seconds.

2. Thoroughly rinse each side of the lens for five seconds, place in case and fill with fresh solution and soak for at least four hours. Discard solution from lens case after each use.

3. Rinse any remaining debris on lenses with solution prior to insertion.

renu Advanced multipurpose Formula solution

soft contact lenses, including silicone hydrogel lenses

1. Place three drops of solution on each • Unique triple disinfectant system kills side of the lens surface and gently rub 99.9% of germs for 20 seconds.

• Helps prevent the formation of deposits on 2. Thoroughly rinse each side of the lens lenses when used daily for five seconds, then place in the lens • Provides all day comfort case and fill with solution.

3. Soak at least four hours. Discard solution from lens case after each use.

4. If any debris remains on contact lenses, rinse with renu Advanced Formula.

Biotrue

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• Contains hyaluronan, a lubricant found naturally in eyes • Matches the pH of healthy tears • Keeps certain beneficial tear proteins active • Up to 20 hours of moisture • Kills 99.9% of germs

SOLUTION

TYPE

INDICATION

CARE REGIMEN

BENEFITS

CooperVision | 800.341.2020 | CooperVision.com Lite multipurpose suitable for all lens 1. Place three drops of multipurpose • Specially formulated for patients with types solution solution on each side of the lens. sensitive eyes

3% hydrogen Refine One Step Hydrogen peroxide solution Peroxide Solution

soft contact lenses

2. Gently rub both sides of the lens with • Contains a lubricant to help prevent the tip of the forefinger for 10 seconds. contact lenses from drying out 3. Thoroughly rinse each side of the lens for five seconds with fresh solution.

4. Fill the lens case with fresh solution and let lenses soak at least six hours.

Rinse each side of the lens with fresh multipurpose solution prior to insertion.

5. Discard remaining solution, rinse the lens case thoroughly with fresh solution and let air dry.

1. Place lenses in basket, close and rinse • Highly effective disinfection against each lens for five seconds with the bacteria and fungi solution.

• Preservative-free 2. Fill the lens case with fresh solution, place the lens holder inside the lens case, make sure the lens case is in an upright position and allow lenses to soak for at least six hours.

3. Discard remaining solution and leave lens case open to air dry.

Johnson & Johnson Vision. | 800.843.2020 | JNJVisionPro.com

Blink Revitalens

multipurpose disinfecting solution

soft (hydrophilic) contact lenses, including silicone hydrogel lenses

1. Place three or more drops of solution • Provides exceptional disinfection and all-day on one side of lens surface, rub lens for comfort two to four seconds, turn the lens over • Disinfects like a peroxide with the simplicity and repeat. of an advanced multi-purpose solution 2. Rinse each side of the lens for five • Dual-Disinfecting Technology effectively seconds with solution. kills harmful bacteria 3. Allow lenses to soak for at least six hours.

COMPLETE

multipurpose solution

soft (hydrophilic) contact lenses

Oxysept Disinfecting Solution/ Neutralizer Ultracare Formula

3% hydrogen peroxide solution

Soft contact lenses

1. Place three drops or more of solution on one side of the lens surface. Rub lenses gently for at least 10 seconds, then turn over and repeat.

2. Rinse each side of the lens for five seconds with fresh solution, place in lens case and fill with solution.

3. Allow lenses to soak for a minimum of six hours.

1. Gently rub each lens with an appropriate daily cleaner, rinse thoroughly with sterile saline, and place in the lens holder.

2. Fill the cup with disinfecting solution, drop one neutralizing tablet into the solution, and place the lens holder into the cup. Turn the cup upside down, then right side up three consecutive times.

3. Soak for at least six hours. Before removing lenses, turn the lens case upside down to ensure full neutralization of all residual disinfecting solution.

• Promotes disinfection by removing and killing a broad range of bacteria and microorganisms on lenses to help protect eyes against infection • Contains four beneficial electrolytes to promote a healthy lens-wearing experience

• Dissolving tablet that changes color to indicate that it’s been added at the beginning of the soaking period, eliminating the risk of residual peroxide • Protection against a broad range of microorganisms • Preservative-free • Built-in lubricant

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CONTACT LENSES

PRODUCT FOCUS: NATURALVUE MULTIFOCAL AND PEDIATRIC MYOPIA While you likely think of multifocal contact lenses for your presbyopic patients, research suggests that the NaturalVue Multifocal 1 Day Contact Lenses from Visioneering Technologies, Inc. may slow the progression of myopia and possibly reduce refractive error.

In a recent study published in Eye & Contact Lens, Jeffrey Cooper, OD, MS, of SUNY College of Optometry, and colleagues conducted a retrospective case series analysis of 32 patients.1 The patients ranged in age from 6 to 19, at least −0.50D myopic progression since their previous exam and had at least one six-month follow-up visit (though some patients were followed for up to 25 months).

NaturalVue Multifocal uses VTI’s Neurofocus Optics technology, meaning the lens works with the brain. Visioneering Technologies rolled out the lenses in plus powers at Optometry’s Meeting in June, bringing the power range to +4.00D to -12.25D (0.25D steps), with an expansion of up to +6.00D planned for the future.

LESS PROGRESSION

The patients showed an average annual progression -0.85D of

myopia before wearing the NaturalVue lenses. After wearing the lenses, however, myopic progression was reduced to -0.03D per year, with no significant differences between the left and right eyes, the researchers found.

Overall, 98.4% of the children showed reduction of annualized myopic progression; 91% showed a decrease of 70% or greater, results show. Furthermore, 81.25% showed complete halting of myopic progression, including 6.25% demonstrating myopic regression.

Cooper’s team found that the decrease in myopic progression ranged from −6.5% (increasing myopia) to 167.7% (decreasing myopia).

PERIPHERAL PLUS

The researchers believe that the extended depth of focus (center distance), the result of a gradual, continuous nature of the relative plus power increase, and a higher amount of plus power in the periphery are what allow the NaturalVue Multifocal to slow the progression of myopia and possibly lead to regression of the refractive error.

“When myopia is corrected with

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traditional contact lenses or glasses, the central retina is in focus, whereas the peripheral retina is out of focus, resulting in relative peripheral hyperopic defocus,” they write. “From animal studies, it is believed that this peripheral hyperopic defocus may be the stimulus for the development of myopia. Therefore, treatment of myopic progression must eliminate the peripheral relative hyperopic defocus created by spherically correcting ophthalmic lenses/contact lenses, or somehow block the biochemical process causing axial elongation.”

The researchers conclude that eyecare practitioners should consider using multifocal contact lens designs that slow the progression of myopia in children as part of their clinical practice.

1. Cooper J, OʼConnor B, Watanabe R, et al. Case Series Analysis of Myopic Progression Control With a Unique Extended Depth of Focus Multifocal Contact Lens. Eye Contact Lens 2018 Sep;44(5):e16-e24.

WHERE TO FIND IT Visioneering Technologies, Inc. 844.884.5367 | VTIVision.com

NEW PRODUCT | GALLERY RIGHTEYE SYSTEM GETS FDA CLEARANCE

RightEye LLC has received 510(k) clearance from the U.S. Food and Drug Administration for its RightEye system for recording, viewing and analyzing eye movements in support of identifying visual tracking impairment in patients. The system includes RightEye EyeQ tests, reports and training tools. Applications include: • RightEye functional vision test, which helps identify a host of functional vision issues that affect quality of life and automatically recommends computer-based exercises for patients to do at home.

• RightEye Reading EyeQ, which tracks reading proficiency in real time, identifying hidden vision issues associated with learning difficulties.

• RightEye Sports Vision EyeQ, which identifies opportunities to strengthen performance-related aspects of vision, while Sports Vision Trainer offers personalized exercises to athletes looking to improve coordination and reaction times.

• RightEye Brain Health EyeQ, which showcases the severity levels of vision skill problems and how this may relate to brain performance. It also provides computer-based vision exercises to help address oculomotor issues.

Go to RightEye.com.

I-MED OFFERS NEW DRY EYE PRODUCTS

I-MED Pharma Inc. has signed an exclusive distribution agreement with Quidel Corp. to bring these three dry eye products to the U.S.: • I-LID ’N LASH, a water-based cleanser with hydrating ingredients and hyaluronic acid used to soothe inflamed skin around the eyes and remove make-up. It is available in a 50mL metered dose pump that can be used for up to 12 months after opening or a jar of 60 pre-soaked wipes that can be used for up to six months after opening.

• I-RELIEF HOT & COLD THERAPY EYE MASK, which can be used for patients who have blepharitis, dry eye disease, meibomian gland dysfunction, and various other conditions. The mask features temperature-retaining and naturally hydrating ThermaBeads, an elastic strap for a comfortable fit, adjustable closure for proper compression and soft cloth fabric. It is latex free, non-allergenic and antibacterial, and a machine-washable fabric slipcover protects the mask from oils, makeup and dirt.

• SMTube, a strip meniscometry test for measuring tear volume. SMTube is a tube used as a diagnostic method to examine and measure tear function by absorbing the tears. The test takes five seconds per eye and is non-invasive.

The box contains 50 strips.

Go to IMEDPharma.com.

O p tometr ic O ffic e. c om | November 2018 15

OPTILANES MAKES ROOM FOR WHEELCHAIRS

OptiLanes offers a fully automated chair that pivots to make room for a wheelchair to sit in the same position. The base remains in the same spot, but controls on each side of the back of the chair allow you to lay the chair down flat, move it up and down, and return it to the original position. You can also operate the chair by foot pedals, the stand console or a switch on the slit lamp arm. A second switch on the slit lamp arm raises and lowers the slit lamp, and a knob on the phoropter arm lets you move the phoropter up or down an extra three inches. Both the chair and stand are motor driven, and the stand has three hand tool wells. An emergency stop lever under the slit lamp table stops the table’s motion when activated to prevent injury to the doctor’s or patient’s legs. Go to OptiLanes.com.

OCULUS INTRODUCES COMPACT PERIMETER

The Smartfield compact perimeter from OCULUS performs standard automated perimetry using an ultra-high luminance LCD display. Its short measurement times make it suited for standard screening methods.

In addition, the control software offers a wide array of state-of-the-art measurement procedures for diagnostic and follow-up examinations.

The new OCULUS perimeter requires little set-up space, can be operated in rooms with normal lighting conditions and, with its carrying handle, is portable. It comes with a translucent lateral eye shield, eliminating the need for an eyepatch, and patients with presbyopia require no refractive correction prior to testing. Go to OculusUSA.com.

KONAN OFFERS NEW VISUAL FIELD TECHNOLOGY

Konan Medical USA has received 510(k) clearance from the U.S. Food and Drug Administration for objectiveFIELD, a perimeter designed to assess the human visual field in a completely objective and non-contact manner with no manual input from the patient required. The objectiveFIELD, which Konan acquired from the Australian National University (ANU), uses a patented multifocal pupil objective perimetry method (mfPOP) to test both eyes simultaneously in only a few minutes.

The company plans to offer additional features with supportive data as regulatory requirements are met.” Go to KonanMedical.com.

DIGITAL HEAT INTRODUCES SCORPION 1-TOUCH EYELID HEATER

Digital Heat Corporation’s Scorpion 1-Touch Eyelid Heater, an FDA-cleared medical device, allows for both in-office treatment of dry eye and over-thecounter sale to patients. The Scorpion 1-Touch features three preset time and temperature modes, exerts minimal corneal pressure and is portable.

Go to HeatedEyePad.com.

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Know who’s in your corner The leadership supporters of Think About Your Eyes have your back.

Do you have theirs?

Think About Your Eyes grew the eyecare industry by more than $750 million in one year thanks to our leadership supporters. But thanking them isn’t enough. Support the brands and companies that are supporting your industry and show them just how far their investment can go!

Visit thinkaboutyoureyes.com/supporters to learn more about the companies investing in you.

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