Optometric Office July 2018

OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

PHARMACEUTICALS: CHILD-FRIENDLY CONTACT LENS CARE

ONE-TO-ONE: JOSEPH MALLINGER

JULY 2018

SEEN AND HEARD AT OPTOMETRY’S MEETING 2018

KIDS AND CONTACTS:

WHEN IS THE TIME RIGHT? CONSIDER RESPONSIBILITY, THE PARENTS, AND HYGIENE. SUPPLEMENT TO VCPN JULY 2018

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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 9

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 Lindsay Berry, OD | Mile Brujic, OD, FAAO Linda Hardy, LDO- GA, CPOT, COA, ABOC, NCLC

BUSINESS STAFF President/Publisher Terry Tanker | TTanker@FVMG.com Executive Vice President Shawn Mery | SMery@FVMG.com

DEPARTMENTS 2 | Views

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4 | One-to-One: Joseph Mallinger 5 | Think About Your Eyes 6 | Product Buzz

Vice President, Marketing Debby Corriveau | DCorriveau@FVMG.com

14 | New Product Gallery

Regional Sales Manager Eric Hagerman | EHagerman@FVMG.com

16 | Docs Speak Out

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.

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FEATURES 8 | Seen and Heard at Optometry’s Meeting 10 | CONTACT LENSES: Kids And Contacts: When Is The Time Right?

12 | PHARMACUETICALS: Care Regimens Become Child-Friendly 15 | INSTRUMENTS: New Tools When Caring for Children www.Facebook.com/OptometricOffice www.Twitter.com/OO_Magazine www.Linkedin.com/showcase/Optometric-Office-Magazine

VIEWS

Jeffrey Eisenberg

THE VIEW THROUGH

THOSE GLASSES

HAS BECOME SOMEWHAT ROSIER

At this time last year, more than 20 million individuals were at risk of losing their healthcare coverage, with a number of individuals arguing that coverage is a privilege rather than a right. The FTC was (and still is) mulling changes to the Fairness to Contact Lens Consumers Act to create more recordkeeping requirements for optometrists. The emphasis seemed more on allowing patients to buy contact lenses where they want and less on whether they have a valid prescription and appropriate follow-up care.

The proverbial rose-colored glasses were starting to turn black.

However, there still were some lighter hues. For example, students and ODs rallied on Capitol Hill and met with members of Congress to advocate for legislation that not only would be good for the optometric profession but would be good for their patients. That’s where there is inspiration this year as well.

Take for example, the subject of this month’s “One-toOne” (page 4). Joseph Mallinger, OD, MBA, FAAO, whom the American Optometric Association gave its Distinguished Service Award in Denver last month, describes how he retired and sold his practice in the late 1990s but went on to earn an MBA. Inspired by several past AOA presidents and armed with his new degree, he continued working on behalf of the profession. “I think it’s important for those of us who can give back to the profession to take the time to volunteer,” he said.

Mallinger isn’t the only one. In this month’s “Docs Speak Out” survey (page 16), two-thirds of respondents said they have been involved, or plan to become involved, in advocacy efforts. Their top issues include optometric scope of practice, illegal contact lens sales, and changes to the Fairness to Contact Lens Consumers Act. Meanwhile, at Optometry’s Meeting last month, the House of Delegates passed resolutions not only for the benefit of the profession but the general public as well. These include advocating for adequate vision testing in states’ driver’s licensing requirements and collaborating with federal healthcare stakeholders on a response to the nation’s opioid epidemic.

Optometry is a profession that is devoted to the general public’s well-being. Also inspiring is the realization of how optometrists can have an impact on individuals’ lives. For example, in this month’s “Think About Your Eyes” (page 5), Lindsay Berry, OD, reminds us how optometrists can help diagnose vision problems in children that go beyond myopia and hyperopia—disorders that children and their parents may be unaware of even though they can hinder a child’s success.

True, some small patches of black remain in those glasses.

However, the view through them has become much rosier.

*** Jeffrey Eisenberg | Editor-In-Chief | JEisenberg@FVMG.com

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and apply it to all the decisions that you make to help the profession, it’s pretty hard to go wrong.

W. David Sullins, OD (1989-1990), who was an admiral in the Navy, was the true leader who started the InfantSEE program. And others in that era were certainly ones that inspired me to see if I couldn’t give back.

After I retired and sold my practice in the late 1990s, I was fortunate enough to go back to business school and over time to become the president and CEO of Vision West, a group purchasing organization.

ONE-TO-ONE

Joseph Mallinger Joseph Mallinger, OD, MBA, FAAO, senior vice president of professional relations for Healthy Eyes Advantage, received the American Optometric Association’s Distinguished Service Award last month at Optometry’s Meeting in Denver. He has served as president of the San Diego County Optometric Society, president of the California Optometric Association (COA), and president of the COA’s Public Vision League. He currently serves as secretary-treasurer of Marshall B. Ketchum University board of trustees and president of Optometry Cares, the AOA’s charitable foundation.

Jeffrey Eisenberg: Congratulations on receiving this award.

You have a long list of service to the optometric profession.

Joseph Mallinger, OD, MBA, FAAO: I think it’s important for those of us who can give back to the profession to take the time to volunteer. There are quite a number of individuals who inspired me to give back when I could, mentor when I could, and do what I could to help grow the profession.

JE: Who are some of the people that inspired you?

JM: The ones that stand out are some past AOA presidents.

Richard Hopping, OD (1971-1972), gave me a little mantra that I used through my volunteer time and in business dealings: “If it’s not right for the profession of optometry, just don’t do it.” If you, as a volunteer, live by something as simple as that 4 J uly 2 01 8 | O p to m e tri c O f f i c e .c o m

Past AOA president, Mitchell Munson, OD (2013-2014), gave me the opportunity by an appointment to the Optometry Cares board. We oversee the InfantSEE program along with Healthy Children’s programs. This year and next, I am lucky enough to be the president of Optometry Cares. I’m also the secretary-treasurer of the Marshall B. Ketchum University board of trustees. In those roles, I find my ability to give back to the profession somewhat different but certainly as rewarding as any volunteer could ask for.

JE: What are the priorities for the profession to address?

JM: From my perspective, I can’t think of a higher priority than our profession not being recognized by a number of the major medical plans. Another volunteer priority for us is making sure that all the ODs who are willing to participate in the InfantSEE program and provide free vision care for infants do so.

JE: Can you talk about Healthy Eyes Advantage?

JM: Healthy Eyes Advantage was created by the acquisition

by Nautic Partners, a private equity entity that acquired C&E Vision Services, HMI Buying Group, Red Tray Network, Club Zero, Block Buying Group and Vision West in November 2017. Nautic combined those entities to create Healthy Eyes Advantage, which now has 10,000 active members.

Purchasing products through one entity creates an entirely different capability for the corporation to be able to bring additional professional management products and services to our member accounts. My role focuses on acting as a liaison between corporations and organized optometry.

It fits into my volunteerism. It’s something that I have a passion about doing; keeping the profession of optometry at the forefront of everything that HEA does.

JE: How does HEA work?

JM: Members of Healthy Eyes Advantage have immediate, single-source access to industry-best product discounts and rebates from leading and niche vendors in all product categories — frames, labs and contact lenses — as well as our strategic solutions partners. The HEA team is committed to, and focused on, delivering simplified solutions to independents nationwide in five areas: savings, technology, education, patient management and payment solutions. We will begin making these offerings available to our members and the community at large in the next few weeks.

THINK ABOUT YOUR EYES

CHILDREN’S VISION HEALTH

STARTS WITH PARENTS

Vision health involves more than the ability to see letters clearly on an eye chart. However, there remains a common misconception that a vision screening, whether at school or a pediatrician’s office, is enough to detect all vision problems.

SKILL DEFICIENCIES

Lindsay Berry, OD

Hyperopia and myopia are the most common vision issues children face. Luckily, these conditions are easily corrected with either glasses or contact lenses. However, some vision problems go beyond requiring glasses and contact lenses.

For example, many children can have deficiencies in their visual perceptual skills (ability to accurately process visual information).

Lindsay Berry, OD, is a member of the Texas Optometric Association and among the 19,000 doctors listed on the Think About Your Eyes online locator. Think About Your Eyes is a nationwide public awareness initiative promoting the importance of annual eye exams and overall vision health. First Vision Media Group supports Think About Your Eyes as a media partner.

Many also have deficiencies in their visual efficiency skills, namely the ability to track, focus and have the eyes work as a team. Eye-tracking skills are important for efficient reading ability. Children with poor tracking skills often demonstrate slow reading speeds, skip lines or words of text, use a finger as a reading guide, and have poor reading comprehension. Children with poor eye teaming skills may complain of words moving on the page, tired eyes after school, headaches, or even double vision.

and symptoms of visual issues. Children often don’t understand blurred vision, nor do they realize that their eyes work harder or differently than those of other children. We must inform parents so that they recognize the struggles of their own child. A casual conversation with adult patients about their children and the importance of routine eyecare can be life changing for the child in need.

Parents are often surprised when I explain that their child has a vision problem, even though the child may not need glasses or contact lenses. Instead, children who have deficiencies in their visual efficiency or visual perceptual skills often benefit from vision therapy. Vision therapy trains the child’s brain to use the eyes and the visual system more efficiently for school, learning and general body movement and eye-hand skills.

EDUCATING PARENTS

Children’s vision care starts with educating parents about the importance of annual eye exams, as well as the signs

This summer, Think About Your Eyes will focus on educating parents about the importance of an annual eye exam for children, both for performance in school and overall vision health. The campaign has partnered with pro-athlete and lifestyle expert Laila Ali, daughter of the late boxing champ, Muhammed Ali, to encourage parents to schedule an annual eye exam this summer for the whole family. In addition to sponsored social media posts and interviews with Ali, Think About Your Eyes will spread this message through parenting bloggers.

Optometrists can support Think About Your Eyes by signing up for a listing or upgrading an existing listing to premium.

Go to ThinkAboutYourEyes.com/Enroll. O|O

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

SHIRE EDUCATION INITIATIVE SEEKS RESPONSIBLE SCREEN USE

Shire plc has launched “screen responsibly,” an educational initiative about the intersection between screen use and eye health. Shire, in partnership with behavior-change media and technology company Thrive Global, surveyed 1,001 adults with self-reported dry eye or dry eye symptoms and 1,000 eyecare practitioners and found that: • Adults were more comfortable discussing how much they weigh (41%), how much junk food they eat (44%), how much time they spend online shopping (51%) or how much they drink on the weekends (55%) than they were willing to share their screen usage.

• Seventy percent of adults agreed they cannot pursue their life passions without screens.

• Nearly two-thirds of surveyed eyecare professionals reported a rise in eye-related issues that they attribute to screen usage.

The screenresponsibly.com website discusses a screen-healthy lifestyle and offers a screen personality quiz that will guide users to tailored content. Go to Shire.com.

SYNERGEYES, HOLDEN INSTITUTE TEAM UP TO OFFER NEW DESIGNS

SynergEyes has formed a partnership with the Brien Holden Vision

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Institute, which has developed new optical designs that incorporate an extended depth of focus (EDOF).

The EDOF lens provides a series of smooth, non-monotonic power variations across the optic zone to deliberately manipulate multiple higher-order aberrations. Under the exclusive worldwide licensing agreement, SynergEyes will manufacture the design technologies developed by Brien Holden Vision Institute on its hybrid contact lens platform. Go to SynergEyes.com.

JOHNSON & JOHNSON LAUNCHES NEW U.S. WEBSITE

Johnson & Johnson Vision announced the U.S. launch of JJVISION.COM, a new online presence featuring rich video content, high-resolution images, infographics and downloadable materials. The website highlights J&J’s history of innovation; products and portfolios; commitment to professional education, collaboration, and advocacy; and efforts to improve global health, local communities and sustainability.

The site includes links to easily navigate to Acuvue.com, JNJVisionPro.com, Surgical.JNJVision.com and Sightbox.com.

Also, J&J has announced a partnership with professional U.S. tennis player

Madison Keys (pictured) as part of a global See It Through campaign to celebrate the ambitions and aspirations of teens. Keys will talk about how ACUVUE Brand contacts helped her game and will talk about the importance of setting goals. Follow @Acuvue on Instagram and use #SeeItThrough on social media to follow the campaign globally, or go to Acuvue.com.

ALCON TAKES MULTIFOCAL CAMPAIGN DIRECT TO CONSUMERS

Alcon, a division of Novartis, has launched its “See Near and Far” direct-to-consumer (DTC) campaign to increase consumer awareness of multifocal contact lens options and encourage individuals to visit an eyecare professional. The campaign will include a television spot that will run on networks such as ABC, NBC, CBS, and ESPN throughout 2018, and will feature national print and digital media. The new campaign aims to reach presbyopes who may already wear reading glasses or who are just starting to experience difficulties with their near vision. The campaign shares how DAILIES TOTAL1 Multifocal contact lenses may be able to meet their needs. For more information, go to SeeNearAndFar.com.

FDA APPROVES CUSTOMFLEX PROSTHETIC IRIS

The U.S. Food and Drug Administration has granted Clinical Research Consultants, Inc. approval for the CustomFlex Artificial Iris for adults and children whose iris is completely missing or damaged.

The prosthetic device is made of thin, foldable medical-grade silicone and is custom-sized and colored for each patient. A surgeon inserts the

device under a small incision, and the prosthetic iris is held in place by the anatomical structures of the eye or, if needed, by sutures. In one randomized clinical trial, more than 70% of patients reported significant decreases in light sensitivity and glare and improvement in healthrelated quality of life following the procedure, and 94% were satisfied with the appearance of the artificial iris.

MARK YOUR CALENDARS JULY 31, AUGUST 13 AND AUGUST 27: SynergEyes VS Scleral Lens: Design Overview and Complex Cases for Current Prescribers webinar. Speakers: Louise Sclafani, OD, FAAO; Melissa Barnett, OD, FAAO, FSLS; Christine Sindt, OD, FAAO, FSLS; and Jeffrey Sonsino, OD, FAAO. Visit Info.SynergEyes.com/SynergEyes-Webinar-Series-2018.

AUGUST 11, 8 A.M. TO 12 P.M.:

Primary Eyecare Network’s workshop on scleral lenses. CE credits: Four hours (COPE approval pending). Speaker: Mile Brujic, OD. Location: Concord Hilton, 1970 Diamond Boulevard, Concord, CA. Cost: $175 for PEN members, $200 for non-members. For information, go to PrimaryEye.net or email Education@PrimaryEye.net.

AUGUST 19, 8 A.M. TO 5 P.M.:

PEN’s Eyes of America Summer Seminar. Topics: Profit margin analysis and practice metrics, dry eye disease management, lid margin disease, and scleral lens fitting. CE credits: Eight hours. Speakers: Mark Wright, OD; Paul Karpecki, OD; and Katie Greiner, OD, MS, FAAO. Location: Great Wolf Lodge in Mason, OH. Cost: $230 morning session, $200 afternoon session, or $275 full day. Includes lunch.

For information, visit PrimaryEye.net or call 800-444-9230.

AUGUST 20: Duette Progressive Hybrid Lenses: Personalized Contact Lenses for Presbyopia, with Case Studies webinar.

Speaker: Louise Sclafani, OD, FAAO. Visit Info.SynergEyes.com/ SynergEyes-Webinar-Series-2018.

News

ABB OPTICAL GROUP has agreed to acquire Glimpse Live, a data and analytics provider for eyecare professionals and other healthcare practitioners Sightbox, an eye health membership service, has joined the Health Care Alliance for Patient Safety.

The Onefit family of scleral lenses, including Onefit MED, from Blanchard Contact Lenses now has 510(k) clearance from the FDA for therapeutic applications, including treatment of dry eye, when manufactured in Contamac’s Optimum Extra, Optimum Extreme, and Hexa 100 materials.

Bausch + Lomb’s ULTRA for Astigmatism contact lenses now come in cylinder power of -2.75D, which is available across all power ranges (+6.00D to -9.00D) in the portfolio.

The Foundation Fighting Blindness and CheckedUp have formed a collaborative partnership to deliver patient-friendly diagnostic and disease-management information to people with retinal diseases such as age-related macular degeneration, retinitis pigmentosa, and Stargardt disease during their visits to ECPs. The Illinois College of Optometry (ICO) board of trustees has appointed Mark Colip, OD, as its sixth president, effective August 6, succeeding Arol Augsburger, OD, who retires after 16 years as president.

The Cooper Companies, Inc. has appointed Holly Sheffield executive vice president and chief strategy officer and promoted Robert Auerbach, MD, to president of CooperSurgical.

O p tometr ic O ffic e. c om | Jul y 2018 7

SEEN AND HEARD | AT OPTOMETRY’S MEETING

AOA NAMES DAVID REDMAN OPTOMETRIST OF THE YEAR

At its annual meeting in Denver last month, the American Optometric Association named David M. Redman, OD, (pictured above) partner in Precision Eyecare Centers in San Jose and Mountain View, CA, as its “Optometrist of the Year” for 2017. Redman served as president of the California Optometric Association from 2008 to 2009 and currently chairs its legislative and regulatory committee. He advocated for expanding optometrists’ roles in treating glaucoma and caring for diabetic patients and has been a voice in the effort to expand eyecare access to school-age children. He has organized and participated in vision care clinics, served on the board of Salud Para La Gente clinics and on the First 5 San Benito Children’s and Family 8 J uly 2 01 8 | O p to m e tri c O f f i c e .c o m

Commission, and he has made numerous appearances on the NBC affiliate channel KNTV to educate viewers about dry eye and children’s vision issues.

COOPERVISION UNVEILS EYEDEA LAB

CooperVision, Inc. unveiled the Best Practices EYEdea Lab, with this “think tank” taking place on June 21 in the exhibit hall. 2018 Best Practices honorees were joined in the EYEdea Lab by several past award recipients to develop novel, high-value solutions for the industry, working together to conduct research, collect ideas, and bring recommendations forward. The collaboration is being facilitated by Prof. David S. Ricketts, PhD, Innovation Fellow at Harvard University. These outcomes will be unveiled at the Global Contact Lens Forum at Vision Expo West in Las

Vegas this September. More details will be revealed in the Mile High City. For more information about the EYEdea Lab, visit EyecareBestPractices. com/EYEdea-lab.

NUSIGHT MEDICAL INTRODUCES AT-HOME DRY EYE TREATMENT

NuSight Medical introduced the NuLids System, a doctor-prescribed, home-use medical device for treating clinical signs and symptoms of blepharitis and dry eye. Requiring just one minute per eye, NuLids gently stimulates, de-caps and rejuvenates the meibomian glands to a healthier state. The compact and cordless device is only available through licensed eyecare practitioners. Visit NuSightMedical.com, or call 1.833.3NULIDS (1.833.368.5437.)

AMERICAN OPTOMETRIC ASSOCIATION OFFICERS AND TRUSTEES SWORN IN AT OPTOMETRY’S MEETING 2018

NATURALVUE MULTIFOCAL NOW IN PLUS POWERS

Visioneering Technologies Inc. announced that its NaturalVue (etafilcon A) Multifocal 1 Day Contact Lenses are now available in Plus Powers. This expansion will take the full power range of the lens from +4.00D to -12.25D (0.25D steps), with an expansion to up to +6.00D planned for the future. NaturalVue plus powers will be available in 30and 90-packs as well as 10-pack trials.

For more information, visit VTIvision.com, or call 844.884.5367, ext. 104.

EYECARROT INNOVATIONS OFFERS SACCADIC FIXATOR

Eyecarrot Innovations Corp. used Optometry’s Meeting to showcase its new Binovi Touch Saccadic Fixator. Eyecarrot’s Binovi platform helps optometrists treat vision issues with in-office therapy as well as lead home-based activities. Features include 49 tactile responsive buttons, multi-colored button options, four LED Matrix displays, Bluetooth connectivity through the Binovi Touch mobile app, secure data connectivity to the Microsoft Azure API, and modular design that allows for scaling the size of the device. The device weighs about 14kg. Visit Eyecarrot.com/ Binovi-Platform, or call 416.943.6271.

OPTOMETRY STUDENT BOWL INCLUDES 25 SCHOOLS

More than 700 attendees at Optometry’s Meeting gathered to

watch students from all 25 schools and colleges of optometry to play Essilor’s 27th annual Optometry Student Bowl. Students answered optometry-related questions while their fellow classmates cheered them on wearing war paint and school colors while displaying brightly colored banners. The winning school, Northeastern State University College of Optometry, took home $1,000 and will house the coveted crystal trophy until next year’s meeting in St. Louis.

David Hurd, Class of 2019, answered the winning question. As in previous years, each contestant was presented with a Volk Pan Retinal 2.2 blue ringed lens, donated by Volk Optical president Jyoti Gupta, PhD, and the first place winner received six Volk diagnostic lenses. For more information and to see this year’s Essilor Optometry Student Bowl, go to Facebook.com/ EssilorPro.

Leaders of the American Optometric Association (AOA) were sworn in to office on June 23 at Optometry’s Meeting in Denver. The board leadership for 2018-2019 consists of Samuel D. Pierce, OD, president; Barbara L. Horn, OD, presidentelect; William T. Reynolds, OD, vice president; Robert C. Layman, OD , secretary-treasurer; and Christopher J. Quinn, OD, immediate past president. The trustees are James P. DeVleming, OD; Ronald L. Benner, OD; Steven T. Reed, OD; Jacqueline Bowen, OD; Fred Farias III, OD; and Lori L. Grover, OD, PhD. In other news, the House of Delegates approved resolutions to: • Advocate for states’ drivers’ licensing requirements to include sufficient vision screenings.

• Establish an AOA Education Center.

• Support bolstering optometric education.

• Commit AOA to the nationwide opioid response.

• Urge licensing exam entities to reform exams.

• Urge licensing exam agencies to reform testing administration.

• Reform the nominating process for AOA’s Nominating Committee.

For more about the board of trustees, visit AOA.org/About-The-AOA/ Board-of-Trustees.

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

CONTACT LENSES

KIDS AND CONTACTS: | WHEN IS THE TIME RIGHT?

Consider factors such as responsibility, the parents, and hygiene.

By Li nd a Hardy, LD O- GA , CP OT, COA , ABOC , N C LC The number of children being fit with contact lenses has increased in the past few years at a considerable rate. That’s not surprising given the benefits. Children’s self-esteem can be improved, and they can participate in extracurricular activities without relying on glasses. In addition, you now have a patient who will return annually for an eye exam and contact lens evaluation, allowing you to ensure the patient’s eyes remain 10 J uly 2 01 8 | O p to m e tri c O f f i c e .c o m

healthy and that the ever-changing vision is always corrected at its best.

However, as a practitioner, you need to be cautious when fitting children.

There are several things to consider: Is the child responsible enough and mentally ready for contacts? How helpful will the parents be? Is the child’s skin condition healthy? Does the child have appropriate hygiene?

RESPONSIBILITY IS KEY

Before you fit a pediatric patient in contact lenses, you need to have an in-depth discussion with both the patient and the patient’s parents (or guardians). This conversation needs to include the importance of caring for and cleaning contact lenses, the importance of adhering to the wear schedule, and the severe consequences of misusing contact lenses.

Be sure to limit the wear of the contact lenses so that children do not become so dependent on them. Make sure they have a time that they can rest their eyes and use glasses. That will require them to keep an updated pair of glasses always on stand-by.

Include the patient’s family as much as possible. A well-informed adult can be a great asset. Make sure that the adults are trained on how to insert and remove the lenses and how to clean and care for the lenses. They can help keep the child on task and motivate the patient during the training process. During the training, a child can be very nervous, especially at the thought of touching the eyes, but a positive motivator can help the child be successful with the training process.

DEAL BREAKER

Hygiene can be a deal breaker. For example, a young male patient presented with –2.00D of myopia in each eye, an ideal prescription for contact lenses. When I entered the exam room, however, I saw that he had severe acne for which a dermatologist prescribed facial creams and an oral antibiotic. I had him return in three months to recheck his acne issues before fitting him with contact lenses. His dermatology treatment worked well, so I felt he was ready for contact lenses. You never want to fit patients, especially children, with contact lenses if there is a risk of bacterial infections, which can lead to corneal scarring and vision loss.

Acne is not the only issue to worry about. Patients need to have clean hands, faces and eyes, including eyelashes. Inform patients not to touch their eyes without clean hands.

Sometimes that is difficult, especially after playing sports or doing some other school activities.

Blepharitis is especially common among children and teens.

Blepharitis, which is caused by a skin condition, allergies, or bacte-

rial infection, occurs when the tiny oil glands in the inner eyelid become inflamed. Treatment is simple—the patient cleanses the eyelids with lid scrubs or warm water and baby shampoo—but blepharitis is a recurring issue that requires daily treatment. In severe cases, an antibiotic ointment may be needed. These treatments will need to be done before fitting the patient with contact lenses.

There can be many concerns with fitting kids with contact lenses, but given the positive outcomes I’ve seen, I believe that the good outweighs the bad.

LENS OPTIONS

Once the patient is ready to be fit, my go-to is a daily disposable lens.

This gives the patient a clean, fresh contact lens every day, making it the safest way to ensure that patients care for their contact lenses. There is no worry because there is no cleaning process. Daily disposables also offer the option of using contact lenses more on a part-time basis rather than for extended periods.

I have several lenses that I prefer.

For example, the DAILIES Total 1 from Alcon offers comfort and clear vision. The ACUVUE OASYS 1- DAY with HydraLuxe Technology from Johnson & Johnson Vision stays hydrated all day, making it ideal for individuals who have dry eyes or for kids who are out on the soccer field all day.

The toughest selling point on these lenses is the price. It’s hard to get parents to invest $500 to $800 for a one-year supply of contact lenses.

If the parents are unable to afford a one-day disposable, my next step is a two-week lens, such as ACUVUE OASYS 2-WEEK with HYDRACLEAR PLUS from J&J. These lenses provide comfort, and

the price is more affordable. The only issue is making sure patients dispose of the lenses in two weeks. Many patients forget when they opened the pack and wear them for one month.

If that’s the case, you might need to consider a monthly disposable option, such as ACUVUE VITA from J&J, Biofinity from CooperVision, or Bausch and Lomb’s ULTRA contact lenses. They are all easy to handle and cost-effective. These brands have a toric version for patients who have astigmatism and a multifocal version for patients who have problems with accommodation.

OUTWEIGHING THE BAD

There can be many concerns with fitting kids with contact lenses, but given the positive outcomes I’ve seen, I believe that the good outweighs the bad. Caring for contact lenses will help teach them the importance of hygiene and the health of the eyes.

The key to success is having good communication skills with the patients and their families. Have a well-trained staff that can demonstrate how to handle contact lenses and care for them. Finally, make sure that your office keeps track of your patients. Get those recall cards ready.

O|O

Linda Hardy, LDO-GA, CPOT, COA, ABOC, NCLC, a licensed optician in Georgia, has been in the ophthalmic/ optometric field since 1997 and is currently the office manager at Eyexam of Peachtree City in Peachtree City, GA.

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 | JJVision.com

O p tometr ic O ffic e. c om | Jul y 2018 11

PHARMACEUTICALS

CARE REGIMENS BECOME |

CHILD-FRIENDLY

Multipurpose and hydrogen peroxide-based systems can help children care for their contact lenses.

Mi l e Br uj i c, OD , FAAO At one time, we believed that children had to be at least age 12 or older to begin contact lens wear. Not so. In 2006, Jeffrey Walline, OD, of Ohio State University, and colleagues announced results of the Contact Lens in Pediatrics, or CLIP, Study, in which they compared children ages 8 to 12 and teenagers ages 13 to 17.

They found that the younger children could be just as successful as the teenagers when it came to contact lens wear. And, while insertion and removal training initially was about 14 minutes more when fitting chil12 J uly 2 01 8 | O p to m e tri c O f f i c e .c o m

dren with contact lenses, by the end of the training both groups showed excellent understanding of contact lens care, the study found.

These results instilled a greater sense of confidence among practitioners fitting children in contact lenses.

When deciding whether to fit a child in contact lenses, I ask the parents whether they believe their child is responsible enough for contact lenses and whether their child is motivated for contact lenses. I also consider whether the child’s prescription is

available and if the ocular surface is healthy enough to proceed with contact lenses.

Whenever possible, I like to fit patients in daily disposable contact lenses, as the patient puts on a fresh new lens each day without having to worry about care regimens. However, if the patient’s prescription is not available in a daily disposable or if the parents don’t want to incur the cost, it may become necessary to fit the child in a two-week or monthly disposable option. In some instances,

we may place the child in gas permeable lenses, usually orthokeratology for myopia control.

As with adults, a discussion about the care regimen and patient education becomes essential.

FIRST UP: MULTIPURPOSE

Essentially, there’s no significant difference in what I consider when recommending a care regimen to a child or adult. I typically start the patient with a multipurpose solution such as Alcon’s OPTI-FREE Puremoist Contact Lens Solution, Bausch + Lomb’s Biotrue Multipurpose Solution or Johnson & Johnson’s Blink RevitaLens MultiPurpose Disinfecting Solution, as a first-line regimen. These tend to be easy for patients to use, and there are few adverse events. These solutions were developed in an era of silicone hydrogel lenses. As such, they have been optimized for this material.

While patients should follow the manufacturer’s recommended soak time (four to six hours), there is a low risk of adverse events if the patient needs to insert the lenses before that time has expired. This is especially helpful for individuals with irregular schedules.

(For more on multipurpose solutions, see “The Solutions for Cleanliness,” July 2017.)

SWITCHING TO PEROXIDE

If the patient has allergies or if we suspect hypersensitivity to the preservatives in a multipurpose solution, we switch that patient to a hydrogen peroxidebased system such as Alcon’s CLEAR CARE Cleaning and Disinfecting Solution and CLEAR CARE PLUS Cleaning and Disinfecting Solution with HydraGlyde. (Other available peroxide-based systems include Refine One Step from CooperVision and Oxysept Disinfecting Solution/ Neutralizer Ultracare Formula from Johnson & Johnson Vision.)

When using a peroxide-based system, the solution starts out as 3% hydrogen peroxide, but after a full six-hour soak,

the solution is neutralized, leaving minimal amounts of peroxide. Essentially, the solution transitions to a saline bath, making it gentle on the patient’s eyes.

One precaution, however: Failure to follow the recommended soak time means that the solution won’t be completely neutralized. That means, the individual will place large amounts of hydrogen peroxide on the eye and is at risk of corneal staining or a corneal burn. (For more on hydrogen peroxidebased systems, see “Why Hydrogen Peroxide is My First Choice,” October 2017.)

ADDITIONAL REMINDERS

As with adults, you’ll need to give pediatric contact lens wearers some additional reminders: • Digitally rub each side of the lens for about 10 seconds using the solution.

• Rinse each side of the lens using a continuous stream of solution for five to 10 seconds after digitally rubbing the lens.

• Replace contact lens cases approximately once every three months.

(Even though cases are readily accessible, I’ve seen patients stockpile them and continue using the same case for much longer periods.)

Children are among the most compliant

contact lens patients I have in my practice. That’s because their lives are about following instructions from parents and educators. So, they generally do well at following rules for caring for contact lenses. It’s when patients get older that they may start being less compliant with their wear schedule or care regimen, but hopefully by this point you’ve educated them well about the importance of compliance.

O|O

Mile Brujic, OD, FAAO, is a partner of Premier Vision Group, a three-location practice in northwest Ohio. He has authored more than 250 articles for publication and given more than 1,300 lectures, including lectures about contact lenses and about contact lenses for children.

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 | JJVision.com

O p tometr ic O ffic e. c om | Jul y 2018 13

NEW PRODUCT | GALLERY B+L INTRODUCES VITAMIN TO FILTER BLUE LIGHT

Bausch + Lomb has introduced Ocuvite Blue Light eye vitamins, a nutritional supplement formulated to protect eyes from blue light that comes with increased usage of digital devices. Ocuvite Blue Light eye vitamins contain 25mg of lutein and 5mg of zeaxanthin isomers, the key eye nutrients that help absorb blue light before it reaches the macula. Ocuvite Blue Light eye vitamins will be available for purchase in the vitamin and eyecare aisles at major retailers in the third quarter of 2018.

B+L also introduced Soothe Xtra Protection (XP) Preservative Free lubricant eyedrops, which combine Restoryl mineral oils to restore the lipid layer, seal in moisture, and protect against further irritation.

For information, go to Ocuvite.com and SootheEyedrops.com.

LACRYDIAG ANALYZES TEAR FILM OF INDIVIDUALS WITH DRY EYE

Quantel Medical, a subsidiary of the LUMIBIRD Group, has launched LacryDiag, an ocular surface analyzer that lets you determine the cause of a patient’s dry eye in order to offer the appropriate treatments. Specifically, LacryDiag offers four non-contact exams: interferometry to evaluate the lipid layer, noninvasive tear breakup time (NIBUT) to evaluate the mucin layer, tear meniscus to evaluate the aqueous layer, and meibography to evaluate the meibomian glands. For information, go to Quantel-Medical.com.

OPTOVUE’S ANGIOANALYTICS APPROVED FOR BLOOD VESSEL MEASUREMENT

Optovue has received FDA 510(k) clearance of AngioAnalytics, which works with its AngioVue optical coherence tomography angiography (OCTA) to provide high-resolution imaging of retinal blood vessels. The two technologies create color-encoded maps of the vessel densities of the retina or optic nerve and provide analyses of areas in which there is blood vessel loss (nonperfusion), abnormal blood vessel growth (flow area), and several parameters to assess change to the foveal avascular zone, an area of the retina profoundly affected by diabetic retinopathy.

The new AngioAnalytics software also provides trend analysis so that physicians can objectively monitor retinal and vascular changes caused by disease progression or from treatment.

Optovue also received clearance for its 3D projection artifact removal (3D PAR) software, which is designed to improve OCTA image quality and enable accurate measurement and interpretation of OCTA images. Projection artifacts occur when ghost images of blood vessels that exist in one retinal layer are projected onto other layers.

In other news, Optovue, has received expanded FDA 510(k) clearance for its epithelial thickness mapping software, which is now available on the Avanti Widefield OCT system. The expanded clearance adds a 9mm ETM scan to the previously available 6mm one to detect epithelial irregularities. For information, go to Optovue.com.

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This patient looks at the new vision screening system from Objective Acuity.

INSTRUMENTS

NEW TOOLS WHEN CARING FOR CHILDREN VISION SCREENER PROVIDES OBJECTIVE RESULTS IN CHILDREN

Objective Acuity has just successfully completed a proof-of-concept pediatric trial in Dallas and in Melbourne and Auckland, Australia, of its new objective screening system designed for preschool-aged children.

Proprietary moving patterns on a computer screen are coupled with a system designed to record and interpret eye movements. A child simply looks at the pattern to complete the screening test.

A trial of 3- to 7-year-olds that compared Objective Acuity’s test to electronic HOTV visual acuity found that the test can reliably screen for reduced vision.

“The trials showed high agreement between the Objective Acuity test and the electronic HOTV visual acuity test, which is currently considered the global clinical trials gold standard but is not

used in screening,” Adam Podmore, chief executive of Objective Acuity, said. “To put the results in context, we have compared this to previously published screening results in New Zealand, and using our test we would have had considerably fewer incorrect referrals to eye specialists.” For information, email A.Podmore@ObjectiveAcuity. com, or go to ObjectiveAcuity.com.

RIGHTEYE UNVEILS EYEQ VISION REHAB PROGRAM

RightEye LLC unveiled its new EyeQ Trainer computer-based vision rehabilitation program last month at Optometry‘s Meeting in Denver. EyeQ Trainer gives optometrists a tool their pediatric and adult patients can use at home to rehabilitate eye-movement issues. With the introduction of EyeQ Trainer, optometrists can now prescribe targeted, at-home vision exercises to improve and strengthen areas of weakness.

RightEye EyeQ Trainer integrates with EyeQ reports—offering personalized recommendations for improvement for each patient. RightEye EyeQ Trainer activates the eyes’ muscles as well as key elements of brain circuitry as patients engage in specific eye movements through a series of simple exercises conducted on a personal computer or tablet with an Internet connection. The circuitry activation is designed to result in better functional vision and smoother and more accurate eye movements that directly impact quality of life.

EyeQ Trainer is personalized to meet the unique needs of each patient.

Once the patient returns to the optometrist’s practice to be retested, reports will provide quantifiable data to mark improvements.” Call 301.979.7970, or go to RightEye.com.

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

DOCS | SPEAK OUT A dvo c a c y

Though advocacy efforts have long been a part of optometry, contact lens legislation, patients’ access to eyecare, and online eye examinations are some of the issues that have captured attention in recent years. In this month’s “Docs Speak Out,” we look at optometrists’ involvement with advocacy on behalf of patients and the profession.

Have you done, or do you plan to do, any of the following? (Check all that apply.)

80

80

NO 33%

70 60 50

YES 67%

30 10

70 60 50 40

40 20

Have you advocated for or against legislation that deals with any of these? (Check all that apply.)

76%

40%

48%

19%

5%

0

al ve t s der s tac abo ent he h fe aker o con akers cy ev t t i f t eo et w awm ients lawm dvoca Non me te l a t nd l or or sta ge pa l e t a t c / a A te, and our Wri Enc

Have you been involved, or do you plan to become involved, in any advocacy efforts?

“The abolition of vision-care plans, because they basically force ODs to accept low reimbursement rates and lead to lower quality of care and ‘up selling’ of eyewear.”

“Fixing healthcare—fees, access, EHRs. We can do better, but there isn’t enough time or money.”

“Integrating optometric physicians into the healthcare system. This will be necessary going forward to remain relevant in the future.”

“Illegal sales of online contact lenses without an Rx and failure to get an Rx by calling offices in the middle of the night for patients who have not been seen in as long as 11 years.”

16 J uly 2 01 8 | O p to m e tri c O f f i c e .c o m

20 10

69% 57% 36% 79% 29% 19% 0%

0

o nt es Act ove tice tie Act ss t Act sal ns rne mers ccess f prac the Pa Care the ab i e l a F t A e o u f l e c e s ) o e b c h n C ta p a a e to t s Co (DO sco repl ford Non con gal mentsct Len c Care etric peal/ nd Af Ille i e a m a d r r o et en nt Opt rts to ection Am Co ptom t O Effo Pro d n a tal n e D

er

Oth

If you had enough time to advocate for one specific issue or piece of legislation, what would it be and why?

30

“Concentrating on my state’s local scope-of-practice issues, which have lagged behind the rest of the country.”

“Allow competition across state lines.

Limit pay/salary to CEOs of health insurance carriers.”

“Open access to insurance panels. So many panels are closed to optometry.

We need a federal mandate for ‘any willing provider.’”

“Against free eye exam advertising by anyone, unmonitored eye exams.”

“Optometry boards should be the group to determine scope of practice for optometrists, as is the case with other professions. Technology is advancing quickly, and it’s ridiculous that our ability to move at that speed is hindered by antipatient groups who are only interested in their profit margin.”

“Continue direct advocacy to the FTC concerning the FCLCA.” “Access issues/any willing provider. No matter what scope of practice we have, if we can’t get paid to see patients, we cannot use it.”

“Scope of practice in our state, which is one of the worst states, by far, to practice optometry. And I do advocate for it.”

“Repeal and replace Obamacare. Too expensive for patients and little or no options for healthcare plans.”

“Illegal contact lens sales, since there is no concern for patient welfare by the seller.”

“Repeal of the (Un) Affordable Healthcare Act in equal effort with stopping the formation of any new optometry schools, as there is no need.”

“Against e-exams, online Rx of any sort.”

er

Oth

Your Donations at

Photo Credit Brien Holden Vision Institute

Work

Your donations will help support more programs like the first ever School of Optometry in Haiti. After almost 5 years in planning, the school has welcomed 17 new students to the Bachelor of Vision Science program.

Pierre Christopher (pictured) was delighted to commence his 5-year degree on November 6th.

The creation of locally trained optometrists will be a huge benefit for the 70% of the population who currently have little or no access to eye care services. Within 10 years, there will be at least 80 new locally educated eye care professionals who will be providing eye care to more than 360,000 Haitians per year.

A regular donation to Optometry Giving Sight will help transform even more lives.

To learn more or to donate today please visit: givingsight.org or call 1-888- 647-4483

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6/21/18 11:46 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.

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OO0718OA

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