Download What`s trending in ocular allergy treatment

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Transcript
FEBRUARY 2015
VOL. 7, NO. 2
Practical Chairside Advice
OptometryTimes.com
What’s trending in
ocular allergy treatment
Many AMD supps
do not meet
AREDS standards
Prevalence of disease is increasing,
and so should your knowledge
patients can
THIS IS WHY
enjoy refreshing comfort with every Figure
blink—no
matter
1.
A patient with
what the day may bring.
giant papillary
BLINK-ACTIVATED
MOISTURIZING AGENTS
+
conjunctivitis.
While not a
true ocular
allergic condition, it is commonly seen in
patients wearing soft contact
lenses or those
with exposed
suture barbs.
Treatment is
the same as
for patients
suffering from
allergic conjunctivitis.
See Supplements on page 1
=
Experts issue
vision screening
recommendations
BLINK-ACTIVATED MOISTURE
MOISTURIZING AGENTS
TEAR FILM STABILITY
Moisture is released with every
PVA, PEG and HPMC help
Tear film stability helps
blink, which helps result in a
deliver comfort from insertion
support clear vision.
stable tear film.
to the end of the day.
By Colleen E. McCarthy
By Ernie Bowling, OD, FAAO
Offer your patients innovative
technologies
that
provide
outstandingContent
all-day Specialist
comfort.
he advent
of spring
yields
the annual
Visit of
myalcon.com
pilgrimage
patients into our offices
Chicago—The National Expert Panel to the Nacomplaining of the itchy, watery eyes
tional Center for Children’s Vision and Eye
of allergy. As any eyecare practitioner
Health at Prevent Blindness has issued new
can attest, ocular allergy is one of the most
recommendations to provide an evidence-based
common presentations to an eyecare pracapproach to screening children from 36 to 72
tice. The ocular conjunctiva is particularly
months old. The recommendations include syssusceptible to airborne allergens and is a
tem-based public health strategies to ensure
very common site of allergic inflammation.1
™
improved surveillance and program accountOcular allergy presents in conjunction with
PERFORMANCE DRIVEN BY SCIENCE
ability as it relates to children’s vision in the
other systemic atopic manifestations, includU.S. The new recommendations were recently
ing rhinoconjunctivitis (hay fever), rhinopublished in Optometry and Vision Science.
sinusitis, asthma, urticaria (hives), and/or
T
See Allergy prevalence on page 1
*Based on DAILIES ® AquaComfort Plus ® sphere contact lenses.
Reference: 1. Wolffsohn J, Hunt O, Chowdhury A. Objective clinical performance of ‘comfort-enhanced’ daily disposable soft contact lenses. Cont Lens
Anterior Eye. 2010;33(2):88-92.
See product instructions for complete wear, care, and safety information.
© 2014 Novartis 12/14
Q A DAF15001JAD
& | DR.
See Screening on page 1
DORI CARLSON discusses Nor th Dakota , leadership, weightlif ting, and ice S e e p a g e 4 2
FeBRUaRY 2015
VOL. 7, NO. 2
PRACTICAL CHAIRSIDE ADVICE
optometrytimes.com
What’s trending in
ocular allergy treatment
Many aMD supps
do not meet
aReDS standards
Prevalence of disease is increasing,
and so should your knowledge
By colleen e. Mccarthy
Content Specialist
figurE 1.
a patient with
giant papillary
conjunctivitis.
While not a
true ocular
allergic condition, it is commonly seen in
patients wearing soft contact
lenses or those
with exposed
suture barbs.
treatment is
the same as
for patients
suffering from
allergic conjunctivitis.
T
Q&a
magenta
cyan
yellow
black
See Supplements on page 5
experts issue
vision screening
recommendations
By ernie Bowling, OD, fAAO
he advent of spring yields the annual
pilgrimage of patients into our offices
complaining of the itchy, watery eyes
of allergy. As any eyecare practitioner
can attest, ocular allergy is one of the most
common presentations to an eyecare practice. The ocular conjunctiva is particularly
susceptible to airborne allergens and is a
very common site of allergic inflammation.1
Ocular allergy presents in conjunction with
other systemic atopic manifestations, including
rhinoconjunctivitis (hay fever), rhinosinusitis, asthma, urticaria (hives), and/or atopic
dermatitis (eczema).1 Ocular allergy includes a spectrum of
sAn frAnCisCO— A study recently published in
Ophthalmology found that nutritional supplements marketed to help treat age-related macular degeneration (AMD) may not be backed
by scientific evidence.
According to the study, researchers examined the five top-selling brands of ocular nutritional supplements in the U.S. according to
dollar sales tracked by SymphonyIRI (Waltham,
MA) from June 2011 to June 2012. The study
reviewed the ingredients and manufacturer
claims of 11 ocular nutritional supplements
on the companies’ consumer information websites. Those ingredients were compared with
those contained in the Age-Related Eye Disease Study (AREDS) and Age-Related Eye
Disease Study 2 (AREDS2) formulas.
The researchers determined that some of
disorders with overlapping symptoms and
progressing in severity; these disorders include seasonal allergic conjunctivitis (SAC)
and perennial allergic conjunctivitis (PAC),
atopic keratoconjunctivitis (AKC), and vernal
keratoconjunctivitis (VKC). SAC and PAC are
the most common forms of ocular allergy.
By colleen e. Mccarthy
Content Specialist
Approximately 15-20 percent of the world
population is affected by some form of allergic disease. Ocular symptoms present
in about 40-60 percent of allergic patients2
and contribute significantly to poor qual-
CHiCAgO—The National Expert Panel to the National Center for Children’s Vision and Eye
Health at Prevent Blindness has issued new
recommendations to provide an evidence-based
approach to screening children from 36 to 72
months old. The recommendations include system-based public health strategies to ensure
improved surveillance and program accountability as it relates to children’s vision in the
U.S. The new recommendations were recently
published in Optometry and Vision Science.
See Allergy prevalence on page 26
See Screening on page 6
Prevalence of allergy
| DR. DORI CARLSON discusses Nor th Dakota , leadership, weightlif ting, and ice
See paGe 42
ES558388_OP0215_CV1.pgs 01.23.2015 03:41
ADV
THIS IS WHY 4 out of 5 patients
1
agree their lenses feel like new.
The scientifically proven formula of CLEAR CARE® Solution deeply cleans,
then neutralizes, to create a gentle saline similar to natural tears. The result
is pure comfort and is why CLEAR CARE® has the most loyal patients of any
lens care brand.2
The Science Behind a Pristine, Clean Lens:
Pluronic 17R4
Triple-Action Cleaning
Pristine, Clean Lens
• Patented formula deeply cleans
• Carries away dirt & debris
• Pluronic^ 17R4 lifts away protein
• Less residual H2O23-5
• Irritant-free comfort
• No added preservatives
Range of Residual H2O2 on Lens:
0
5
20
40
60
80
RESIDUAL H 2 O 2 IN PARTS
100 PER MILLION (PPM)
CLEAR CARE® Solution1
SOFTWEARTM Saline 2
OCULAR AWARENESS
THRESHOLD3
Recommend CLEAR CARE® Solution and learn more at MYALCON.COM
PERFORMANCE DRIVEN BY SCIENCE ™
^Trademarks are the property of their respective owners.
References: 1. A market research study conducted amongst 107 US contact lens wearers representative of CLEAR CARE® purchasers in the United States,
2007. 2. Based on third party industry report 52 weeks ending 12/29/12; Alcon data on file. 3. Alcon data on file, 2009. 4. SOFTWEAR™ Saline package
insert. 5. Paugh, Jerry R, et al. Ocular response to hydrogen peroxide. American Journal of Optometry & Physiological Optics: 1988; 65:2,91–98.
© 2014 Novartis 02/14 CCS14004ADi
magenta
cyan
yellow
black
ES558311_OP0215_CV2_FP.pgs 01.23.2015 03:38
ADV
| PRACTICAL CHAIRSIDE ADVICE
FROM
THE
3
Chief Optometric Editor
Embracing new contact lens technology
By Ernie Bowling, OD, FAAO
Chief Optometric Editor
He is in private practice in Gadsden, AL, and
is the Diplomate Exam Chair of the American
Academy of Optometry’s Primary Care Section
[email protected]
256-295-2632
recently attended our webinar “Increasing
your successful multifocal fits,” presented
by Editorial Advisory Board member David
Geffen, OD, FAAO. David is one of the sharpest ODs I know, and his mastery of the subject matter was evident. I consider myself to
be up to speed on this topic and was amazed
at what I didn’t know! The webinar is available on our website (http://www.modernmedicine.com/webinars#eyecare).
After the presentation, I wondered: with
the outstanding multifocal options for our
contact lens patients, why would anyone still
choose monovision as a primary selection?
Monovision is an antiquated technology dating
back at least to the 1960s1 and goes against almost every tenet we’ve been taught regarding
binocular vision. At its inception, it was the
only method we had to keep our presbyopic
patients in their contact lenses. Not a week
I
goes by where I don’t see a patient wearing
this modality. Many come to my office on
the recommendation of a family member or
friend who raved about their improved vision
after I fitted them with multifocals. I understand the attraction of monovision,
especially in a busy practice: it requires no
special lens, fitting is no more complicated
than traditional lenses, and it is generally accepted visually by more than 70 percent of
patients.2 Likewise, some practitioners shy
Why would
anyone still choose
monovision as a
primary selection?
away from multifocals due to a perceived
complexity of the fit and increased chair time.
Not saying that monovision doesn’t have
a place. It still does, albeit for those few rare
cases when I just can’t get them comfortable
in a multifocal. I am also a firm subscriber to
grandma’s old adage: if it ain’t broke, Ernie,
don’t fix it. But not when it comes to monovison. Many patients have simply gone along
with that modality. They may not be aware
of other options. That’s where we come in.
Let’s face it: today’s presbyopes aren’t our
grandparents. They are more active with more
visual demands and more disposable income.
This cohort is growing and is seriously underserved regarding presbyopic correction.3
These patients want the best correction we
have to offer, do not want to compromise
their vision, and are willing to pay for better
technology. Today, that means multifocals.
So, if you haven’t given multifocals a whirl
lately, consider them. These new multifocal
designs have resulted in increased success
rates and patient satisfaction vs. monovision.3 Your patients will appreciate your efforts at bringing them the latest in contact
lens technology.
REFERENCES
1. Fonda G. Presbyopia corrected with single vision spectacles or corneal lenses in
preference to bifocal corneal lenses. Trans Ophthalmol Soc Aust. 1966:25;70-80.
2. Westin E, Wick B, Harrist RB. Factors influencing success of monovision contact
lens fitting: survey of contact lens diplomates. Optometry.
2000 Dec;71(12):757–63.
3. Bennett ES. Contact lens correction
of presbyopia. Clin Exp Optom. 2008
May;91(3):265-78.
Read
more from
Dr. Bowling.
Turn to page 26
for his take on
allergy.
Editorial Advisory Board
Ernie Bowling, OD, FAAO Chief Optometric Editor
Editorial Advisory Board members are optometric thought leaders. They contribute ideas,
offer suggestions, advise the editorial staff, and act as industry ambassadors for the journal.
Jeffrey Anshel, OD, FAAO
Michael P. Cooper, OD
Alan G. Kabat, OD, FAAO
Mohammad Rafieetary, OD, FAAO
Joseph Sowka, OD, FAAO
Ocular Nutrition Society
Encinitas, CA
Chous Eye Care Associates
Tacoma, WA
Southern College of Optometry
Memphis, TN
Charles Retina Institute
Memphis, TN
Sherry J. Bass, OD, FAAO
Douglas K. Devries, OD
David L. Kading, OD, FAAO
Michael Rothschild, OD
Nova Southeastern University College
of Optometry
Fort Lauderdale, FL
SUNY College of Optometry
New York, NY
Eye Care Associates of Nevada
Sparks, NV
Specialty Eyecare Group
Kirkland, WA
West Georgia Eye Care
Carrollton, GA
Justin Bazan, OD
Steven Ferucci, OD, FAAO
Danica J. Marrelli, OD, FAAO
John Rumpakis, OD, MBA
Park Slope Eye
Brooklyn, NY
Sepulveda VA Ambulatory Care
Center and Nursing Home
Sepulveda, CA
University of Houston College
of Optometry
Houston, TX
Practice Resource Management
Lake Oswego, OR
Lisa Frye, ABOC, FNAO
Katherine M. Mastrota, MS, OD, FAAO
Eye Care Associates
Birmingham, AL
Omni Eye Surgery
New York, NY
Eyecare Consultants Vision Source
Englewood, CO
Ben Gaddie, OD, FAAO
John J. McSoley, OD
Gaddie Eye Centers
Louisville, KY
University of Miami Medical Group
Miami, FL
University of Alabama at Birmingham
School of Optometry
Birmingham, AL
David I. Geffen, OD, FAAO
Ron Melton, OD, FAAO
Peter Shaw-McMinn, OD
Gordon Weiss Schanzlin
Vision Institute
San Diego, CA
Educators in Primary Eye Care LLC
Charlotte, NC
Southern California College of Optometry William D. Townsend, OD, FAAO
Sun City Vision Center
Advanced Eye Care
Sun City, CA
Canyon, TX
Jeffry D. Gerson, OD, FAAO
Highland, CA
Diana L. Shechtman, OD, FAAO
William J. Tullo, OD, FAAO
Patricia A. Modica, OD, FAAO
Nova Southeastern University
Fort Lauderdale, FL
TLC Laser Eye Centers/
Princeton Optometric Physicians
Princeton, NJ
Marc R. Bloomenstein, OD, FAAO
Schwartz Laser Eye Center
Scottsdale, AZ
Crystal Brimer, OD
Crystal Vision Services
Wilmington, NC
Mile Brujic, OD
Premier Vision Group
Bowling Green, OH
Benjamin P. Casella, OD
Casella Eye Center
Augusta, GA
Michael A. Chaglasian, OD
Illinois Eye Institute
Chicago, IL
WestGlen Eyecare
Shawnee, KS
Milton M. Hom, OD, FAAO
A. Paul Chous, OD, MA
Azusa, CA
Chous Eye Care Associates
Tacoma, WA
Renee Jacobs, OD, MA
magenta
cyan
yellow
black
Practice Management Depot
Vancouver, BC
Pamela J. Miller, OD, FAAO, JD
SUNY College of Optometry
New York, NY
Laurie L. Pierce, LDO, ABOM
Hillsborough Community College
Tampa, FL
John L. Schachet, OD
Leo P. Semes, OD
Joseph P. Shovlin, OD, FAAO, DPNAP
Northeastern Eye Institute
Scranton, PA
Kirk Smick, OD
Clayton Eye Centers
Morrow, GA
Loretta B. Szczotka-Flynn, OD, MS, FAAO
University Hospitals Case Medical Center
Cleveland, OH
Marc B. Taub, OD, MS, FAAO, FCOVD
Southern College of Optometry
Memphis, TN
Tammy Pifer Than, OD, MS, FAAO
University of Alabama at
Birmingham School of Optometry
Birmingham, AL
J. James Thimons, OD, FAAO
Ophthalmic Consultants of Fairfield
Fairfield, CT
Walter O. Whitley, OD, MBA, FAAO
Virginia Eye Consultants
Norfolk, VA
Kathy C. Yang-Williams, OD, FAAO
Roosevelt Vision Source PLLC
Seattle, WA
ES556137_OP0215_003.pgs 01.20.2015 20:59
ADV
[email protected]
4
FEBRUARY 2015
• VOL. 6, NO. 02
Content
CONTENT CHANNEL DIRECTOR Gretchyn M. Bailey, NCLC, FAAO
[email protected] 215/412-0214
CONTENT SPECIALIST Colleen McCarthy
[email protected] 440/891-2602
VIDEO GALLERY Follow us to stay up-to-date with the latest news
GROUP CONTENT DIRECTOR Mark L. Dlugoss
[email protected] 440/891-2703
GROUP ART DIRECTOR Robert McGarr • ART DIRECTOR Lecia Landis
Publishing/Advertising
and advice, then join in the conversation and share with your peers.
EXECUTIVE VICE PRESIDENT Georgiann DeCenzo
[email protected] 440/891-2778
USING QUESTIONNAIRES TO IDENTIFY DRY EYE
VP, GROUP PUBLISHER Ken Sylvia
[email protected] 732/346-3017
GROUP PUBLISHER Leonardo Avila
[email protected] 302/239-5665
In this video, Dr. Leslie O’Dell discusses how asking the right questions can
help identify dry eye patients who may not realize that they have a problem.
Dr. O’Dell utilizes the Standard Patient Evaluation of Eye Dryness (SPEED)
questionnaire. To read more from Dr. O’Dell, turn to page 34. http://ow.ly/HIr43
ASSOCIATE PUBLISHER Erin Schlussel
[email protected] 215/962-5399
NATIONAL ACCOUNT MANAGER Cherie Pearson
[email protected] 609/636-0172
DIR. OF BUSINESS DEVELPMENT, HEALTHCARE TECHNOLOGY SALES Margie Jaxel
[email protected] 732/346-3003
ACCOUNT MANAGER, CLASSIFIED/DISPLAY ADVERTISING Karen Gerome
[email protected] 440/891-2670
WHAT’S TRENDING IN
ALLERGY TREATMENT
STAYING HIPAA
COMPLIANT ONLINE
HOW TO GET
SAMPLES
Dr. Ernie Bowling talks
about the latest treatments
for ocular allergies in this
new video.
Dr. Justin Bazan
shares his tips for staying
HIPPA compliant on
social media platforms.
http://ow.ly/HIrC7
http://ow.ly/HIrXA
Dr. Scott Schachter
explains the best ways
to get samples for your
patients from pharma
reps.
ACCOUNT MANAGER, RECRUITMENT ADVERTISING Joanna Shippoli
[email protected] 440/891-2615
http://ow.ly/HIshA
BUSINESS DIRECTOR, EMEDIA Don Berman
[email protected] 212/951-6745
SPECIAL PROJECTS DIRECTOR Meg Benson
[email protected] 732/346-3039
DIRECTOR OF MARKETING & RESEARCH SERVICES Gail Kaye
[email protected] 732/346-3042
SALES SUPPORT Hannah Curis
[email protected] 732/346-3055
REPRINTS 877-652-5295 ext. 121, [email protected]
Outside US, UK, direct dial: 281-419-5725. Ext. 121
LIST ACCOUNT EXECUTIVE Renée Schuster
[email protected] 440/891-2613
PERMISSIONS/INTERNATIONAL LICENSING Maureen Cannon
[email protected] 440/891-2742
TOP HEADLINES Check out
what your colleagues are reading.
1
2
3
Production
Optometry Times
app user breakdown:
Vision therapy:
A top 10 must-have list
38%
Two-way communication
is essential to patient care
One door vs. two door
debate continues
OptometryTimes.com/onedoorvstwodoor
62%
FEMALE
OPTOMETRY TIMES does not verify any claims or other information appearing in any of the advertisements contained in the publication, and cannot take responsibility for any losses or other damages incurred
by readers in reliance of such content.
Get access to all the
benefits Optometry Times offers at your fingertips. The Optometry
Times app for iPad and iPhone is now free in the iTunes store.
OPTOMETRY TIMES cannot be held responsible for the safekeeping or return of unsolicited articles,
manuscripts, photographs, illustrations or other materials.
Library Access Libraries offer online access to current and back issues of Optometry Times through the
EBSCO host databases.
To subscribe, call toll-free 888-527-7008. Outside the U.S. call 218/740-6477.
OPTOMETRY TIMES (Print ISSN: 0890-7080, Digital ISSN: 2328-3904) is published monthly (12 issues)
by UBM Advanstar, 131 W. First Street, Duluth, MN 55802-2065. Subscription rates: $49 for one year in the
United States & Possessions; $59 for one year in Canada and Mexico, and $89 for one year for all other countries. Periodicals Postage paid at Duluth MN 55806 and additional mailing offices. POSTMASTER: Please
send address changes to OPTOMETRY TIMES, P.O. Box 6089, Duluth, MN 55806-6089. Canadian G.S.T. number: R-124213133RT001, PUBLICATIONS MAIL AGREEMENT NO. 40612608, Return Undeliverable Canadian
Addresses to: IMEX Global Solutions, P. O. Box 25542, London, ON N6C 6B2, CANADA. Printed in the U.S.A.
MISSION STATEMENT
Optometry Times is an optometry-driven publication that
disseminates news and information of a clinical, socioeconomic, and political
nature in a timely and accurate manner for members of the optometric
community. In partnership with our readers, we will achieve mutual success by:
CHIEF EXECUTIVE OFFICER Joe Loggia
EXECUTIVE VICE-PRESIDENT, CAO & CFA Tom Ehardt
EXECUTIVE VICE-PRESIDENT Georgiann DeCenzo
EXECUTIVE VICE-PRESIDENT Chris DeMoulin
EXECUTIVE VICE-PRESIDENT, BUSINESS SYSTEMS Rebecca Evangelou
EXECUTIVE VICE-PRESIDENT, HUMAN RESOURCES Julie Molleston
EXECUTIVE VICE-PRESIDENT, STRATEGY & BUSINESS DEVELOPMENT Mike Alic
SR VICE-PRESIDENT Tracy Harris
VICE-PRESIDENT, GENERAL MANAGER PHARM/SCIENCE GROUP Dave Esola
VICE-PRESIDENT, LEGAL Michael Bernstein
VICE-PRESIDENT, MEDIA OPERATIONS Francis Heid
VICE-PRESIDENT, TREASURER & CONTROLLER Adele Hartwick
UBM Advanstar provides certain customer contact data (such as customers’ names, addresses, phone
numbers, and e-mail addresses) to third parties who wish to promote relevant products, services, and
other opportunities that may be of interest to you. If you do not want UBM Advanstar to make your contact
information available to third parties for marketing purposes, simply call toll-free 866/529-2922 between
the hours of 7:30 a.m. and 5 p.m. CST and a customer service representative will assist you in removing your
name from UBM Advanstar’s lists. Outside the U.S., please phone 218/740-6477.
OPTOMETRY TIMES APP
Optometry Times is part of the
ModernMedicine Network, a Webbased portal for health professionals
• Being a forum for optometrists to communicate their clinical knowledge, insights, and discoveries. offering best-in-class content and
• Providing management information that allows optometrists to enhance and expand their practices. tools in a rewarding and easy-to-use
environment for knowledge-sharing
• Addressing political and socioeconomic issues that may either assist or hinder the optometric
community, and reporting those issues and their potential outcomes to our readers.
among members of our community.
magenta
cyan
yellow
black
Circulation
CORPORATE DIRECTOR Joy Puzzo
DIRECTOR Christine Shappell
MANAGER Molly Tomfohrde
MALE
OptometryTimes.com/visiontherapy
OptometryTimes.com/communication
SENIOR PRODUCTION MANAGER Karen Lenzen
©2015 Advanstar Communications Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording, or information storage and retrieval without permission in writing from the publisher. Authorization to
photocopy items for internal/educational or personal use, or the internal/educational or personal use of
specific clients is granted by Advanstar Communications Inc. for libraries and other users registered with
the Copyright Clearance Center, 222 Rosewood Dr. Danvers, MA 01923, 978-750-8400 fax 978-646-8700
or visit http://www.copyright.com online. For uses beyond those listed above, please direct your written
request to Permission Dept. fax 440-756-5255 or email: [email protected]
ES558256_OP0215_004.pgs 01.23.2015 02:41
ADV
In Focus
| praCtiCal ChairSide adviCe
Supplements
Continued from page 1
the top-selling products do not contain identical ingredient dosages to formulas proven effective in clinical trials.
Addressing AREDS2 controversies
“All of the ocular nutritional supplements contained the ingredients from the AREDS or AREDS2 formula; 36 percent
(4/11) of the supplements contained equivalent doses of
AREDS or AREDS2 ingredients; 55 percent (6/11) included
some information about the AREDS on their consumer information websites,” the study’s authors write.
“Product descriptions from four of the 11 supplements
(36 percent) stated that the supplements were important
to maintain general eye health; none of these supplements
duplicated the AREDS or AREDS2 formula. All the individual supplements claimed to ‘support,’ ‘protect,’ ‘help,’
or ‘promote’ vision and eye health, but none specified that
there is no proven benefit in using nutritional supplements
for primary prevention of eye disease.”
The study’s authors say their findings emphasize the
importance of eyecare professionals educating their patients on the evidence-based role of supplements in the
management of eye health. Optometry Times Editorial Advisory Board member Steven Ferrucci, OD, FAAO, agrees.
“This article, in my mind, underscores the importance
of patient education regarding vitamin supplements and
the eye, specifically AMD,” he says. “The doctor should
recognize which patients are candidates for nutritional
supplementation, and exactly what supplement is most
appropriate for that given patient.”
Dr. Ferrucci says that the doctor’s recommendation is
key in ensuring the patient is taking the correct supplement for their condition. “Just like we as optometrists recommend specific contact lenses, contact lens solutions, or
progressive lenses, we should be recommending specific
nutritional supplements that contain the correct ingredients for the appropriate patients,” he says. “Products that
adhere to the AREDS2 formulation are the most appropriate because they have been the most validated by studies,
most notably the AREDS2 study that was released last May.”
The study also mentioned that a noted side effect in
AREDS was the increase in genitourinary hospitalizations,
a known side effect of high dosages of zinc.
“Since AREDS2 found no significant difference in progression to advanced AMD using 80 mg vs. 25 mg of zinc,
the practitioner should be aware of this when counseling AMD patients about ocular vitamins,” says Optometry
Times Editorial Advisory Board member Sherry Bass, OD,
FAAO. “There are other formulations available—not studied
here—with AREDS ingredients but with low-dose zinc. “
“Bausch + Lomb fully supports the efforts of researchers and organizations to study the role of vitamins in eye
health and to help clarify their benefits for clinicians and
patients,” says Kristy Marks, manager, product public relations at Bausch + Lomb.
Marks noted that three of the four supplements that were
found to have the same ingredients in the same concentra-
magenta
cyan
yellow
black
tion as those used in the AREDS and
AREDS2 studies were Bausch + Lomb
products— PreserVision Eye Vitamin
AREDS Formula Tablets, PreserVision Eye Vitamin AREDS Formula
Soft Gels, and PreserVision AREDS2
Formula.
Donna Lorenson, spokesperson for
Alcon, said the company is evaluating
study results. Alcon’s ICaps AREDS
Formula supplement represented the
fourth supplement that had the same
ingredients in the same concentrations as AREDS and AREDS2.
“As stated in this study, there are
currently no regulations for the vitamin industry,” says Dr. Bass. “Regulation may be needed, not only to
prevent wasteful spending, but more
5
importantly, to reduce the risk of side
effects from the unnecessarily high
dosages of some ingredients.”
Unproven is not disproven
Commentary from Dr. Stuart Richer
This meticulously written, but narrowly focused article concerns ocular nutritional supplements for the
primary prevention of eye disease.
While there’s a dearth of long-term
multi-year studies on the efficacy of
nutritional supplements on progression
of early AMD, there are several international placebo controlled, doublemasked, randomized controlled trials evaluating improvement of vision
function in these same patients. That
See Supplements on page 6
Income limiters
for the eyecare practitioner
30% Reimbursement
12%
11%
8%
decreases
Changes from
healthcare reform
Personal choice
(work less, etc.)
Patient volume/
patient load
7%
6%
4%
4%
2%
16%
Payer mix
Overhead increases
Competition with other ODs
Inefficiency
Malpractice premium costs
Other
Source: Opthalmology Times
ES558391_OP0215_005.pgs 01.23.2015 03:42
ADV
6
In Focus
Screening
Continued from page 1
“It would be great if every preschool child
received a comprehensive eye exam, but that
is not the current reality,” says Susan Cotter,
OD, MS, FAAO, lead author of the recommendations, speaking exclusively to Optometry
Times. “However, many kids undergo a vision screening in their pediatricians’ offices
or at a Head Start or community screening.
Opinions vary widely regarding which techniques should be used.”
The panel and recommendations
The National Expert Panel consists of leading
professionals in optometry, ophthalmology,
pediatrics, public health, and other related
fields. Dr. Cotter says the panel reviewed the
current scientific literature to explore best
practices for vision screenings for children
in this age range.
The panel recommends that children 36 to
72 months be screened annually (best practice)
or at least once using one of the best-practice
approaches (accepted minimum standard).
There are two best practice vision-screen-
Supplements
Continued from page 5
is not a trivial issue, as early AMD indeed
affects vision, and macular re-pigmentation
through dietary carotenoid supplementation
(lutein/zeaxanthin) quickly improves night
driving visual ability.1,2
Higher-dosed zeaxanthin has also been
shown to lengthen the treatment cycle between anti-VEGF injections and other invasive procedures. When 20 mg of dietary
zeaxanthin (Z-RR) was added to patients
receiving triple therapy for exudative AMD
(PDT, dexamethasone, and bevacizumab),
the number of treatment cycles required to
achieve stabilization with comparable visual acuity results was reduced by about
25 percent.3 Nonetheless, the question of
supplementation efficacy for an aging population, in terms of disease progression, requires further insight and study.
The authors’ conclusions exemplify another failure of the evidence-based medicine scientific model to provide solutions for
actual patients concerned about individual
chronic medical conditions, including AMD
as well as those who do not respond to antiVEGF injections.4,5 Statistical medicine pro-
magenta
cyan
yellow
black
February 2015
ing methods for preschool-aged children. The
first, according to the experts, is monocular
visual acuity testing using single HOTV letters or LEA Symbols surrounded by crowding bars at a 5-ft test distance, with the child
responding by either matching or naming.
The second is instrument-based testing using
the Retinomax autorefractor or the SureSight
Vision Screener with the Vision in Preschoolers (VIP) Study data software installed (version 2.24 or 2.25 set to minus cylinder form).
AOA survey finds parents are
unaware of infant vision needs
|
“If a child undergoes a vision screening,
then we want it to be a good one—that is, a
screening that has a high likelihood of correctly identifying the kids in need of professional eye care. With the best tests, lay or
nurse screeners can identify 78 to 88 percent
of preschool children with the most severe
vision conditions,” she says. “Finally, there
also must be mechanisms in place to ensure
that the children who fail the screenings receive appropriate follow-up care with an optometrist or ophthalmologist.”
Collecting screening data
The recommendations say that using the Plusoptix Photoscreener is acceptable practice, as
is adding stereoacuity testing using the Preschool Assessment of Stereopsis with a Smile
(PASS) stereotest as a supplemental procedure
to visual acuity testing or auto-refraction.
“Our goal was to determine the methods
expected to provide the ‘most bang for your
buck’ in identifying amblyopia, strabismus,
significant refractive error, and their associated risk factors, when used by a nurse or
lay screener in educational, community, public health, or primary healthcare settings,”
says Dr. Cotter.
The National Expert Panel also calls for the
creation of the development and implementation of an integrated data system for recording vision screening and eyecare follow-up
outcomes in preschool-aged children.
“Currently, there is a lack of data on the
proportion of children screened and no effective system to ensure that children who fail
screenings access appropriate comprehensive eye examinations and follow-up care,”
the authors write.
The panel also recommends a standardized approach to measuring progress toward
viding an exact AREDS2 formulation of a
few high-dosed nutrients to high-risk AMD
patients at best reduces the overall risk of
catastrophic visual loss by only one third.
Moreover, recent AREDS2 data provide little
guidance for the unfortunate AMD patient
with geographic atrophy.6
Isn’t it our individual moral imperative as
doctors to attempt to save vision with nutrients “not on the list?” This has been accomplished in individual cases with a resveratrol-based supplement at our medical center.7
Unfortunately, the authors draw the conclusion that ophthalmologists need not consider supplementation for chronic eye disease
prevention beyond “evidence-based” publications. This conveniently leaves open only
the possibility for drug-based treatment(s)
and “detect–collect” protocols. What we are
really interested in is an AMD prevention
diet, along with a wider array of nutrients
and environmental measures to shift the
discussion to “prevention-cure.”
I applaud manufacturers large and small
and private entrepreneurs who are moving
beyond the narrow constraints of evidencebased medicine in providing doctors and patients with choices where none now exist.
In summary, this publication provides little
direction and little room for innovation, discretion, and medical judgment.
See Screening on page 13
RefeRences
1. Richer S, Park D-W, Epstein R, et al. Macular
Re-pigmentation Enhances Driving Vision in Elderly
Adult Males with Macular Degeneration. J Clin Exp
Ophthalmology. 2012 April.
2. Yao Y, et al. Lutein supplementation improves visual
performance in Chinese drivers: 1 -year randomized,
double-blind, placebo-controlled study, Nutrition. 2013
Jul-Aug;29 (7-8):958-64.
3. Peralta E, Olk RJ, et al. Oral zeaxanthin improves
anatomic and visual outcome of triple therapy for
subfoveal CNV in age-related macular degeneration.
Retina Society Meeting, poster Sept 21th-25th, 2011,
Rome, Italy.
4. Hickey S and Roberts H, Tarnished Gold: The Sickness
of Evidence-based Medicine, ISBN 9781466397293.
5. The NNT. Quick summaries of evidence-based
medicine. Available at: www.the nnt.com Accessed
01/07/2015.
6. Age-Related Eye Disease Study 2 (AREDS2) Research
Group, Chew EY, Clemons TE, Sangiovanni JP, Danis RP,
Ferris FL 3rd et al, Secondary analyses of the effects of
lutein/zeaxanthin on age-related macular degeneration
progression: AREDS2 report No. 3. JAMA Ophthalmol.
2014 Feb;132(2):142-9.
7. Richer S, Stiles W, Ulanski L, Carroll D, Podella
C, Observation of human retinal remodeling in
octogenarians with a resveratrol based nutritional
supplement. Nutrients. 2013 Jun 4;5(6):1989-2005.
ES558389_OP0215_006.pgs 01.23.2015 03:41
ADV
RELIEF AT THE MAIN SOURCE
of dry eye symptoms
Target Lipid Layer Deficiency:
Soothe XP
®
With Restoryl® Mineral Oils
Recommend Soothe XP as your first choice for dry eye patients.
To request samples, please call 1-800-778-0980.
Now available at major retailers nationwide.
Distributed by Bausch + Lomb, a Division of Valeant Pharmaceuticals North America LLC, Bridgewater, N.J. © 2014 Bausch & Lomb Incorporated. Soothe and Restoryl are trademarks of Bausch & Lomb Incorporated or its afliates.
All other brand/product names are trademarks of their respective owners. PNS07316 US/SXP/14/0006
magenta
cyan
yellow
black
ES558313_OP0215_007_FP.pgs 01.23.2015 03:38
ADV
8
Opinion
FEBRUARY 2015
|
Treat rosacea by treating
the cause—demodex
I now believe rosacea can be treated by battling demodex with tea tree oil
By Milton M. Hom, OD, FAAO,
FACAAI (Sc)
no cure. Prescribing several treatments in clinical practice with little
to no success is almost the norm.
Based on the studies, I really do
think the demodex mite causes rosacea. Our patterns of frustration
with rosacea pretty much follow
the patterns with demodex. Try
this, try that. ears ago, Mark Dunbar, OD,
FAAO, of Bascom Palmer
shared with me some cases
about rosacea. I was a little
taken aback because the cases he
MILTON M. HOM,
OD, FAAO, FACAAI
shared concerned Hispanic patients,
(SC)
not the usual patients of Northern
English isles descent we read about
Tea tree oil treatment
in school. The skeptic in me was doubtful,
We know that the best treatment for demoeven though Mark had great pictures and
dex is tea tree oil.9 Tea tree oil is merciless
detailed data from the cases.
against the mite. It comes in pads, ointments,
Fast forward to today. Dry eyes and lid
soaps, shampoos, etc. We have noticed it
disease are the main buzzwords in ocular
is also effective against rosacea. Typically,
surface. In the past, everyone had aqueous
we recommend the patient to use the tea
tear deficiency, now everyone has meibomian gland dysfunction (MGD)/evaporative/
blepharitis. With respect to blepharitis, Gary
Gerber, OD, says it seems like staphylococcus has left the planet and demodex has
taken its place.1
Y
Demodex and rosacea
So, let’s look at the demodex prevalence
studies. Three studies posit the rates of demodex in blepharitis: 62.9 percent, 88 percent, 97 percent of patients with blepharitis have demodex.2-5 The figures are not
exactly the same, but they all represent the
majority. There was a time when I believed
97%
of patients with blepharitis
have demodex; other studies posit 63% or 88%
there was blepharitis and, on a rare occasion, demodex blepharitis. Now, I believe
that most blepharitis is actually caused by
demodex. Yes, it is that prevalent.
What does this have to do with rosacea?
Recent research has pointed to an undeniable link between rosacea and demodex.
Meta-analysis of several studies bears this
out.5 Demodex even shares the same bacteria as rosacea patients.7,8
We are aware of the treatments for rosacea, and we know it is a chronic disease.
Most of the treatments are palliative; there is
magenta
cyan
yellow
black
3. Alejo RL, Valenton MJ, Abendanio R. Demodex
folliculorum infestation of the lids in Filipinos. Philipp J
Ophthalmol. 1972;4:110Y3.
4. De Venecia AB, Siong RL. Demodes sp. infestation
in anterior blepharitis, meibomian gland dysfunction,
and mixed blepharitis. Philipp J Ophthalmol.
2011;36:15Y22.
5. Zhao YE, Wu LP, Hu L, et al. Association of
blepharitis with Demodex: a meta-analysis.
Ophthalmic Epidemiol. 2012 Apr;19(2):95-102.
6. Zhao YE, Wu LP, Peng Y, et al. Retrospective
analysis of the association between Demodex
infestation and rosacea. Arch Dermatol. 2010
Aug;146(8):896-902. 7. Li J, O’Reilly N, Sheha H, et al. Correlation
between ocular Demodex infestation and serum
immunoreactivity to Bacillus proteins in patients with
facial rosacea. Ophthalmology. 2010 May;117(5)870877. There was a time when I believed there
was blepharitis and, on a rare occasion,
demodex blepharitis. Now, I believe that
most blepharitis is actually caused by
demodex.
tree oil wipes on their face after using on
the lids. The results have been excellent.
Patients for the first time have the redness
in their cheeks resolve. The mite does not
only reside in the lashes, it also resides in
the skin. Our luck in treating rosacea has
increased when we think of it as a demodex problem first.
Since learning more about demodex, I
am seeing much more rosacea than ever,
even in places I would never expect, like
my own clinical practice. Because my patient demographic is mostly Hispanic, I am
seeing lots of rosacea and demodex in, of
course, mostly Hispanics.
Mark Dunbar, you were right all along.
REFERENCES
1. Power Hour. http://powerhour.info/demodex-andblepharitis-where-were-you-5-years-ago. Accessed
1/5/15.
2. Sumer Z, Arıcı MK, Topalkara A, et al. Incidence of
Demodex folliculorum in chronic blepharitis patients.
Cumhuriyet Univ Tıp Fak Dergisi. 2000;22:69Y72.
8. Jarmuda S, O’Reilly N, Zaba R, et al. Potential role
of Demodex mites and bacteria in the induction of
rosacea. J Med Microbiol. 2012 Nov;61(Pt. 11):150410.
9. Hom M, Mastrota K, Schachter SE. Demodex.
Optom Vis Sci. 2013 Jul;90(7):e198-205.
Dr. Hom receives research support from, or serves as a
consultant to, Abbott Medical Optics, Allergan, Bausch +
Lomb, CibaVision/Alcon, CooperVision, Essilor, and Inspire
Pharmaceuticals.
[email protected]
WANT MORE STORIES ON
DEMODEX? WE GOT ‘EM!
A different approach to treating demodex
blepharitis
OptometryTimes.com/treatdemodex
Diagnosing demodex
OptometryTimes.com/diagnosedemodex
Why has demodex gone viral?
OptometryTimes.com/viraldemodex
ES556135_OP0215_008.pgs 01.20.2015 20:59
ADV
SYMPTOMATIC VITREOMACULAR
ADHESION (VMA)
SYMPTOMATIC VMA MAY LEAD TO VISUAL IMPAIRMENT FOR YOUR PATIENTS1-3
IDENTIFY
REFER
Recognize metamorphopsia as a key sign of symptomatic VMA
and utilize OCT scans to confirm vitreomacular traction.
Because symptomatic VMA is a progressive condition that may lead
to a loss of vision, your partnering retina specialist can determine
if treatment is necessary.1-3
THE STEPS YOU TAKE TODAY MAY MAKE A DIFFERENCE
FOR YOUR PATIENTS TOMORROW
© 2014 ThromboGenics, Inc. All rights reserved. ThromboGenics, Inc., 101 Wood Avenue South, Suite 610, Iselin, NJ 08830 – USA. THROMBOGENICS and the THROMBOGENICS logo are trademarks or registered trademarks of
ThromboGenics NV. 9/14 OCRVMA0220
References: 1. Sonmez K, Capone A, Trese M, et al. Vitreomacular traction syndrome: impact of anatomical configuration on anatomical and visual outcomes. Retina. 2008;28:1207-1214. 2. Hikichi T, Yoshida A,
Trempe CL. Course of vitreomacular traction syndrome. Am J Ophthalmol. 1995;119(1):55-56. 3. Stalmans P, Lescrauwaet B, Blot K. A retrospective cohort study in patients with diseases of the vitreomacular interface (ReCoVit).
Poster presented at: The Association for Research in Vision and Ophthalmology (ARVO) 2014 Annual Meeting; May 4-8, 2014; Orlando, Florida.
magenta
cyan
yellow
black
ES558312_OP0215_009_FP.pgs 01.23.2015 03:38
ADV
Opinion
10
February 2015
|
Looking back at a year
of Energeyes success
O
our success lies.
By Mark J. Uhler, OD
In the 16 months the Energeyes
n September 1, 2013, life was
Association has now been in busibreathed into this idea we
ness, we have garnered the support
now call the Energeyes Asof 422 dues-paying members. Our
sociation. I am humbled by
members, risk takers and adventhe experience to have completed
turers each and every one, have
our first full calendar year of operaBy MArK J.
supported our nascent organizations. It is no longer about launchuHlEr, Od
tion, shaped so many of our deciing or “getting off the ground” but
co-founder and
sions and provided the motivation
the true operationalizing, the impresident of
and impetus for all of us to conplementation, and the hard part
energeyes, the
tinue to make this journey a realof putting a great idea into action.
association of
corporate-affiliated
ity. Our members are pioneers in
I am reminded of what it must
optometrists
their own right.
have been like for the forefathers
of our country. I think for George
Washington, our reluctant first president, it
Taking a look back
wasn’t so much about being the first presiMuch of our best learning is conducted
dent but that we had ourselves a new counthrough reflection. As I reflect on this past
try with new ideals and plans. How exciting
calendar year, the staff, leadership, vendors,
that must have been. I have been privileged
and members of the Energeyes Association
to lead a different revolution that I believe
have accomplished so much. Remember back
is having, and will continue to have, a proto your first year of practice. Hopefully you
found effect on the future of optometry and
took a moment to reflect on what that first
the provision of eye care from coast to coast. year was like. Our Association’s first year of
practice had the following elements:
From the ground up
422 corporate optometrists are now duespaying ($250 per year) members.
Creating something where there is nothing
is never easy, no matter how great that idea
Our members come from Walmart, Sam’s
is. Read the stories of great innovators who
Club, LensCrafters, Costco, Sears, Pearle,
today we celebrate and applaud—the Wright
and Target. We are truly reaching corBrothers, Thomas Edison, Henry Ford, George
porate optometry.
Washington Carver—all fought uphill batOur members reside in 44 different states,
tles to bring new ideas to life. Some were
making us a true, national organization.
even laughed at for their innovations. EnThe programming we have developed,
ergeyes has also experienced our requisite
and continue to develop, includes free
In the 16 months the Energeyes Association
has been in business, we have garnered the
support of 422 dues-paying members.
share of starts and stops, steps backward,
delays, and all manner of obstacles for each
and every step we took forward.
Part of the secret of our success to date is
our Board of Directors—a courageous, resilient, innovative, professional group of people
I have ever had the privilege to serve with.
I use the word serve because these doctors
are volunteers generously giving of their talents and time. It is in this generosity where
magenta
cyan
yellow
black
professional websites for all members
(150+ have been implemented to date,
bringing an average of 5 new patients
per month to the participating practices;
60 new patients per year per practice!).
Our national meeting in Colorado Springs
in April 2014 was a huge success with
50 members attending (18 percent of
active membership), 22 vendors, and
12 speakers.
Our mentoring program has served 3
new members.
Our monthly webinar series is attended
by 30 to 50 members each month, with
an educational focus of the move to the
medical model.
Our Product Purchasing Program created a competitive bidding process for
three products to date: OCT, anterior
segment cameras, and patient communication tools.
Our newsletter is published monthly
and is read by over 1,000 optometrists.
We launched a new student program in
July designed to educate optometry students on the choices they have (including
corporate optometry) upon graduation.
We have turned our Board. I list this
as an accomplishment because it was
done seamlessly without a misstep. Those
doctors who helped get the Association
off the ground did not see their skills
fitting with a Board poised for growth.
Our additional Board members have
raised the bar on our Board, and I expect great things from the entire Board
in the coming year.
We are piloting products to ensure their
efficacy and appropriateness for a corporate practice and continue to have
vendors approach our association with
new product and service ideas.
I was fortunate to be recognized on behalf of the Association as one of the top
influencers in the industry by Jobson
Optometric Business Innovator’s program. This is a great illustration of the
positive impact we are having.
My colleague Dr. Eric Botts and I were
featured earlier this year on Dr. Gary
Gerber’s Power Hour radio show.
Of course these accomplishments sit atop
a legal, accounting, marketing, membership,
and operations structure that one year later
we all seem to take for granted. Suffice it
to say, that for this young start-up in our
first year of practice, we have accomplished
much and have laid a strong foundation for
our future.
dr. uhler is a pittsburgh native and leases space next to two
Walmart Vision centers in pittsburgh and carnegie, pa.
[email protected]
ES558387_OP0215_010.pgs 01.23.2015 03:41
ADV
For allergic conjunctivitis1
THE POWER
TO CALM
THE ITCH
BEPREVE® — FIRST-LINE, YEAR-ROUND,
WITH BROAD-SPECTRUM ALLERGEN COVERAGE
Scan this QR code or visit beprevecoupon.com to
• Order samples
• Learn about the automatic co-pay program
• Help your patients find participating pharmacies
INDICATION AND USAGE
BEPREVE® (bepotastine besilate ophthalmic solution) 1.5% is a histamine H1 receptor antagonist indicated for the treatment of
itching associated with signs and symptoms of allergic conjunctivitis.
IMPORTANT RISK INFORMATION
BEPREVE® is contraindicated in patients with a history of hypersensitivity
reactions to bepotastine or any of the other ingredients. BEPREVE® is for
topical ophthalmic use only. To minimize risk of contamination, do not touch
the dropper tip to any surface. Keep the bottle closed when not in use.
BEPREVE® should not be used to treat contact lens–related irritation.
Remove contact lenses prior to instillation of BEPREVE®.
The most common adverse reaction occurring in approximately 25% of
patients was a mild taste following instillation. Other adverse reactions
occurring in 2%‐5% of patients were eye irritation, headache,
and nasopharyngitis.
Made by the trusted eye-care
specialists at
Please see the accompanying prescribing information
for BEPREVE® on the following page.
Reference: 1. BEPREVE [package insert]. Tampa, FL: Bausch + Lomb, Inc; 2012.
For product-related questions and concerns, call 1-800-323-0000 or visit www.bepreve.com.
®/TM are trademarks of Bausch & Lomb Incorporated or its affiliates.
©2014 Bausch & Lomb Incorporated. US/BEP/12/0026a(1) 1/14
magenta
cyan
yellow
black
ES558309_OP0215_011_FP.pgs 01.23.2015 03:38
ADV
BEPREVE® (bepotastine besilate ophthalmic solution) 1.5%
HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information
needed to use BEPREVE® (bepotastine besilate
ophthalmic solution) 1.5% safely and effectively.
See full prescribing information for BEPREVE®.
BEPREVE® (bepotastine besilate ophthalmic
solution) 1.5%
Initial U.S. Approval: 2009
-------------RECENT MAJOR CHANGES-------------Contraindications (4)
06/2012
--------------INDICATIONS AND USAGE-------------BEPREVE® is a histamine H1 receptor antagonist
indicated for the treatment of itching associated
with allergic conjunctivitis. (1)
-----------DOSAGE AND ADMINISTRATION---------Instill one drop into the affected eye(s) twice a day
(BID). (2)
----------DOSAGE FORMS AND STRENGTHS-------Solution containing bepotastine besilate, 1.5%. (3)
-----------------CONTRAINDICATIONS----------------Hypersensitivity to any component of this product. (4)
------------------ADVERSE REACTIONS---------------The most common adverse reaction occurring in
approximately 25% of patients was a mild taste
following instillation. Other adverse reactions
which occurred in 2-5% of subjects were eye
irritation, headache, and nasopharyngitis. (6)
To report SUSPECTED ADVERSE REACTIONS,
contact Bausch & Lomb Incorporated. at 1-800-3230000, or FDA at 1-800-FDA-1088 or www.fda.gov/
medwatch.
See 17 for PATIENT COUNSELING INFORMATION
Revised: 10/2012
FULL PRESCRIBING INFORMATION:
CONTENTS*
1 INDICATIONS AND USAGE
2 DOSAGE AND ADMINISTRATION
3 DOSAGE FORMS AND STRENGTHS
4 CONTRAINDICATIONS
5 WARNINGS AND PRECAUTIONS
5.1 Contamination of Tip and Solution
5.2 Contact Lens Use
5.3 Topical Ophthalmic Use Only
6 ADVERSE REACTIONS
6.1 Clinical Trial Experience
6.2 Post-Marketing Experience
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.3 Nursing Mothers
8.4 Pediatric Use
8.5 Geriatric Use
11 DESCRIPTION
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.3 Pharmacokinetics
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis and
Impairment of Fertility
14 CLINICAL STUDIES
16 HOW SUPPLIED/STORAGE AND HANDLING
17 PATIENT COUNSELING INFORMATION
17.1 Topical Ophthalmic Use Only
17.2 Sterility of Dropper Tip
17.3 Concomitant Use of Contact Lenses
FULL PRESCRIBING INFORMATION
The most common reported adverse reaction
occurring in approximately 25% of subjects was a
mild taste following instillation. Other adverse
reactions occurring in 2-5% of subjects were eye
irritation, headache, and nasopharyngitis.
1 INDICATIONS AND USAGE
BEPREVE® (bepotastine besilate ophthalmic
solution) 1.5% is a histamine H1 receptor antagonist
indicated for the treatment of itching associated
with signs and symptoms of allergic conjunctivitis.
2 DOSAGE AND ADMINISTRATION
Instill one drop of BEPREVE into the affected
eye(s) twice a day (BID).
3 DOSAGE FORMS AND STRENGTHS
Topical ophthalmic solution containing
bepotastine besilate 1.5%.
4 CONTRAINDICATIONS
Bepreve is contraindicated in patients with a
history of hypersensitivity reactions to bepotastine
or any of the other ingredients [see Adverse
Reactions (6.2)].
5 WARNINGS AND PRECAUTIONS
5.1 Contamination of Tip and Solution
To minimize contaminating the dropper tip and
solution, care should be taken not to touch the
eyelids or surrounding areas with the dropper tip
of the bottle. Keep bottle tightly closed when not
in use.
5.2 Contact Lens Use
Patients should be advised not to wear a contact
lens if their eye is red. BEPREVE should not be
used to treat contact lens-related irritation.
BEPREVE should not be instilled while wearing
contact lenses. Remove contact lenses prior to
instillation of BEPREVE. The preservative in
BEPREVE, benzalkonium chloride, may be
absorbed by soft contact lenses. Lenses may be
reinserted after 10 minutes following
administration of BEPREVE.
5.3 Topical Ophthalmic Use Only
BEPREVE is for topical ophthalmic use only.
6 ADVERSE REACTIONS
6.1 Clinical Trials Experience
Because clinical trials are conducted under
widely varying conditions, adverse reaction rates
observed in the clinical trials of a drug cannot be
directly compared to rates in the clinical trials of
another drug and may not refect the rates
observed in clinical practice.
black
-----------WARNINGS AND PRECAUTIONS---------• Tominimizetheriskofcontamination,donot
touch dropper tip to any surface. Keep bottle
tightly closed when not in use. (5.1)
• BEPREVEshouldnotbeusedtotreatcontact
lens-related irritation. (5.2)
• Removecontactlensespriortoinstillationof
BEPREVE. (5.2)
*Sections or subsections omitted from the full
prescribing information are not listed
6.2 Post Marketing Experience
Hypersensitivity reactions have been reported
rarely during the post-marketing use of BEPREVE.
Because these reactions are reported voluntarily
from a population of unknown size, it is not
always possible to reliably estimate their
frequency or establish a casual relationship to
drug exposure. The hypersensitivity reactions
include itching, body rash, and swelling of lips,
tongue and/or throat.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
Pregnancy Category C: Teratogenicity studies
have been performed in animals. Bepotastine
besilate was not found to be teratogenic in rats
during organogenesis and fetal development at
oral doses up to 200 mg/kg/day (representing a
systemic concentration approximately 3,300 times
that anticipated for topical ocular use in humans),
but did show some potential for causing skeletal
abnormalities at 1,000 mg/kg/day. There were no
teratogenic effects seen in rabbits at oral doses
up to 500 mg/kg/day given during organogenesis
and fetal development (>13,000 times the dose in
humans on a mg/kg basis). Evidence of infertility
was seen in rats given oral bepotastine besilate
1,000 mg/kg/day; however, no evidence of
infertility was observed in rats given 200 mg/kg/
day (approximately 3,300 times the topical ocular
use in humans). The concentration of radiolabeled bepotastine besilate was similar in fetal
liver and maternal blood plasma following a single
3 mg/kg oral dose. The concentration in other
fetal tissues was one-third to one-tenth the
concentration in maternal blood plasma.
An increase in stillborns and decreased growth
and development were observed in pups born
from rats given oral doses of 1,000 mg/kg/day
during perinatal and lactation periods. There
were no observed effects in rats treated with
100 mg/kg/day.
There are no adequate and well-controlled
studies of bepotastine besilate in pregnant
women. Because animal reproduction studies are
not always predictive of human response,
BEPREVE® (bepotastine besilate ophthalmic
solution) 1.5% should be used during pregnancy
only if the potential beneft justifes the potential
risk to the fetus.
8.3 Nursing Mothers
Following a single 3 mg/kg oral dose of radiolabeled
bepotastine besilate to nursing rats 11 days after
delivery, the maximum concentration of radioactivity
in milk was 0.40 mcg-eq/mL 1 hour after
administration; at 48 hours after administration the
concentration was below detection limits. The milk
concentration was higher than the maternal blood
plasma concentration at each time of measurement.
It is not known if bepotastine besilate is excreted
in human milk. Caution should be exercised when
BEPREVE (bepotastine besilate ophthalmic
solution) 1.5% is administered to a nursing woman.
8.4 Pediatric Use
Safety and effcacy of BEPREVE (bepotastine
besilate ophthalmic solution) 1.5% have not been
established in pediatric patients under 2 years of
age. Effcacy in pediatric patients under 10 years
of age was extrapolated from clinical trials
conducted in pediatric patients greater than 10
years of age and from adults.
8.5 Geriatric Use
No overall difference in safety or effectiveness has
been observed between elderly and younger patients.
11 DESCRIPTION
BEPREVE (bepotastine besilate ophthalmic
solution) 1.5% is a sterile, topically administered
drug for ophthalmic use. Each mL of BEPREVE
contains 15 mg bepotastine besilate.
Bepotastine besilate is designated chemically as
(+) -4-[[(S)-p-chloro-alpha -2-pyridylbenzyl]oxy]-1piperidine butyric acid monobenzenesulfonate.
The chemical structure for bepotastine besilate is:
Bepotastine besilate is a white or pale yellowish
crystalline powder. The molecular weight of
®
bepotastine besilate is 547.06 daltons. BEPREVE
ophthalmic solution is supplied as a sterile,
aqueous 1.5% solution, with a pH of 6.8.
The osmolality of BEPREVE (bepotastine besilate
ophthalmic solution) 1.5% is approximately
290 mOsm/kg.
Each mL of BEPREVE® (bepotastine besilate
ophthalmic solution) 1.5% contains:
Active: Bepotastine besilate 15 mg (equivalent to
10.7 mg bepotastine)
Preservative: benzalkonium chloride 0.005%
Inactives: monobasic sodium phosphate
dihydrate, sodium chloride, sodium hydroxide to
adjust pH, and water for injection, USP.
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
Bepotastine is a topically active, direct H1receptor antagonist and an inhibitor of the release
of histamine from mast cells.
12.3 Pharmacokinetics
Absorption: The extent of systemic exposure to
bepotastine following topical ophthalmic
administration of bepotastine besilate 1% and 1.5%
ophthalmic solutions was evaluated in 12 healthy
adults. Following one drop of 1% or 1.5% bepotastine
besilate ophthalmic solution to both eyes four times
daily (QID) for seven days, bepotastine plasma
concentrations peaked at approximately one to two
hours post-instillation. Maximum plasma
concentration for the 1% and 1.5% strengths were
5.1 ± 2.5 ng/mL and 7.3 ± 1.9 ng/mL, respectively.
Plasma concentration at 24 hours post-instillation
were below the quantifable limit (2 ng/mL) in 11/12
subjects in the two dose groups.
Distribution: The extent of protein binding of
bepotastine is approximately 55% and
independent of bepotastine concentration.
Metabolism: In vitro metabolism studies with human
liver microsomes demonstrated that bepotastine is
minimally metabolized by CYP450 isozymes.
In vitro studies demonstrated that bepotastine
besilate does not inhibit the metabolism of various
cytochrome P450 substrate via inhibition of
CYP3A4, CYP2C9, and CYP2C19. The effect of
bepotastine besilate on the metabolism of
substrates of CYP1A2, CYP2C8, CYP2D6 was not
studied. Bepotastine besilate has a low potential
for drug interaction via inhibition of CYP3A4,
CYP2C9, and CYP2C19.
Excretion: The main route of elimination of
bepotastine besilate is urinary excretion (with
approximately 75-90% excreted unchanged in urine).
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis and
Impairment of Fertility
Long-term dietary studies in mice and rats were
conducted to evaluate the carcinogenic potential
of bepotastine besilate. Bepotastine besilate did
not signifcantly induce neoplasms in mice
receiving a nominal dose of up to 200 mg/kg/day
for 21 months or rats receiving a nominal dose of
up to 97 mg/kg/day for 24 months. These dose
levels represent systemic exposures
approximating 350 and 200 times that achieved
with human topical ocular use. The no observable
adverse effect levels for bepotastine besilate
based on nominal dose levels in carcinogenicity
tests were 18.7 to 19.9 mg/kg/day in mice and 9.6
to 9.8 mg/kg/day in rats (representing exposure
margins of approximately 60 and 20 times the
systemic exposure anticipated for topical ocular
use in humans).
There was no evidence of genotoxicity in the
Ames test, in CHO cells (chromosome aberrations),
in mouse hepatocytes (unscheduled DNA
synthesis), or in the mouse micronucleus test.
When oral bepotastine was administered to male
and female rats at doses up to 1,000 mg/kg/day,
there was a slight reduction in fertility index and
surviving fetuses. Infertility was not seen in rats
given 200 mg/kg/day oral bepotastine besilate
(approximately 3,300 times the systemic
concentration anticipated for topical ocular use
in humans).
14 CLINICAL STUDIES
Clinical effcacy was evaluated in 2 conjunctival
allergen challenge (CAC) studies (237 patients).
BEPREVE (bepotastine besilate ophthalmic
solution) 1.5% was more effective than its vehicle
for relieving ocular itching induced by an ocular
allergen challenge, both at a CAC 15 minutes postdosing and a CAC 8 hours post dosing of BEPREVE.
The safety of BEPREVE was evaluated in a
randomized clinical study of 861 subjects over a
period of 6 weeks.
16 HOW SUPPLIED/STORAGE AND HANDLING
BEPREVE® (bepotastine besilate ophthalmic
solution) 1.5% is supplied in a white low density
polyethylene plastic squeeze bottle with a white
controlled dropper tip and a white polypropylene
cap in the following size:
5 mL (NDC 24208-629-02)
10 mL (NDC 24208-629-01)
STORAGE
Store at 15º – 25ºC (59º – 77ºF).
17 PATIENT COUNSELING INFORMATION
17.1 Topical Ophthalmic Use Only
For topical ophthalmic administration only.
17.2 Sterility of Dropper Tip
Patients should be advised to not touch dropper tip
to any surface, as this may contaminate the contents.
17.3 Concomitant Use of Contact Lenses
Patients should be advised not to wear a contact
lens if their eye is red. Patients should be advised
that BEPREVE should not be used to treat contact
lens-related irritation.
Patients should also be advised to remove
contact lenses prior to instillation of BEPREVE.
The preservative in BEPREVE, benzalkonium
chloride, may be absorbed by soft contact lenses.
Lenses may be reinserted after 10 minutes
following administration of BEPREVE.
Manufactured by: Bausch & Lomb Incorporated
Tampa, FL 33637
Under license from:
Senju Pharmaceutical Co., Ltd.
Osaka, Japan 541-0046
®/TM are trademarks of Bausch & Lomb
Incorporated or its affliates
© 2012 Bausch & Lomb Incorporated.
US/BEP/13/0028
4/13
ES558310_OP0215_012_FP.pgs 01.23.2015 03:38
ADV
Opinion
| praCtiCal ChairSide adviCe
LetterS
To the Editor
More darndest patient stories
Chief Optometric Editor Ernie Bowling invited readers to share their funny patient stories (“Patients say the darndest things,” November 2014). Following are two responses we
received.
I refit a patient from one bifocal contact lens
to another.
Me: How do you feel with this new pair?
Patient: These aren’t as comfortable. My
hair gets into my eyes more with this brand.
Me: (what I was thinking): You need a
haircut.
I examined a gentleman and found significant hemorrhagic changes in his right eye. I
sent him directly to my buddy the retina specialist. His tech called to ask who was the referring doctor. I said it was myself, of course.
She told me the gentleman said he was seen
by the male doctor in my office. I am the only
doctor, and I am female. The optician, a man,
did have the patient sign insurance forms. I
guess this patient will need some glasses after
the retinal treatment!
Thanks for letting me vent.
Anne Rafal, OD
Brooklyn, NY
My father-in-law was monocular. He would
wear only an executive bifocal. When I first examined him in the UABSO clinic, he obtained
new glasses. I was so proud that he liked them.
Later on a visit home, I walked in his room to
find him laid back in his recliner watching television with the new glasses perched on his
nose upside down. I was embarrassed! After a
few minutes, he told me this was the best pair
of glasses he ever had because he could turn
them upside and see television perfectly—a
balance lens with moderate cylinder axis 90
degrees.
Mike Parker, OD
Fort Payne, AL
We Want to hear from you!
like something we published? hate
something we published? have
a suggestion? We want to hear
from you! Send your comments to
[email protected] letters
may be edited for length or clarity.
Screening
Continued from page 6
national goals to improve the eye health of
preschool-aged children.
“Currently, providers of vision screening
and eye examinations lack a system to provide national- or state-level estimates of the
proportion of children who receive either a
vision screening or an eye examination,” the
authors write.
The panel developed a system to measure
the rates of children who completed a vision
screening in a medical or community setting
using a recommended method, or received
an eye examination by an eyecare practitioner at least once between the ages of 36 and
72 months old. The panel also developed a
separate measure for children with neurodevelopmental disorders and measures for eye
magenta
cyan
yellow
black
OE Tracker update
I am the current chair of OE tracker. I was
very pleased to read your positive comments
on COPE and OE Tracker (“COPE makes CE
easy,” December 2014). Thank you! OET is
examination and follow up.
The American Optometric Association recently responded to the new recommendations, stating that the organization remains
committed to ensuring more children have
direct access to early and periodic comprehensive eye examinations provided by an
eyecare practitioner.
“While schools or pediatricians may provide periodic vision screenings, these screenings often miss more than they find,” the AOA
stated. “Because of vision screenings’ particularly low sensitivity and selective testing,
many children may pass the screening while
having undetected vision disorders, delaying
further examination and profoundly affecting children’s quality of life.”
States vary in their requirements for children’s screenings or eye exams. For example, in Kentucky, all children ages 3-6 are re-
13
nearing 50,000 QR scans and has proven to
be efficient and reliable. One of the proposed
updates to the app will be the ability to download lecture PowerPoint notes directly to your
mobile device.
I became involved with OE Tracker after our
State Board of North Dakota decided to perform a 100 percent audit at the end of each
three-year CE cycle and pay the OET fee for
all ND licensed optometrists. I believe there
are currently five states and two provinces
which pay for all optometrists in their jurisdictions. I hope many more will see the value of
OET after reading your comments.
Jeff Yunker, OD
Grand Forks, ND
my favorite app
Zite
My favorite new app is
Zite. it is a news app
that you can customize
for areas of interest,
such as sports, travel,
movies, etc. Zite pulls
in articles from other
sites that match your
areas of interest.
—Steven ferrucci, oD, faao
Sepulveda, CA
quired to have an eye exam by an optometrist
or ophthalmologist before entering school.
“The Affordable Care Act has recognized
that full coverage for eye exams is essential,
and that’s why it’s included in the essential
benefit package,” says Richmond, KY OD William T. Reynolds, who is also a member of the
AOA Board of Trustees. “It is a doable thing
to get an eye exam for every child. So many
parents believe that a screening takes the
place of an eye exam. When Kentucky had
just screening laws before 2001, we would
get kids in who were age 14 or 15 who had
been screened over and over but had amblyopia. We know that the earlier you catch it,
the easier it is to treat. In Kentucky, we don’t
have that problem now.”
For more information on the recommendations, visit visionsystems.preventblindness.org.
ES558385_OP0215_013.pgs 01.23.2015 03:41
ADV
14
Focus On
RETINA
FEBRUARY 2015
|
Anti-VEGF treatment helps diabetic patient
Visual acuity improves and pre-retinal hemorrhage almost completely resolves
A 76-year-old white female presented for her periodic diabetic eye examination at UAB Eye Care in July 2014. She
A
admitted to blurry vision in her left eye for approximately
one week. Her significant medical history included diabetes of at least 15 years duration for which she was
treated with Humalog (insulin lispro, Lilly), Lantus (insulin glargine, Sanofi), and metformin.
retinal hemorrhage. She quoted her most recent A1C
as 8.2 percent. She was treated
with hydrochlorothiazide for sysAnti-VEGF treatment
temic hypertension of unknown
She had a consult with a retina
duration. Blood pressure was not
specialist that day and was adminassessed at this visit. She has
istered Avastin (bevacizumab, Genever smoked and was appronentech) via intravitreal injection
BY LEO SEMES,
priately oriented with respect to
and was scheduled for follow-up
OD, FAAO Professor
time, place, person, mood, and
in one month. At the four-month
of optometry at
affect. Body mass index (BMI)
follow-up visit, best-corrected vithe University
was greater than 30.
sual acuity OS improved to 20/40,
of AlabamaBirmingham
Best-corrected visual acuity
and the pre-retinal hemorrhage
was 20/25 OD and 20/400 OS
resolved almost completely (botwith minimal correction. She was
tom right). Fortunately, she is free
pseudophakic in each eye with a clear capof other diabetic retinal complications. sule in the right and S/P capsulotomy in
Among the lessons from this case are
the left. Dilated fundus evaluation of the
the significant disparity in visual aculeft eye revealed the presentation top right.
ity between the two eyes with apparently
Presence of the pre-retinal hemorrhage
minimal patient awareness as well as the
Presence of the pre-retinal hemorrhage
is consistent with her history of diabetes
despite the absence of apparent diabetic
changes within the visible portion of
the posterior pole.
is consistent with her history of diabetes
despite the absence of apparent diabetic
changes within the visible portion of the
posterior pole. There is macular swelling,
which accompanies the juxtapapillary pre-
Lucentis FDA approvals
2006 Neovascular AMD
2010 Macular edema following
CRVO and BRVO
2012 Diabetic macular edema
magenta
cyan
yellow
black
significant hemorrhagic response secondary to minimal attendant diabetic fundus
changes. There was no evidence of proliferative retinopathy throughout either fundus. With resolution of the hemorrhage
and a brighter exposure, asteroid bodies
become evident in the left eye. The family
of anti-VEGF agents, of which Avastin is a
member, is intended to restore the integrity
of the circulatory system. Since the introduction of Lucentis (ranimizubab, Genentech) with FDA approval in June 2006 for
the treatment of neovascular age-related
B
A Fundus photo of the left eye focused at
the plane of the RNFL showing striations
of blood within that layer of the retina.
There is macular swelling, which
accounts for the reduced visual acuity.
B Fundus photo of the left eye
demonstrating almost complete
resolution of the pre-retinal hemorrhage.
The visibility of the macula has improved
consistent with her improvement in
visual acuity. Note the presence of
asteroid bodies, as well.
macular degeneration (AMD), many additional applications have been reported.
In 2010 and 2012, respectively, the FDA
granted approval for Lucentis to treat macular edema following retinal vein occlusion (central [CRVO] and branch [BRVO])
as well as diabetic macular edema. The
safety and efficacy of these agents makes
the future bright for this and other neovascular complications.
Dr. Semes is a founding member of the Optometric
Glaucoma Society and a founding fellow of the Optometric
Retina Society.
[email protected]
ES556134_OP0215_014.pgs 01.20.2015 20:59
ADV
magenta
cyan
yellow
black
ES558327_OP0215_015_FP.pgs 01.23.2015 03:39
ADV
16
Focus On
Technology
February 2015
|
HIPAA in the age of social media
Ensuring you and your practice stay compliant on social media platforms
Human beings are social creatures. We take tremendous
pleasure in sharing our world with others. There is no
better evidence than to look at the social media revolution
that has taken place over the last few years. Often, when
we see something cool, we want to share it with other
people. As healthcare providers in an age where digital
information can be just as viral as the viruses we treat,
it is of the utmost importance to understand the implications of our social media posts.
“(B) relates to the past, presSo where does sharing someent, or future physical or mental
thing cool become troublesome?
health or condition of an indiWhen you violate Health Insurvidual, the provision of health
ance Portability and Accountabilcare to an individual, or the past,
ity Act of 1996 (HIPAA). Social
present, or future payment for
media has the power to amplify
the provision of health care to
somebody’s lapse of judgment
BY JUSTIn BAZAn, an individual.”1
to the point where the content
OD Owner of Vision
is seen by millions around the
Source Park Slope
world in just a matter of minutes.
What does this mean
Eye in Brooklyn.
Prior to social media, the error
for you?
may have not spread to much
So for the average OD, what does
more than a handful of people—often
HIPAA mean? Most impactful, the Priavoiding implications—it now is often
vacy Rule will require optometrists to
brought front and center to the public’s
inform patients about how their informaregulatory eye. It becomes very easy for
a potential HIPPA violation to occur and
get noticed. It is quite impressive that
upon HIPAA creation, disks were floppy
and websites were rag tag, and we now
find ourselves in the midst of massive
multi-million dollar penalties served to
entities violating the act.
According to U.S. Department of Health
and Human Services, HIPAA called for the
establishment of standards and requirements for transmitting certain health information to improve the efficiency and
tion can be used and what their privacy
effectiveness of the healthcare system while
rights are. It also means setting up and
protecting patient privacy. This means
implementing privacy procedures for our
that because protected health information
practices that outline and detail how a
(PHI) is a major HIPAA theme, it needs
patient’s PHI is appropriately used and
to be accurately defined. Defined in the
adequately protected. An employee will
law, “health information” means any inneed to take responsibility that this proformation, whether oral or recorded in
cedure is adopted and adhered to. For
any form or medium, that:
most of our small private practices, an
“(A) is created or received by a healthoffice manager or other responsible emcare provider, health plan, public health
ployee will work fine. This person can
authority, employer, life insurer, school or
also serve as a contact for handling comuniversity, or health care clearinghouse; and
plaints and HIPAA concerns. An employee
must review these policies and document
he understands. For most small private
practices, this will suffice as adequate
employee training. Finally, the patient’s
records need to be secured. The authoritative source for guidance is http://www.
hhs.gov/ocr/privacy.2
How to avoid a HIPAA violation
What are the basic things an OD should
do to avoid HIPAA trouble? The best way
to avoid trouble is to always and above all
else protect and secure a person’s health
information. Regarding social media, the
rule is simple: unless you have informed
consent, never post enough personal information, such as the medical condition involved and office, for anyone to
recognize who is being described. The
best policy is to eliminate all info that
can be used to identify the patient. The
patient-doctor relationship is built upon
trust. There is no quicker way to break
that bond than to publically disrespect
a patient, intentionally or not.
The top three HIPAA violations fall into
three categories: impermissible uses and
disclosures of PHI, lack of safeguards of
PHI, and a lack of patient access to their
PHI.3 It’s of note that private practices are
Social meida has the power to amplify
somebody’s lapse of judgment to the
point where the content is seen by
millions around the world in just a
matter of minutes.
magenta
cyan
yellow
black
the most common type of covered entity
that have been required to take corrective
action to achieve voluntary compliance.4
Hypothetical social media
HIPAA violations
example
An employee at your office tweets
to her followers “OMG! James
Franco was in for an eye exam
today! Even with pink eye, he
is still so cute!” Although this was not
directly on any of the office’s social media
1
See HIPAA on page 18
ES556136_OP0215_016.pgs 01.20.2015 20:59
ADV
magenta
cyan
yellow
black
ES558328_OP0215_017_FP.pgs 01.23.2015 03:39
ADV
18
Focus On
Technology
HIPAA
February 2015
because you sent it to a person in confidence doesn’t mean he will respect that. Continued from page 16
pages, it is still a HIPAA violation because personal info, the patient’s name,
was directly linked to medical info, his
pink eye, and broadcast where unauthorized people had access to the info. The
employee might have thought that since
James Franco is a celebrity and he is all
over social media, that it was OK to tweet
about him. An in-office social media policy, backed with proper training and follow-up, might have been helpful in preventing this. However, if James Franco
signed an informed consent form and
was cool with the post, then all is well.
example
A technologically progressive
and social media savvy office
uses Facebook (FB) to correspond
with its patients. Most commonly,
messages are exchanged using the messenger feature, which is HIPAA compliant because you are directly and privately
communicating. However, if you do use
FB for correspondence, be very careful.
One might think posting to a patient’s
timeline on FB is OK, when in reality,
his timeline may be public, making it a
violation. Furthermore, be cognizant that
digital content can easily spread. Just
2
example
Healthcare providers can partake in consultation over social
media provided the network
meets security protocols. Direct,
private messaging between two healthcare providers in consultation, utilizing
the minimum necessary HPI, is OK. However, disclosing PHI in a social media
group is not. Popular FB groups like ODs
on Facebook need to be utilized in ways
that safeguard against HIPAA breaches.
3
example
A patient writes a user review
and includes his PHI. It is of the
utmost importance to not breach
HIPAA despite the apparent public airing of PHI. Simply do not disclose
anything that has not been already publicly disclosed. The patient is free to say
what he wants about himself; however,
you are not. Develop and implement your
own social media policy, but be sure to
frame it around HIPAA guidelines.
HIPAA requires substantial research,
time, and effort to correctly abide. Social media represents one area that has
the potential for HIPAA violations to easily occur. However, one can avoid most
problems by getting direct informed consent. If you want to risk it and post HPI
4
|
without it, you must be sure to remove
all information that can be used to identify the patient.
RefeRences
1. U.S. Department of Health & Human Services.
Health Insurance Portability and Accountability
Act of 1996. Available at: http://www.hhs.gov/
ocr/privacy/hipaa/administrative/statute/index.
html#1171. Accessed 11/25/2014.
2. U.S. Department of Health & Human Services.
Generally, what does the HIPAA Privacy Rule
require the average provider or health plan to do?
Available at: http://www.hhs.gov/ocr/privacy/
hipaa/faq/privacy_rule_general_topics/189.html.
Accessed 11/25/2014.
3. U.S. Department of Health & Human Services.
Top Five Issues in Investigated Cases Closed with
Corrective Action, by Calendar Year. Year. Available
at: http://www.hhs.gov/ocr/privacy/hipaa/
enforcement/data/top5issues.html. Accessed
11/25/2014.
4. U.S. Department of Health & Human Services.
Enforcement Highlights. Available at: http://
www.hhs.gov/ocr/privacy/hipaa/enforcement/
highlights/2009/01092009.html. Accessed
11/25/2014.
5. State of Rhode Island Department of Health
Board of Medical Licensure and Discipline No.
C10-156. Available at: http://www.health.ri.gov/
discipline/MDAlexandraThran.pdf. Accessed
11/25/2014.
Dr. Bazan is a 2004 SUNY grad.
Reach him on his Facebook page.
In BrIef
Shire acquires NPS
New antibiotic may be
Pharmaceuticals for $5.2 billion less prone to resistance
DUBlIn—Shire PLC acquired all outstanding shares of NPS Pharmaceuticals Inc. for $46 per share in cash, for a total of approximately $5.2 billion.
NPS Pharmaceuticals, headquartered in Bedminster, NJ, is
a rare disease-focused biopharmaceutical company. According to Shire, the company plants to accelerate growth of NPS’
portfolio through its market expertise in gastrointestinal disorders, core capabilities in rare disease patient management,
and global footprint.
“The acquisition of NPS Pharma is a significant step in advancing Shire’s strategy to become a leading biotechnology
company,” says Shire CEO Flemming Ornskov, MD, MPH. “We
look forward to accelerating the growth of the NPS Pharma
portfolio based on our proven track record of maximizing
value from acquired assets and commercial execution. The
NPS Pharma organization will be a welcome addition to Shire
as we continue to help transform the lives of patients with
rare diseases.”
magenta
cyan
yellow
black
Researchers have isolated a novel antimicrobial compound
which may be the first in a new class of antibiotics. Teixobactin
is safe and effective in mice and may not induce antimicrobial
resistance. It may translate into a shorter course of treatment
and a better adverse effect profile for patients.
The discovery is a result of collaboration between academia
and NovoBiotic Pharmaceuticals. The reseachers’ approach to
identify teixobactin and the early efficacy data were published
in Nature in January.
“We did not obtain any mutants of Staphylococcus aureus
or Mycobacterium tuberculosis resistant to teixobactin,” the authors write. “The properties of this compound suggest a path
toward developing antibiotics that are likely to avoid development of resistance.”
The team expects the novel antibiotic to go to clinical trials
in two years. If it makes it through clinical trials and is approved, teixobactin will be the first of a new class of antibiotics.
medical sales representatives expected to be in place in 2015.
ES556133_OP0215_018.pgs 01.20.2015 20:59
ADV
What we do every day matters.
AvenovaTM with NeutroxTM (pure hypochlorous acid)
removes microorganisms and debris from the lids and
lashes. Avenova is an ideal addition to any daily lid and
lash hygiene regimen, including for use by patients with
Blepharitis and Dry Eye. Avenova may also be used
after make-up removal as well as pre and post contact
lens wear.
Daily lid and lash hygiene.
OPHTHALMOLOGIST AND OPTOMETRIST TESTED
A V E N O VA . C O M
magenta
cyan
yellow
black
|
|
RX ONLY
1-800-890-0329
ES558329_OP0215_019_FP.pgs 01.23.2015 03:38
ADV
20
Focus On
Allergy
FeBrUarY 2015
|
3 tips for discussing allergy with kids
Rise to the pediatric allergy challenge with these top six questions
How often do you ask a child in the exam chair if her
eyes were “ever” itchy or watery? When I started to ask
this question to every patient in my pediatric population,
it was quite evident that there was an undiscovered gold
mine in my anterior segment practice. Allergies in the
pediatric population are trending upward in a startling
and truly dangerous manner. 1
2
3
4
might seem simplistic, but they
Statistically, epidemiological
have streamlined and improved
studies and surveys in the U.S.
chair time in my busy clinical
have illustrated approximately
setting. Furthermore, parents are
50 million patients suffer from
both impressed with the clear
some form of allergy and 20 to
responses from their children
25 percent with ocular allergies.1
and in many cases shocked that
Dissecting these numbers furBY MICHAEL S.
the children have any symptoms
ther, Abelson et al found that
COOPER, OD
of allergies. Once the child acapproximately 40 percent of
is in an OD/
knowledges the symptoms of
children were affected by alMD practice in
the condition, the parent will
lergic conjunctivitis.2 After digWillimantic, CT
begin to engage you. This beging through the literature, my
comes your platform to educate the parmission statement became how to effect
ent about chronic allergy treatment and
change today in the hearts and minds of
management, whether it is seasonal aloptometric physicians to start treating
lergic conjunctivitis (SAC), perennial alpediatric patients in a more aggressive
lergic conjunctivitis (PAC), or vernal kermanner in their practices.
atoconjunctivitis (VKC). At this moment,
the doctor has waged the adherence war
What’s in it for me?
and achieved a significant victory.
The short answer is everything to lose
but immensely more to gain! Although
children can take more time to examine
The pharmacy conundrum
and be confounding in their history, I
Now that you have the diagnosis, the next
have found easy open-ended questions
logical step is selecting your medication
helpful to slice through for the purpose of
of choice. Let me take a moment to emtime management (See box). The queries
phasize this tremendous opportunity to
Figure 1. Dr. Cooper’s
4-year-old daughter
Hannah. She suffers
from severe seasonal
allergies.
magenta
cyan
yellow
black
Top 6 questions for
pediatric patients
5
6
Do your eyes ever itch?
Do your eyes ever water?
Do you ever rub your eyes
in the morning when you
wake up?
Do you keep your window
open at night?
Do you have trouble
breathing inside in the
morning or when you are
outside?
Does your brother or
sister rub his or her eyes?
diffuse a bomb: be the doctor and use
your power of the electronic pen. We all
live in an age where the pharmacy benefit
manager makes many calls beyond our
wishes, but let me share a pearl. If you
40%
of children are
affected by allergic
conjunctivitis
desire to prescribe a specific product, it
is within your doctoral right to specify
“brand medically necessary.” These words
essentially bar pharmacists from substituting a generic product of their choice
without your permission. In addition, I
would suggest looking at your state laws
for further guidance because there are always slight differences in legal doctrine.
Another hurdle is who carries the purse
strings, the parent or caregiver. We might
think we captured them hook, line, and
sinker with education, but ultimately in
some cases there are financial obstacles.
I do not take these situations lightly, yet I
don’t harp on them either to hemorrhage
valuable chair time. Once you have stated
your case and actively suggested a rebate
card to defray a substantial amount of
the cost for products such as Lastacaft
(alcaftadine, Allergan), Pataday (olopatadine hydrochloride, Alcon), and Bepreve
(bepotastine besilate, Bausch + Lomb),
ES557436_OP0215_020.pgs 01.22.2015 04:35
ADV
| practical chairside advice
Allergy
Focus On
21
Figure 2. Papillary reactionin 4-year-old child suffering from seasonal allergies.
your job is mostly done.
I say mostly done because the “rub” is
step therapies with certain generic products that might be dictated by the patient’s Rx benefit for which you must
once again be flexible. A quick takeaway
in your decision tree is patient comfort
when given the typical popular choice
between generic forms of Elestat (epinastine, Allergan) and Optivar (azelastine,
Meda). The ratio of ocular burning and
stinging is highly in favor with epinastine with 1 to 10 percent of patients expe-
I never tell
a pediatric
patient the
following words:
medication, drop,
or pill.
riencing these symptoms comparatively
to 30 percent with azelastine.3,4 Finally,
Allergy apps
Apps to embrace for allergy
sufferers.
–
–
–
–
–
magenta
cyan
yellow
black
Zyrtec AllergyCast
WebMD Allergy
Allergy Alert
EyeDROPS Free or Pro
Kids Eye Doctor Lite or Pro
if there is a tremendous financial burden
below the poverty level, I have utilized
the RxHope patient assistance program
as a viable alternative.
Figure 3. Closer look at papillary
reaction in seasonal allergies. Images
courtesy Michael S. Cooper, OD
The lion, the drop, and the
wardrobe
I never tell a pediatric patient the following words: medication, drop, or pill. From
the eyes and ears perspective of a young
child, including my 4-year-old daughter
Hannah, and even younger adolescents,
the thought of taking any medicinal therapy is emotionally upsetting and confusing.5 How do I confront these situations?
The chief golden rule is to have a cheerful and positive attitude while explaining
how the medication will help them improve their allergy symptoms.6 Additionally, with a huge assist from fairy tales
and fictional characters, I utilize the following vocabulary in place of drops and
pills: magic potions and magic beans. I
find that children feel more at home with
these analogies, which leads to far less
resistance when it is time to take their
medication at night before bedtime. Finally, I encourage parents to empower
their child to include them in the experience by holding the bottle together to
instill the “potion” into their eyes.
Although allergic conjunctivitis might
seem annoying and not as glamorous
as glaucoma and macular degeneration;
nonetheless, it can truly change a patient’s
life. From my clinical experience, it astonishes me time and again where my
pediatric population will come back for
a follow up or a comprehensive examination with a smile on their face in order
to tell me that they did not miss school
due to their “itchy and scratchy” eyes. Personally, these moments are gratifying and have increased my drive to treat
more in this disease state.
RefeRences
1. Centers for Disease Control and Prevention.
“CDC Fast Facts A-Z,” Vital Health Statistics,
2003. Asthma and Allergy Foundation of America.
http://www.aafa.org/display.cfm?id=9&sub=30.
Accessed 10/1/14.
2. Abelson MB, Granet D. Ocular allergy in pediatric
practice. Curr Allergy Asthma Rep. 2006; 6(4):30611. 3. Elestat [package insert]. Irvine, CA; Allergan;
December 2011.
4. Optivar [package insert]. Somerset, NJ; Meda
Pharmaceuticals; April 2009.
5. Iliades, Chris, Bass PF ed. “10 Ways to Get Kids
to Take Medicine.” everyday HEALTH. Everyday
Health Media, 3 February 2011. http://www.
everydayhealth.com/kids-health/10-ways-to-getkids-to-take-medicine.aspx. Accessed on 1/10/15
6. Food and Drug Administration. “Giving Medicine
to Children.” FDA. US Department of Health and
Human Services, 12 March 2013. http://www.
fda.gov/ForConsumers/ConsumerUpdates/
ConsumerUpdatesEnEspanol/ucm291741.htm.
Accessed on 1/10/15.
Dr. Cooper is a consultant to Allergan, BioTissue, Johnson
& Johnson Vision Care, Alcon Surgical, Valean/B+L,
TearLab, Epocrates, and has received past honoraria from
Alcon Vision Care and inVentiv Health.
[email protected]
ES557435_OP0215_021.pgs 01.22.2015 04:34
ADV
Exceptional all-day lens wear,
every day, for every eye
UNSURPASSED COMFORT
Clinically unsurpassed in overall comfort and rated superior to Dailies® AquaComfort Plus®
in beginning to end-of-day comfort
EXCELLENT SAFETY PROFILE1 ¶
Confirmed in an unprecedented, year-long, observational study of 570 wearers—
no other lens has published this kind of safety data, including Dailies® AquaComfort Plus®
UV PROTECTION†
Blocks approximately 97% UVB & 82% UVA rays.‡ Dailies® AquaComfort Plus®
does not meet ANSI/ISO standards for UV blocking
1-DAY ACUVUE® MOIST® Brand Contact Lenses for ASTIGMATISM
SAME COMFORT, SAFETY, AND UV PROTECTION WITH ENHANCED STABILITY
— BLINK STABILIZED™ Design creates equal/opposite forces to limit
rotation and better stabilize vision
— Nearly 200 more parameters than Dailies® AquaComfort Plus® Toric Lenses||
REALIGNS WITH EVERY BLINK
Stabilization zones
magenta
cyan
yellow
black
Stabilization zones
ES558673_OP0215_022_FP.pgs 01.23.2015 19:40
ADV
ANSI=American National Standards Institute; ISO=International Organization for Standardization.
ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation,
itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems.
Consult the package insert for complete information. Complete information is also available from VISTAKON® Division of Johnson & Johnson Vision Care, Inc., by calling 1-800-843-2020 or by
visiting acuvueprofessional.com.
†
Helps protect against transmission of harmful UV radiation to the cornea and into the eye.
WARNING: UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses, because they do not completely cover the eye
and surrounding area. You should continue to use UV-absorbing eyewear as directed. NOTE: Long-term exposure to UV radiation is one of the risk factors associated with cataracts. Exposure
is based on a number of factors such as environmental conditions (altitude, geography, cloud cover) and personal factors (extent and nature of outdoor activities). UV-blocking contact lenses
help provide protection against harmful UV radiation. However, clinical studies have not been done to demonstrate that wearing UV-blocking contact lenses reduces the risk of developing
cataracts or other eye disorders. Consult your eye care practitioner for more information.
‡
UV-blocking percentages are based on an average across the wavelength spectrum.
¶
This observational/surveillance registry relied on patient reports of symptomatic adverse events that led them to seek clinical care. These results should be considered in conjunction with other
clinical results on the safety and efficacy of daily disposable etafilcon A contact lenses, which also generally show low rates of such events. Although no symptomatic infiltrative events were
reported in this study, such events can occur with daily disposable lenses, including 1-DAY ACUVUE® MOIST®, as noted in the product labeling.
||
Based on Tyler’s Quarterly Soft Contact Lens Parameter Guide; June 2014.
1. Chalmers RL, Hickson-Curran SB, Keay LJ, Gleason W. Safety of hydrogel and silicone hydrogel daily disposables in a large post-market surveillance registry—the TEMPO registry.
Presented at: ARVO 2014 Annual Meeting: May 4-8, 2014; Orlando, FL.
The third party trademarks used herein are trademarks of their respective owners.
ACUVUE®, 1-DAY ACUVUE® MOIST®, BLINK STABILIZED™, and VISTAKON® are trademarks of Johnson & Johnson Vision Care, Inc.
© Johnson & Johnson Vision Care, Inc. 2015 ACU-A44519-B January 2015
magenta
cyan
yellow
black
ES558672_OP0215_023_FP.pgs 01.23.2015 19:40
ADV
24
Focus On
RefRactive SuRgeRy
FeBrUarY 2015
|
Are those eyes healthy enough for LASIK?
Ocular conditions to consider when identifying candidates for laser correction
Before recommending laser vision correction for your patient, there are a number of factors you as an eyecare practitioner must consider. In a previous issue (“Is your patient
healthy enough for LASIK surgery?” February 2014), we
discussed how your patient’s systemic health can affect the
safety and efficacy of refractive surgery.
Today, I would like to look at
the ocular conditions that must
be considered before making a
patient candidacy decision. Most
refractive surgeons base their
criteria for patient candidacy on
the original criteria described
in the original FDA approval of
LASIK more than a decade ago
(Table 1).
Keratoconus
Keratoconus is a progressive
thinning disorder of the cornea that results in irregular astigmatism causing
impairment of visual function. Corneal
refractive surgery is associated with an
increased risk of progressive ectasia and
loss of vision.1 While moderate to severe
keratoconus can often be diagnosed with
a biomicroscope, early subclinical forms
of keratoconus can often be detected only
with corneal topography (Figure 1) or
corneal tomography (Figure 2).2,3 Additionally, recent evidence suggests that
elevated corneal wavefront analysis (vertical coma) and biomechanical analysis
may improve the early detection of corneas susceptible to the development of
keratoconus.4,5
The FDA classification of keratoconus
as an absolute contraindication to laser
vision correction is currently being questioned by many surgeons. Outside of the
U.S., it has become more common to uti-
Corneal herpes simplex
and herpes zoster
Reports of reactivation of herpes
simplex and herpes zoster virus
after excimer refractive surgery
can be found in the literature.7,8
Recent evidence suggests that
LASIK is safe in patients with a history
of ocular herpes that has been inactive
for more than one year.9 Perioperative
use of systemic antiviral prophylaxis is
recommended to reduce the risk of virus
reactivation.
Any active eye disease
History of prior corneal surgery
Thin cornea
History of glaucoma
Cataracts
Large pupils
Severe dry eye
Both LASIK and PRK are known to increase dryness symptoms after surgery.
Possible mechanisms include loss of neurotrophic effect, damage of goblet cells,
and altered corneal shape. Despite the fact
that most dryness symptoms are usually
temporary and resolve in the first six to
12 months after surgery, significant preoperative dry eye signs and symptoms
should be resolved prior to corneal refractive surgery to reduce the risk of patient’s dissatisfaction.10
Overall, most surgeons agree
that any patient with active
eye disease should not be
considered a candidate for an
elective refractive procedure
due to increased risk of sightthreatening complications
and poor visual outcome.
taBLe 1 FDA approval of LASIK: Ocular health considerations
Absolute contra-indications
Relative contra-indications
Keratoconus
Corneal herpes simplex
Corneal herpes zoster
Significant dry eye
magenta
cyan
yellow
black
Unstable Rx (any change by more than 0.50 D)
Corneal scars
lize photorefractive keratectomy
combined with corneal collagen
cross-linking to improve vision
and stabilize the cornea of patients with keratoconus.6
BY WILLIAM
TULLO, OD Vice
president of clinical
services for TLC
Vision.
taBLe 2 Precautions prior
to LASIK Surgery
Other
considerations
In addition to these
contraindications,
several other precautions are recommended when screening your patients for
corneal refractive
surgery (Table 2).
Overall, most surgeons agree that any
patient with active
eye disease should
not be a considered
candidate for an elective refractive procedure due to increased risk of sightthreatening complications and poor visual outcomes. The transient significant
rise in intraocular pressure (IOP) with
femtosecond and mechanical microkeratome used in LASIK surgery may not be
safe for patients with glaucomatous visual field loss or optic nerve compromise.
Corneal scars and prior corneal surgery
ES556953_OP0215_024.pgs 01.21.2015 22:55
ADV
RefRactive SuRgeRy
| practical chairside advice
can reduce the safety, efficacy, and predictability of corneal refractive surgery.
Patients with thin corneas may be at
increased risk of corneal destabilization
due to LASIK flap creation and excimer
ablation. Many surgeons use a cutoff of
480-500 µm for LASIK and 460-480 µm
for PRK when screening patients for surgery. Evidence shows that LASIK and PRK
in patients with thin corneas (less than
500 µm) is safe and predicable providing
no other risk factors such as abnormal
topography exist.11
Patients with early crystalline lens
changes should be cautioned about corneal
refractive surgery, which can reduce the
accuracy of intraocular lens (IOL) power
selection. The unpredictable progression
of crystalline lens changes makes it impossible to accurately predict the timing of significant vision loss. Visually
The FDA
classification
of keratoconus
as an absolute
contraindication
to laser vision
correction has
currently being
questioned by
many surgeons
outside of the U.S.
significant cataracts are best addressed
with lens extraction and IOL implantation, which can also accurately correct
long-standing refractive error.
Early forms of corneal refractive surgery
were often associated with night vision
disturbances. Early evidence suggested
that large scotopic and mesopic pupil size
may play a role in patient symptoms. Most
experts agree that modern excimer lasers
and ablation patterns have eliminated the
majority night vision disturbances including glare, halo, and starbursts. In a recent study of 10,944 eyes of 5,563 myopic
patients treated with wavefront-guided
LASIK, low-light pupil diameter was not
predictive of surgery satisfaction, ability
to perform activities or visual symptoms
magenta
cyan
yellow
black
1
Focus On
25
Figure 1.
Early subclinical forms
of keratoconus can
often be detected
onlly with corneal
topography.
2
Figure 2.
Corneal tomography
is another way to
detect early subclinical
forms of keratoconus.
Moderate to severe
keratoconus can
be detected with a
biomicroscope. (Images
courtesy of Dr. William
Tullo)
at one-month postoperatively.12
Having a thorough understanding of
your patient’s ocular health is necessary
to determine if your patient is a good candidate for refractive surgery.
refractive surgery. Curr Opin Ophthalmol. 2012
Jul;23(4):264-8.
RefeRences
1. Binder PS. Risk factors for ectasia after LASIK. J
Cataract Refract Surg. 2008 Dec;34(12):2010-1.
8. Jarade EF, Tabbara KF. Presumed reactivation
of herpes zoster ophthalmicus following laser in
situ keratomileusis. J Refract Surg. 2002 JanFeb;18(1):79-80
2. Ramos-López D, Martínez-Finkelshtein A,
Castro-Luna GM, et al. Screening subclinical
keratoconus with placido-based corneal indices.
Optom Vis Sci. 2013 Apr;90(4):335-43.
3. Belin MW, Villavicencio OF, Ambrósio RR Jr.
Tomographic parameters for the detection of
keratoconus: suggestions for screening and
treatment parameters. Eye Contact Lens. 2014
Nov;40(6):326-30.
7. Levy J, Lapid-Gortzak R, Klemperer I, et al.
Herpes simplex virus keratitis after laser in
situ keratomileusis. J Refract Surg. 2005 JulAug;21(4):400-2
9. de Rojas Silva V, Rodríguez-Conde R, CoboSoriano R, et al. Laser in situ keratomileusis in
patients with a history of ocular herpes. J Cataract
Refract Surg. 2007 Nov;33(11):1855-9
10. Nettune GR, Pflugfelder SC. Post-LASIK tear
dysfunction and dysesthesia. Ocul Surf. 2010
Jul;8(3):135-45
4. Saad A, Gatinel D. Evaluation of total and corneal
wavefront high order aberrations for the detection
of forme fruste keratoconus. Invest Ophthalmol Vis
Sci. 2012 May 17;53(6):2978-92.
5. Ahmadi Hosseini SM, Abolbashari F, Niyazmand
H, et al. Efficacy of corneal tomography parameters
and biomechanical characteristic in keratoconus
detection. Cont Lens Anterior Eye. 2014
Feb;37(1):26-30.
6. Pasquali T, Krueger R. Topography-guided laser
11. Kymionis GD, Bouzoukis D, Diakonis V, et
al. Long-term results of thin corneas after
refractive laser surgery. Am J Ophthalmol. 2007
Aug;144(2):181-185.
12. Schallhorn S, Brown M, Venter J, et al. The
role of the mesopic pupil on patient-reported
outcomes in young patients with myopia 1 month
after wavefront-guided LASIK. J Refract Surg. 2014
Mar;30(3):159-65
Dr. Tullo is also adjunct assistant clinical professor at SUNY
College of Optometry.
ES556952_OP0215_025.pgs 01.21.2015 22:55
ADV
Special Secti o n
Allergy
26
allergy prevalence
Continued from page 1
ity of life. Most recent estimates suggest
that 15–25 percent of the U.S. population,
or between 50 and 85 million Americans,
suffer from ocular allergy and/or allergic
conjunctivitis.4,5 Other studies have estimated the prevalence of allergic conjunctivitis to range between 15
and 40 percent of the U.S.
population.6 Here in the
United States, the National Health and Nutrition Examination Survey
III (NHANES III) found
that 40 percent of the
ErniE BOWling,
adult population had ocuOd, fAAO chief
optometric editor
lar symptoms, defined as
“episodes of tearing and
ocular itching, with no significant differences according to age, though there was a
predominance in the south vs. other regions
3
20%
the increase of prescriptions for allergic conditions
from 1993 to 2008
of the country.7 The prevalence of allergic
conjunctivitis is similar in Europe, Japan,
and Australia, and is increasing worldwide.6
According to an analysis from 1993 to
2008, prescribing medications for allergic conditions has similarly accelerated
by about 20 percent.8 This likely reflects
an increasing prevalence of allergic disease in developed countries. Although the
exact reason for this increase is not known,
February 2015
taKe-home meSSaGe Given
the worldwide increase in ocular allergy
prevalence, you may see an increase in allergy
patients in your chair. itch is the hallmark of
ocular allergy, but other signs and symptoms
may be present. ocular allergy may mimic
other conditions, so the exam and history
is important. a three-step treatment plan is
determined by the severity of the patient’s
presentation.
many factors are thought to play a role,
including air pollution, industrialization
and urbanization, climate change, and the
“hygiene hypothesis,” which in essence attributes immune hypersensitivity among
city dwellers to low microbial exposure
during childhood.1,9
While not life threatening, the symptoms of ocular allergy as suffered by affected individuals have a significant impact on their productivity and quality of
life.10 Ocular allergy symptoms can produce
patient discomfort and interfere with visual tasks, including computer work and
recreational activities. The quality of life
of patients dealing with allergic conjunctivitis can be affected by intense itching,
which produces sensation of dryness, vision fatigue and reading difficulties. Some
20 percent of allergy suffers report missing some time from work due to allergy
symptoms.11 More severe forms of the ocular allergy, such as AKC12 or VKC,13 are
rare yet can be sight threatening. Similar
to other allergic conditions, allergic con-
|
junctivitis may demonstrate both an early,
acute phase triggered by mast cell degranulation and a late, chronic phase involving
allergic inflammation.14
SAC and PAC have seen a worldwide trend
of increased prevalence over the past few
decades.6 For example, increases in SAC and
PAC in children have been well documented
by the International Study of Asthma and
Allergies in Childhood (ISAAC).15 Earlier
studies suggest a difference between children from developed countries and those
from more rural countries: while the overall health of children from underdeveloped
countries may be worse, their risk of develop-
The symptoms of
ocular allergy as
suffered by affected
individuals have a
significant impact
on productivity and
quality of life.
ing allergic disease was substantially lower
than that seen in Europe, North America,
or Japan.16 Nations undergoing substantial economic growth report spikes in the
prevalence of allergic conjunctivitis and
symptoms associated with rhinitis or allergic conjunctivitis.16
Another factor in the rise in allergic disease prevalence receiving considerable attention in recent literature is the role of air
figurE 2. Note conjunctival redness, eyelid edema, and watery discharge in this patient with seasonal allergic conjunctivitis
magenta
cyan
yellow
black
ES558393_OP0215_026.pgs 01.23.2015 03:42
ADV
Special Secti o n
| praCtiCal ChairSide adviCe
Corticosteroids remain among
the most potent pharmacologic
agents used in the more severe
presentations of ocular allergy.
A diagnosis of allergic conjunctivitis should be questioned if a
patient isn’t complaining with an
itch.23 Itching may be particularly
aggravating in the nasal aspect
of the eye and may range from
mild to severe. Other symptoms
include burning, stinging, photophobia, tearing, watery or mucoid discharge, chemosis, or dry
eye.22 The discharge may contain a
small amount of mucus, rendering
it stringy or ropy, which
could occasionally lead to
a misdiagnosis of bacterial conjunctivitis. Because
the nasal and ocular mucosa tissues have a similar reaction to allergens,
Allergic conjunctivitis can look
most patients with ocular
like these conditions:
complaints also have nasal
– bacterial conjunctivitis
symptoms. Among patients
– rhinitis
whose ocular symptoms
– dry eye
appear isolated, mild nasal
– Meibomian gland disease (resulting in
and/or lower respiratory
tear film abnormality or insufficiency)
symptoms can often be dis– blepharitis
covered during the patient
interview.23
The ocular exam for allergy
should focus primarily on the conwere fed milk other than breast
junctiva because the conjunctival
milk during the first 4 months of
membrane is an active immunolife20 have an increased risk of delogic tissue that responds to allergic
veloping allergies.
stimuli.24 Papillary hypertrophy of
the upper tarsal conjunctiva is a
Diagnosing ocular allergy
sign generally not observed in the
Allergic conjunctivitis is caused by
SAC or PAC sufferer and indicates
an allergen-induced inflammatory
a more chronic and severe form of
response in which allergens interallergic conjunctivitis.1
act with IgE bound to sensitized
mast cells, producing the clinical
Differential diagnosis of allergic
ocular allergic presentation. Enviconjunctivitis can be challenging
ronmental allergens trigger both
because of the wide array of disorSAC and PAC. 21 Symptoms of alders that can mimic or mask the
condition, including dry eye and
lergic conjunctivitis may fluctumeibomian gland disease (resulting
ate throughout the year, but they
in tear film abnormality or insufworsen during times of highest
ficiency), blepharitis, rhinitis and
allergen exposure and in weather
bacterial conjunctivitis.5
that is warm, windy, and dry. The
hallmark signs and symptoms of
When the signs and symptoms
both SAC and PAC are itching and
are consistent with SAC and the
redness,22 but the hallmark symptom
patient history does not indicate
some other disease, allergy testing
of allergic conjunctivitis is itching.
pollution as an exacerbating factor
in allergic signs and symptoms.17
About 89 percent of the world’s
population lives in areas where
the levels of airborne particulate
matter exceed the World Health
Organization’s (WHO) guidelines
for air quality.18 There is also evidence that suggests some allergic
resistance is passed passively from
mother to child. Children born by
Caesarean section19 and those who
Allergy
27
is usually not required.25 However, in stubborn and recurrent cases, allergists can perform skin testing for specific
allergens by scratch tests or intradermal allergen injections. In-vitro tests for allergen-specific IgE antibodies are
also widely used.26 If a causative agent can be determined
by either skin prick tests or allergen challenge, then avoiding the allergen can greatly lessen the severity and symptom frequency.
See Allergy prevalence on page 28
Rely on something that
STAYS PUT
AllErgy diffErEnTiAl
diAgnOsis
magenta
cyan
yellow
black
Parasol®
92%
We’ve taken the worry out of plug
retention, so you can concentrate
RE TENTION
on patient retention. The Parasol
Punctal Occluder trumps the competition with
an unprecented 92% retention rate. Use the
Parasol Punctal Occluder, designed for easy
insertion and guaranteed to stay put.
TO ORDER: 866-906-8080
[email protected]
odysseymed.com or beaver-visitec.com
Beaver-Visitec International, Inc. | 411 Waverley Oaks Road Waltham, MA 02452 USA | BVI, BVI Logo and all other
trademarks (unless noted otherwise) are property of a Beaver-Visitec International (“BVI”) company © 2015 BVI
ES558390_OP0215_027.pgs 01.23.2015 03:41
ADV
Special Secti o n
Allergy
28
allergy prevalence
Continued from page 27
Allergy treatment
The management of ocular allergy includes
patient education and allergen avoidance (if
possible), topical therapies, and immunotherapy. Avoidance of the offending antigen
is the primary behavioral modification for
all types of allergic conjunctivitis. However,
the eyes present a large surface area, so it is
often impossible to avoid ocular exposure
to airborne allergens. Sunglasses should be
worn to reduce direct ocular exposure to
airborne allergens. Treatment options will
February 2015
Alternatively, or concurrently, over the
counter anti-allergy medications or an ocular antihistamine/mast cell stabilizer may
be utilized.
STEP
Treatment with a topical ocular
antihistamine/mast cell stabilizer
is recommended for patients with
itching (ranging from mild to severe and from intermittent to prolonged)
who do not have significant redness or
concurrent ocular conditions. However,
steroids are commonly used. Corticosteroids remain among the most potent pharmacologic agents used in the more severe
2
With the treatment options available to
eyecare practitioners, the prognosis for
ocular allergy is quite good.
often depend on the symptom severity and
the nature of the ocular allergy, and treatment should follow a stepwise approach.27
Following are three steps to design an
allergy treatment plan.
STEP
Patients with mild, intermittent
itching should use nonpharmaceutical measures like cold compresses,
ice packs, and lubricating ophthalmic drops. Cold compresses provide relief
from symptoms (especially itching). Artificial tear substitutes provide an allergen
barrier and help to dilute the various allergens and inflammatory mediators present on the ocular surface—they help flush
away these agents from the ocular surface.
1
presentations of ocular allergy and are also
effective in the treatment of acute and
chronic forms of allergic conjunctivitis.
STEP
Treatment with a topical ocular
antihistamine/mast cell stabilizer
and/or a topical ocular corticosteroid is indicated for allergic conjunctivitis for seasonal allergy patients with
moderate-to severe symptoms of allergic
conjunctivitis and redness. Patients placed
on a topical ocular steroid should receive
careful follow-up to assess its effect and
rule out adverse events, such as drug-induced intraocular pressure (IOP) elevation.
IOP should be checked before steroid therapy is begun and rechecked at two weeks
3
|
if the steroid is continued that long. A slit
lamp examination of the ocular surface
before steroid therapy should be done to
rule out opportunistic infections (e.g., with
herpes simplex virus or fungi).28 In severe
cases, it may be necessary to get symptoms
under control quickly by using a more aggressive approach and then reducing to a
maintenance program. Many allergic conditions tend to be chronic in nature, so
long-term control with agents such as mast
cell stabilizers and antihistamines rather
than a steroid may be preferred.
Allergen-specific immunotherapy is an
effective treatment for patients with allergic rhinoconjunctivitis who have allergenspecific IgE antibodies. The main objective of this treatment is to induce a clinical
tolerance to the specific allergen, which
reduces the seasonal increases of IgE specific for that allergen. However, immune
responses to allergen administration are
not predictive of the therapy’s effectiveness. The therapy itself can produce systemic reactions, the incidence and severity
of which can vary dependent on the type of
allergen administered.29 Traditionally, immunotherapy is delivered via subcutaneous
injection. However, sublingual (oral) immunotherapy (SLIT) is gaining momentum
among allergists. Recent large-scale trials
have focused on SLIT therapy for grass
and ragweed allergies, and trials are underway using allergens from dust mites.30
SLIT requires further evaluation for ocular
allergy relief; it has been shown to control
ocular signs and symptoms, although ocular symptoms do not respond as well as
nasal symptoms.31
figurE 2. another patient with red, itchy eyes secondary to SaC
magenta
cyan
yellow
black
ES558392_OP0215_028.pgs 01.23.2015 03:42
ADV
Special Secti o n
| praCtiCal ChairSide adviCe
Conclusion
The prevalence of allergies is increasing worldwide. Ocular allergies
are a very common presentation in
an optometric practice, especially
in the spring of the year when the
plants burst forth in bloom. Fortunately, with the treatment options available to eyecare practitioners, the prognosis for the disease
is quite good. Familiarity with the
condition and the many treatments
available enable us to better care
for our patients presenting with
those itchy, watery eyes.
RefeRences
1. Bielory L. Ocular allergy overview.
Immunol Allergy Clin North Am. 2008
Feb;(1): 1–23.
2. Petricek I, Prost M, Popova A. The
differential diagnosis of red eye: a survey of
medical practitioners from Eastern Europe
and the Middle East. Ophthalmologica.
2006;220(4):229–237.
3. Palmares J, Delgado L, Cidade M, et al.
Allergic conjunctivitis: a national crosssectional study of clinical characteristics
and quality of life. Eur J Ophthalmol. 2010
Mar-Apr;20(2):257-64.
4. Miraldi V, Kaufman AR. Allergic eye
disease. Pediatr Clin North Am. 2014
Jun;61(3):607-20.
5. O’Brien TP. Allergic conjunctivitis: an
update on diagnosis and management.
Curr Opin Allergy Clin Immunol. 2013
Oct;13(5):543-9.
6. Rosario N, Bielory L. Epidemiology of
allergic conjunctivitis. Curr Opin Allergy
Clin Immunol. 2011 Oct;11(5):471-6.
7. Singh K, Bielory L. The epidemiology of
ocular allergy symptoms in United States
adults (1988-1994). Ann Allergy Asthma
Immunol. 2010 Oct;126(4):778-783.e6.
8. Origlieri C, Bielory L. Emerging drugs for
conjunctivitis.
Expert Opin Emerg Drugs. 2009
Sep;14(3):523-36.
9. Bielory L, Lyons K, Goldberg R. Climate
change and allergic disease. Curr Allergy
Asthma Rep. 2012 Dec;12(6):485-94.
10. Virchow JC, Kay S, Demoly P, et al.
Impact of ocular symptoms on quality of
life (QoL), work productivity and resource
utilisation in allergic rhinitis patients: an
observational, cross sectional study in
four countries in Europe. J Med Econ.
2011;14(3):305-14.
Acad Dermatol 2014; 70:569–575.8.
safety during a 4-year follow-up study. Allergy 1995; 50: 405–413.
13. De Smedt S, Wildner G, Kestelyn P.
Vernal keratoconjunctivitis: an update. Br J
Ophthalmol 2013; 97: 9–14.
30. Gomes PJ. Trends in prevalence and treatment of ocular allergy. Curr
Opin Allergy Clin Immunol 2014,14: 451–456.
14. Leonardi A. Allergy and allergic
mediators in tears. Exp Eye Res 2013;
117:106–117.
15. Ait-Khaled N, Pearce N, Anderson
HR, et al. Global map of the prevalence of
symptoms of rhinoconjunctivitis in children:
the International Study of Asthma and
Allergies in Childhood (ISAAC) Phase
Three. Allergy 2009; 64: 123– 148.
16. Mallol J, Crane J, von Mutius E, et al. The
International Study of Asthma and Allergies
in Childhood (ISAAC) Phase Three: a global
synthesis. Allergol Immunopathol (Madr)
2013; 41:73–85.
31. Vitaliti G, Leonardi S, Miraglia Del Giudice M, et al. Mucosal immunity
and sublingual immunotherapy in respiratory disorders. J Biol Regul
Homeost Agents 2012; 26(1 Suppl): S85-93.
dr. Ernie is in private practice in Gadsden, al, and is the Diplomate exam chair of the
american academy of optometry’s primary care Section
[email protected]
Digital Photography
Solutions
17. Guarnieri M, Balmes JR. Outdoor air
pollution and asthma. Lancet 2014; 383:
1581–1592.
for Slit Lamp
Imaging
18. Brauer M, Amann M, Burnett RT, et al.
Exposure assessment for estimation of the
global burden of disease attributable to
outdoor air pollution. Environ Sci Technol
2012; 46:652–660.
19. Renz-Polster H, David MR, Buist AS, et
al. Caesarean section delivery and the risk
of allergic disorders in childhood. Clinical &
Experimental Allergy 2005; 35:1466-72.
Digital
SLR Camera
20. Halken S. Prevention of allergic disease
in childhood: clinical and epidemiological
aspects of primary and secondary allergy
prevention. Pediatric Allergy & Immunology
Suppl 2004; 16: 4-5, 9-32.
21. American Academy of Ophthalmology
Cornea/External Disease Panel. Preferred
practice pattern guidelines. Conjunctivitis:
limited revision. San Francisco, CA:
American Academy of Ophthalmology;
2011.
22. Moloney G, McCluskey PJ. Classifying
and managing allergic conjunctivitis. Med
Today 2007; 8: 16–21.
23. Bielory L. Ocular allergy. Mt Sinai J Med
2011; 78: 740 –758.
24. Bielory L, Friedlaender MH. Allergic
conjunctivitis. Immunol Allergy Clin North
Am 2008; 28: 43–58.
25. Kari O, Saari KM. Updates in the
treatment of ocular allergies. J Asthma
Allergy 2010; 3: 149–158.
Universal
Smart Phone
Adaptor for
Slit Lamp
Imaging
26. La Rosa M, Lionetti E, Reibaldi M, et al.
Allergic conjunctivitis: a comprehensive
review of the literature. Italian Journal of
Pediatrics 2013, 39: 18.
27. Bielory L, Meltzer EO, Nichols KK, et
al. An algorithm for the management of
allergic conjunctivitis. Allergy Asthma Proc
2013; 34: 408-420.
11. Smith AF, Pitt AD, Rodruiguez AE, et al.
The economic and quality of life impact of
seasonal allergic conjunctivitis in a Spanish
setting. Ophthalmic Epidemiology 2005;
12: 233-42.
28. Ilyas H, Slonim CB, Braswell GR, et al.
Long-term safety of loteprednol etabonate
0.2% in the treatment of seasonal and
perennial allergic conjunctivitis. Eye
Contact Lens 2004; 30:10–13.
12. Chen JJ, Applebaum DS, Sun GS, et al.
Atopic keratoconjunctivitis: a review. J Am
29. Walker SM, Varney VA, Gaga M, et al.
Grass pollen immunotherapy: efficacy and
magenta
cyan
yellow
black
Allergy
29
Made in USA
TTI Medical
Transamerican Technologies International
Toll free: 800-322-7373
email: [email protected]
www.ttimedical.com
ES558386_OP0215_029.pgs 01.23.2015 03:41
ADV
Contact Lenses
30
FeBrUarY 2015
|
Relieve migraines with tinted lenses
Color can offer relief for those struggling from visual disabilities
By Paul Harris, OD, FCOVD,
FACBO, FAAO, FNAP, and
Christina Esposito, OD, FAAO
O
ptometric practices offer tinted
and colored contact lenses to
aid in cosmetic enhancement;
however, many eyecare practices
are unaware of the therapeutic effects that tinting a lens (contact or
spectacle) can offer.
Fluorescent migraines
D.B., a 57-year-old male presented
to The Eye Center at Southern College of Optometry with severe migraines, including auras that triggered when exposed to fluorescent
lighting for as briefly as 15 minutes. At the time of first presentation, he wore very dark sunglasses
and a baseball cap at work to help
prevent the onset of migraines. To
reduce overall brightness, he removed half of the tubes in each
fixture. Occasionally, he needed
to shut off all the lighting.
D.B. was seen by a neurologist
for his headaches, but his medical
and ocular histories were otherwise
unremarkable. D.B. was experienc-
PAUL HARRIS, OD,
FCOVD, FACBO,
FAAO, FNAP
is a professor at
Southern College
of Optometry after
being in private
practice in Baltimore
for more than 30
years.
CHRISTINA
ESPOSITO, OD,
FAAO
works in vision
therapy and
rehabilitation at
the Midwestern
University Eye
Institute.
ing migraines daily which would
last for up to four hours. These migraines were so debilitating that
he remained in bed, losing days
of his life. He takes 100 mg of Imitrex (sumatriptan, GlaxoSmithKline) to help with the pain. He
is allergic to aspartame, caffeine,
cheese, monosodium glutamate,
and tryptophan. Upon examination, his uncorrected distance visual acuities was 20/20 OU, and
all other preliminary testing was
normal. Refraction revealed OD:
+0.50 -0.75 x 110 OS: +0.25 -0.50
x 110 with an add of +2.00 D OU.
Anterior and posterior segment
health is unremarkable. We performed color sensitivity
testing using the Intuitive Colorimeter (Cerium Optical Products).
This logically and sequentially explored color space and helps find
the optimal precision tint for the
relief of perceptual distortions, or
in this case, migraines. The Intuitive Colorimeter changes three parameters of color: hue, saturation,
and brightness. The patient views
colors, which are projected onto
text or other targets, through the
Figure 1. Output from the Excel spreadsheet for the hue of 180 and saturation of 30. The lower left part of the figure
shows which lenses are used to produce the final filter; Turquoise A5 and D2 and Green B4. The lower-right portion of the
figure shows the transmission curve of the final tint.
magenta
cyan
yellow
black
TAKE-HOME MESSAGE Tinting lenses
and contact lenses can help treat a variety
of visual disabilities. In this case, a patient
suffered from debilitating fluorescent lightinginduced migraines. He was first treated with
a pair of custom tinted glasses. Ultimately,
practitioners were able to create customtinted contact lenses for the patient which
helped to relieve him of migraines.
instrument while the examiner changes the
parameters and records subjective responses.
Based on the responses, a computer program
helps to determine which combinations of
filters will produce a color unique to the
patient’s needs. There are 42 different reference filters, which can be used one at a
time or, in rare cases, in combinations of
four to five different reference lenses. The
program gives a specific transmission curve
for the lens combination, which is testable
and reproducible. Using the filters allows
the patient to see the color suggested for
him before tinting. Treating with tinting With D.B., testing indicated a preference
with the spectrum narrowed to 180 at 30
saturation. Producing the right tint for D.B.
required three reference lenses, one from
the green set and two from the turquoise set
(Figure 1). This produces an overall 36 percent transmission with a peak at 500 nanometers. The first step was to make a pair of
glasses to this specification. The preferred
color was then called into the lab (Figure
2). The lenses still did not provide enough
coverage, and he was still experiencing the
migraines. We decided to try placing the tint
closer to the surface of the eye using contact lenses to more effectively block light.
Using the SoftChrome In-Office Tint System, the lenses were tinted in house. The
tinting system kit includes a choice of patterned templates to create pupil and iris
combinations, dyes, tinting equipment, and
instructions. The lens used was CooperVision Biomedics XC (omafilcon). A blue tint
was applied using the system instructions.
A dark tint was required to relieve the migraine symptoms.
ES557478_OP0215_030.pgs 01.22.2015 04:56
ADV
Contact Lenses
| practical chairside advice
31
of color through filters and/or lenses should be considered
for those who are struggling from visual disabilities.
Dr. Harris serves as the president of the Optometric Extension Program Foundation and
lectures on topics of behavioral vision care, vision therapy, and acquired brain injury.
[email protected]
Dr. Esposito graduated from the Arizona College of Optometry in 2013, then served as a
vision therapy/rehabilitation resident at the Southern College of Optometry.
[email protected]
Figure 2. The actual pair of glasses made for D.B. as a first attempt to help him with his
migraines.
Figure 3. The final tinted
contact on D.B.’s right eye.
The lens was an excellent fit
with good limbal to limbal
coverage and with 1 mm to 2
mm of movement with a blink.
He achieved 20/20 acuity with
these lenses in all normal
lighting situations.
It took about five iterations of
making the lenses progressively
darker before we attained an appropriate transmission level. We
combined 2 ml of activator solution with 15 drops of blue dye. The
lenses were left to tint for 45 minutes, then put into a neutralizing
solution to restore pH balance to
them. The lenses were then transferred to a multi-purpose solution
for storage, which was changed several times to be sure no dye was
coming out of the lenses.
We tinted only the pupil with the
first lenses in order to improve cosmesis. Though these were promising, it turned out that they still did
not provide enough coverage. The
most successful tint pattern was a
full diameter very dark tint (Figure 3). The result was a profound
change in the patient’s life. Benefits of in-house tinting
The benefits to tinting contact
lenses in-house include faster delivery time, color modification options, and the ability to apply a tint
for therapeutic use to any available
lenses. You can buy lenses that are
already tinted; however, if darker
or lighter colors are needed, you
would need to order many different
lenses, increasing the turnaround
time. For a patient that is suffering the way D.B. was, the sooner
the lenses were finished, the better.
The patient was able to wear the
tinted contact lenses full time during the day in any lighting condition
without experiencing headaches,
though it should be noted that he
removed them once he got home.
His acuity through the lenses is
20/20 OU. The patient stated, “I am
not tired at the end of my work day
due to the exposure to the fluorescent lighting, nor do I get migraines
as easily. I can tolerate being at
work, and I do not have to consider quitting my job. It is amazing, and I thank you again for what
you have done for me—giving me
a normal life back.” Tinting contact lenses and/or
glasses for therapeutic reasons can
be time consuming, but it can be a
rewarding experience for both the
clinician and patient. Many people
struggle with visual disturbances
on a daily basis. Whether it is light
sensitivity, reading problems, or even
visual sequelae related to vestibular
issues, color helps many of these
patients live a normal life. The use
Better
comfort.
Better
retention.
Better
results.
Take the VeraPlug™ challenge.
Compare the new VeraPlug to the plug you’re
using now and see the diference for yourself.
Visit lacrivera.com/challenge for your free sample
A FRESH PERSPECTIVE™
lacrivera.com
2500 Sandersville Rd
■
(855) 857-0518
Lexington KY 40511 USA
© 2014 Lacrivera, a division of Stephens Instruments. All rights reserved.
magenta
cyan
yellow
black
ES557477_OP0215_031.pgs 01.22.2015 04:56
ADV
Contact Lenses
32
FeBrUarY 2015
|
Corneal size does matter in lens fit
Case shows even subtle size abnormality can make lens wear difficult
By David Kading, OD,
fAAO, fcLSA, and Jeanette
Strommen, OD
C
to lens movement during contact
sports performance. Furthermore,
glasses temples are caught in between the head and a tight-fitting
helmet, which consequently applies extra pressure on the sides of
the athlete’s head. Contact lenses
eliminate all of these variables
and permit athletes to focus on
the game rather than being annoyed at their glasses.
orneal size does matter. In fact,
it can turn a simple soft contact lens fitting into a complex
DAVID KADING, OD,
clinical puzzle. With increased corFAAO, FCLSA
neal size, the sagittal depth does not
owns a threematch the size of the standard sagphysician, twoittal depth of off-the-rack soft conlocation practice in
tact lenses, making custom contact
the Seattle area.
lenses a necessary means to an end.
Looking at the cornea
We encountered this clinical coOur patient was a seemingly
nundrum when a 13-year-old young
straightforward contact lens fit with
man complained of an inability to
-2.00 D OU. Upon further evaluawear contact lenses throughout the
tion of his eye, we noticed his K
day. He had been to several eyecare
readings were 43.1/43.5 @ 017 OD
practitioners, all of which resulted in
and 43.4/43.7 @125 OS, indicating
unsuccessful attempts soft contact
that he had essentially spherical
BY JEANETTE
lens fittings. He was eager to trancorneas. All other aspects of his
STROMMEN, OD
sition into contact lenses because
ocular health were unremarkable.
is the anterior
he is an active athlete, participatWe applied a soft contact lens of
segment disease/
ing in lacrosse and football, both
contact lens resident standard diameter and noticed that
at Davis Duehr Dean
of which require helmets.
the contact lens was decentering
Eye Clinic in Madison, uncomfortably. Noting the size of
The use of spectacles can often
WI.
inhibit performance in sports with
the cornea compared to the size of
helmet requirements. In comparison
the contact lens, we were further
to contact lenses, spectacles limit the field
able to evaluate that his corneal size was
of view and provide less steady optics due
beyond normal.
TAKE-HOME MESSAGE In this case, a
teenage boy had not been successfully fit with
soft contact lenses and discomfort caused
him to discontinue all-day wear. K readings
revealed the patient had essentially spherical
corneas. Topography revealed his corneas
had a diameter of 12.04 mm OD and 12.10
mm OS—just slightly larger than normal, but
enough that it was preventing a correct fit.
Custom contact lenses were ordered and the
patient’s discomfort resolved.
We performed topography on his eyes
and noted that his corneas had a diameter
of 12.04 mm OD and 12.10 mm OS. The
standard corneal size is 11.8 mm.1 Thus,
although the size is not significantly outside of the normal range, we have concluded
that the size of the patient’s corneas and
the associated increased sagittal depth are
the cause to the long history of soft contact
lens fitting challenges in this patient. In this
particular patient’s case, the size abnormality was subtle, but significant enough to
have threatened his desire to wear lenses. Thus, we elected to order a custom soft
note how both eyes show HVID that is larger than 11.8 mm. Patients who have corneal sizes that are smaller or larger may need custom
lenses with custom diameters.
magenta
cyan
yellow
black
ES557597_OP0215_032.pgs 01.22.2015 05:40
ADV
| practical chairside advice
contact lens with a diameter that
is larger than standard. In our particular case, we would order a contact lens with at least 1.5 mm of
limbal coverage, so we will order a
contact lens that is 14.5 to 15 mm
in diameter. If solely customizing
the diameter is not enough to stabilize the contact lens on particu-
In this case,
the size
abnormality
was subtle,
but significant
enough to have
threatened his
desire to wear
lenses.
Don’t be afraid to customize
your lenses
It is very common for patients
who are wearing soft contact lenses
to occasionally not find the comfort
that they desire. They may present
with uncomfortable contact lens
wear, irritation throughout the day,
or possibly hyperemia that develops
after several hours of lens wear.
We are very fortunate to have access to many custom contact lens
laboratories. There are several retailers on the market that are able
to customize soft contact lenses to
our patients’ individual needs. Our
industry partners’ lenses offers custom soft contact lenses with a customizable base curve, power, and
diameter which suits the contact
lens needs of atypical corneas and
prescriptions. Several laboratories
suggest ordering a contact lens with
a diameter of 3.0 to 3.5 mm greater
than the patient’s horizontal visible iris diameter (HVID). Using our
Contact Lenses
33
RefeRence
1. Caroline P, Andre M. The effect of corneal diameter on soft lens fitting,
part 1. Contact Lens Spectrum 2002;17(4)56.
Dr. Kading disclosed speaking, research, or consulting relationships with Alcon, Allergan,
Bausch + Lomb, Contamac, CooperVision, Paragon Vision Sciences, SynergEyes, Unilens,
Valley Contax, Vistakon, and Visionary Optics.
[email protected]
Dr. Jeanette Strommen plans to settle in the Minneapolis-St. Paul area after
completing her residency and plans to practice full-scope optometry with a niche in
anterior segment disease and contact lenses.
[email protected]
Building the Ophthalmic Tech’s Community of Practice
modernmedicine.com/iTech
Resource Center for Technician Education
WEB EXCLUSIVE
CONTENT
Know what sports your patients
play: keep contact lenses in mind
Related Articles
Continuing Education
With the welcomed safety requirements that we are seeing come
into play with more and more of today’s sports, it is important for us
to identify the sports that our patients play. eyeglasses are very difficult to wear under helmets. this
is extremely critical for our patients
who are children. these patients
often will remove their glasses
out of convenience and may not
mention to their parents the significance of their visual problems.
larly large corneas, then the base
curve comes into play. These parameters work synergistically to
increase the sagittal depth of the
contact lens significantly when the
base curve is decreased. The diameter will also increase. The result
is a contact lens with a far greater
sagittal depth, one that may better match the sagittal depth of the
larger than average cornea, permitting a more harmonious contact lens experience.
magenta
cyan
yellow
black
Often, parents are aware of the
significance that a child’s refractive error can have on his daily life.
this is even more important with
high-intensity sports like football
and lacrosse. look closely at your
patient’s hobbies and remember
to keep contact lenses in mind for
patients who play sports. sports
with helmets include hockey, football, baseball, softball, lacrosse,
snowboarding, snowskiing, waterskiing, bobsled, etc.
patient as an example, we would
then order his contact lenses with
a diameter of around 15.60 mm.
Turn to your local custom soft
contact lens provider for further
recommendations in ordering its
particular lens.
In our clinic, we have found that
corneal size is a major factor that
needs to be followed and monitored.
Corneal size variations can be a
significant marker for contact lens
comfort and success.
Clinical Tools & Tips
iTech provides educational
presentations and information
for ophthalmic and optometric
technicians, helping them work
effectively with their doctors to
enhance the practice.
1
AND
SUPPLEM
ENT TO
IM
ERY T
AY, Ee V
Y Dpr
tic
, EVl EfoR
ery ac
N
ev
A
r
E
sentia
IT CL
E
is
hygiene
Hand important
just as
rument
as inst tion
steriliza comes
it
when
solid
ing a
to hav n control
infectio
m.
progra
G program is es
KEEioPnIN
control
Infect
ros
ent
only elem said
be the
m,
uld not
progra
ents sho ction control
Instrum
infe
ctice’s
, CRNO.
Health
of a pra
RN, MN
ty and
Lamb,
ters for
al Safe
Patricia
the Cen
upation
versal
Occ
and
The
lined uni
(OSHA)
tration
have out ction
(CDC)
Adminis
s for infe every
Control
caution
Disease
nt for
dard pre are importa
day,
se
and stan
e, every
, and the every practic
nt of the
control
in
side
er,
pre
mb
past
istered
team me who is the
ic Reg
b,
cialist.
hthalm
said Lam Society of Op ical nurse spe
er
an
clin
Americ
) and a
ne in ord
od,
dici
ORN
(AS
cly to blo
into me
Nurses
ted infe
y goes
tions app
ons
-associa , to practice
“Nobod
d precau , and excreti
lthcare
less
s
standar
ons
vent hea b. “Neverthe prevent
mucou
These
secreti
to pre
Lam
e to
skin, and
y fuids,
abl
said
intact
all bod
tions,”
must be ctions.”
at, non
A
or
caune, you
s, OSH
ept swe
ments ion
ted infe
sal pre
yee
exc
medici
ver
plo
ocia
detach
ial
em
A uni
an
ranes.
eous
the opt es,
are-ass
tion of
a potent
or vitr surgery is
memb
cas
healthc ing to the OSH certain hum
protec
s with
some lmic
posteri
ur,
be
nd in
For the all employee
to be
When breaks occ
Accord an blood and
y fluids
Ophtha
age—a
known
d by
other
and bod
s that
retinal the dam lost vision. some of
all hum treated as if
air
s, and
blood
dictate
tion, pai
tions,
to
viru
cina
re
to rep even restore be aware of
B
are
vac
osu
atitis
fuids
atitis B
for exp
it may ans should
body
HIV, hep .
the hep
uire
nici
us for
s and
req
red
ens
tech
s
ctio
ure
offe
yee
ced
infe
t
pathog
ployer.
the pro rations tha
h emplo
borne
limited
the em ition, all suc
bloodbut not
conside lmologists
rd
ens,
g
uding
In add
standa the concept of
pathog
ophtha n choosin l
g, incl
borne
ed
versal to
trainin
s.
surgica
face whe
annual owing: bloodFrom uni CDC expand changed theed
ir
etinal
onomic
vitreor ches for the
and erg n control
6, the
s” and
lain
the foll
lence,
In 199
s,” exp
caution
s to
approa
lace vio Lamb, infectio that cause
sal pre
deline
ts.
caution
nts
patien
rd pre
“univer
tion gui uce workp
ing to
“standa
in of eve
precau
red
Accord
the cha
term to se standard followed to
3
ak
Page
bre
and
n.
The
IONS on
uld be
borne
aims to
infectio
Lamb.
INFECT
all
bloodCDC sho
ead of
See
of
to
n
the
spr
lied
the
app
from
smissio
ir
of tran
must be
of the
the risk
ens and regardless
,
pathog
n status.
other
ng care
ts receivi sumed infectio
patien
sis or pre
diagno
Mesza
By Liz
E: ocedures
INSIDetina
l pr
to treat
es
ks
approach
Surgicalments and brea
detach
Vitreor
PAGE 11
Brought to you by
e 01 |
volum
issue 04
| Winter
2012
ES557598_OP0215_033.pgs 01.22.2015 05:40
ADV
Dry Eye
34
FeBrUarY 2015
|
SPEED questionnaire identifies dry eye
Asking the right questions can lead to successful tailored treatment plans
By Leslie e O’Dell, OD, fAAO
mation. I’ve learned the phrase,
“No complaints of dry eye” can’t
always be accepted as gospel.
ne of the challenges we face
As I start my exam, there are sevin diagnosing our patients
eral important signs I look for that
with dry eye disease is that
indicate I may be dealing with a dry
clinical findings and the patient’s
eye patient who doesn’t know she
symptoms often do not correlate.1,2
BY LESLIE E
is one—yet. A quick introduction
There’s simply no definitive “one
O’DELL, OD, FAAO
will show me any signs of redness
size fits all” approach.
is the director of the
to the eyelid margin or the ocular
In lieu of improving diagnostic
Dry Eye Treatment
surface, and even the appearance
tests, symptoms have been shown
Center at May Eye
Care Center in
of the patient’s face might show
to be more repeatable than clinical
Hanover, PA.
redness associated with rosacea. findings.3 The challenge is our paDuring my refraction, visual
tients’ perception of dryness when
fluctuations before and after blink can be
using a subjective measure. This challenge
apparent. From there, I get into the most
in diagnosing dry eye parallels the chalcrucial element of my evaluation: a thorlenges eyecare practitioners face when diough slit lamp exam. agnosing glaucoma. We evaluate subjective
I evaluate the lid, tear meniscus, tear breakand objective measures to develop a risk/
up time, corneal and conjunctiva staining,
benefit ratio for each patient that guides
and meibomian glands. I then take time to
our clinical decision on when to treat. We
step back from the slit lamp and begin to ask
do not and cannot use one test for making
questions that can quickly reveal if a patient
this diagnosis; rather, the best diagnosis is
is suffering from ocular surface disease. made using a culmination of data points
I ask questions such as:
over time.
How long can you read before your eyes
fatigue or blur? Defining normal for each patient
During a typical day seeing patients in our
How do you feel after a day in the ofbustling practice, it’s surprising how many
fice on the computer? dry eye patients I encounter, but you wouldn’t
How do your eyes feel in the morning
know it by reviewing patient intake inforwhen you are waking? O
MEIOBOGRAPHY can now be done easily in office with the introduction of dynamic
transillumination available in lipiview ii from tearscience. this image shows truncation and
atrophy of the meibomian glands of a lower lid. these images speak volumes to patients
and enhance their understanding of this chronic condition. Image courtesy of TearScience
magenta
cyan
yellow
black
TAKE-HOME MESSAGE Often, a patient
may come to accept dryness or discomfort as
the “new normal,” and he may not come to you
to seek a solution if he does not know there is
a problem. A simple set of questions, like the
Standard Patient Evaluation of Eye Dryness
(SPEED) survey, can help evaluate the severity
and frequency of dry eye symptoms.
Do your eyes water, look red, or feel
irritated? How do your eyes feel when you outdoors, especially in the wind?
While optometrists are trained to know
what dry eye symptoms are, we need to
be cognizant that patients suffering these
symptoms often accept them as a “new normal” and may not realize that dry eye disease is the cause.
Implementing a questionnaire
This disconnect with patient perception led
our practice to shift from simply asking the
patient if she have dry eyes to utilizing a
detailed questionnaire that the patient fills
out when he is checking into the office. Several years back, I developed my own
questionnaire based on past experience and
would occasionally use the Ocular Surface
Disease Index (OSDI) for patients already
being treated for dry eye, aqueous deficient
or evaporative. About two years ago, we started to implement the Standard Patient Evaluation of Eye
Dryness (SPEED) survey, a validated dry eye
survey that like its name is fast.4,5 This helps
immensely with patient (and staff) compliance. SPEED evaluates both the frequency
and severity of symptoms in just eight questions. The patient grades the severity of her
symptoms on a scale of zero to four with
zero being no symptoms and four being intolerable symptoms. The numeric value for
each answer is simply added with scores
ranging from zero to 28. The questionnaire is
set up to ask patients about their symptoms
in the present and up to three months due
to the variability of symptoms over time.6
The symptoms Korb and Blackie used for
ES556431_OP0215_034.pgs 01.21.2015 00:34
ADV
Dry Eye
| practical chairside advice
the survey help to quickly identify possible
underlying causes. Grittiness is a common
complaint of patients with lid wiper epitheliopathy, while burning is often found
in patients with partial blinks.6
The SPEED questionnaire is able to differentiate symptomatic from asymptomatic
patients.7 Having a number from a questionnaire quickly helps me to identify and
categorize dry eye patients. For those with many symptoms greater
than 8 on the SPEED, their current treatment
should be re-evaluated to gain better symptom control. For those asymptomatic, clinical
signs that might indicate early stages of dry
eye, especially meibomian gland dysfunction, should be evaluated. Start educating
patients even when they are not complaining, less than 6 on the SPEED. Current treatments may be more effective
if we initiated them in early stages. We are
in an evolving role presently; raising public awareness of ocular surface wellness
starts with the optometrist. This challenge
harkens back to the uphill battle dentistry
faced years ago before annual and biannual evaluation were standard of care to
Quick quiz
after the slit lamp exam, i ask patients
these questions to determine if dry eye
might be a problem for them.
– How long can you read before your eyes fatigue or
blur?
– How do you feel after a day in the office on the
computer?
– How do your eyes feel in the morning when you are
waking?
– Do your eyes water, look red, or feel irritated?
– How do your eyes feel when you outdoors, especially
in the wind?
prevent tooth decay and even that of dermatology prior to public awareness of the
importance for sunscreen to prevent skin
cancer. Changing public perception and industry practices related to dry eye disease
will not be an easy or short-term process,
but is a critical element in helping dry eye
sufferers avoid symptoms and find relief. Validated questionnaires
There are a wide variety of options of validated questionnaires to use in a clinical setting. OSDI, Dry Eye Questionnaire (DEQ),
McMonnies Questionnaire (MQ), Subjective
Evaluation of Symptoms of Dryness (SESoD),
and now, SPEED. Studies have shown the
magenta
cyan
yellow
black
35
Figure 1.
The Standard Patient Evaluation
of Eye Dryness (SPEED)
survey can help evaluate the
frequency and severity of dry
eye syptoms. To download a
free copy of this questionnaire
to use in your practice, go to
www.OptometryTimes.com/
SPEEDdryeye.
SPEED questionnaire to be similar to the
OSDI in determining symptomatic from asymptomatic patients.6 The OSDI is a great
tool for assessing the quality of life impact
dry eye is having for a patient, which is a
critical consideration.
Using a validated questionnaire as a routine part of your routine eyecare evaluation
is one more tool that will guide your diagnosis and treatment. With the proven repeatability of these questionnaires, the results can also show outcomes for the treatment you have implemented. If the number
on the SPEED survey is going down, rest
assured your treatment is effective for the
time being. If the number from the SPEED
is stationary or on the rise, step back and
re-evaluate.
The challenge
Start using a questionnaire for every patient you see, it’s fast and you may be surprised with the hidden number of dry eye
patients. Then the real challenge begins.
Take the extra time to talk to your patients
and develop a treatment plan to not only
relieve their symptoms but also slow the
progression of the disease. And schedule a
follow-up, even if you are simply starting
artificial tears. A follow-up not only allows
you to re-evaluate the therapy and repeat
the SPEED but also validates the problem
to your patients.
RefeRences
1. Begley CG, Chalmers RL, Abetz L, et al. The
relationship between habitual patient-reported
symptoms and clinical signs among patients with dry
eye of varying severity. Invest Ophthalmol Vis Sci.
2003 Nov;44(11):4753-61.
2. Sullivan BD, Crews LA, Sonmez B, et al. Clinical
utility of objective test for dry eye disease: variability
over time and implications for clinical trials and
disease management. Cornea. 2012 Sep;31(9):10008.
3. Nichols KK, Nichols JJ, Mitchell FL. The lack of
association between signs and symptoms in patients
with dry eye disease. Cornea. 2004 Nov;23(8):762770.
4. Korb DR, Herman JP, Greiner JV, et al. Lid wiper
epitheliopathy and dry eye symptoms. Eye Contact
Lens. 2005 Jan;31(1):2-8.
5. Korb DR, Scaffidi RC, Greiner JV, et al. The effect
of two novel lubricant eye drops on tear film lipid layer
thickness in subjects with dry eye symptoms. Optom
Vis Sci. 2005 Jul;82(7):594-601.
6. Blackie C, Albou-Ganem C, Korb D. Questionnaire
assists in dry eye disease diagnosis. Four-question
survey helps evaluate patients’ dry eye symptoms
to improve screening. Ocular Surgery News Europe
Edition. November 2012.
7. Ngo W, Situ P, Keir N, et al. Psychometric properties
and validation of the Standard Patient Evaluation
of Eye Dryness questionnaire. Cornea. 2013
Sep;32(9):1204-10. Dr. O’Dell lectures throughout the East Coast and
internationally on dry eye-related topics. She is a graduate
of the Pennsylvania College of Optometry and University of
Delaware and served her residency at the Baltimore VA Hospital.
[email protected]
ES556926_OP0215_035.pgs 01.21.2015 22:50
ADV
InDispensable
36
FEBRUARY 2015
Nearsights
offers
monocles
for women
|
PURITI
DURAHINGE
PuriTi and DuraHinge
launch styles for women
RALEIGH, NC—Nearsights has introduced
a new line geared specifically toward
women with its smallest monocle.
The new diameter makes Nearsights the
only monocle company to provide consumers with a full range line: 34 mm (small), 37
mm (medium), and 40 mm (large).
The 34 mm is available in the classic,
tinted, and mirrored models for comfortable hands-free correction. Monocles can
be adapted to multiple magnifier strengths
(plano to +4.00 D) and written to prescription. The polycarbonate lens and polished
stainless steel frame fits neatly in pockets
or can be worn around the neck with the
included lanyard.
magenta
cyan
yellow
black
HAUPPAGE, NY—ClearVision recently expanded two of its private label collections,
PuriTi 100 percent titanium eyewear
and DuraHinge, to include new styles
for women.
PuriTi for women offers the ultra lightweight, hypoallergenic, and anti-corrosive
benefits associated with titanium, in classic to contemporary designs. The four introductory styles feature pierced temple
designs, metallic pearl temple tips, jewelry-inspired details, and integrated spring
hinges. All four styles are offered in feminine colorations.
Created and designed for women who
need a little more durability in their eyewear,
DuraHinge for women offers strength and
comfort with a touch of feminine style. The
collection is designed with the DuraHinge
five-barrel hinge construction, providing
strength with the added flexibility of a spring
hinge without being too heavy or bulky on
the face. The six introductory styles feature decorative stone accents and marble
temples. The styles are offered in jewel
tone colors like gold, purple, and wine.
To celebrate the introduction of PuriTi
for women and DuraHinge for women,
ClearVision is offering special programs
available to eyecare professionals through
February 27, 2015. In addition, in-store
merchandising materials, including counter
cards and custom displays, are available
for both collections.
ES557513_OP0215_036.pgs 01.22.2015 05:04
ADV
VISIONARIES
IN EDUCATION, FASHION AND TECHNOLOGY
Are you practicing full-scope medical
eyecare? International Vision Expo
offers advanced education focused on
the core competencies of your practice:
management of eye disease, contact
lens technology, practice management
and optical topics. By expanding your
knowledge base, you’ll enhance the
scope of your practice and patient
offerings to the maximum extent of
your license.
It’s no surprise that more Optometrists
and Opticians choose to continue their
education at International Vision Expo
than at any other conference globally.
After all, the conference offers more
than 330 hours of education and
has added tracks to address Retail,
Wearable Technology and Ocular
Wellness, plus clinical, business
solutions and interactive crowd-source
learning.
International Vision Expo has created
the Young Professionals Club, offering
tools to jump-start your career.
Optometrists who have graduated
within the past five years are invited to
join. Enjoy six hours of complimentary
education, free exhibit hall registration,
resources to help you start a practice
and networking opportunities with
other young ODs.
INTERNATIONAL VISION EXPO 2015
EDUCATION: THURSDAY, MARCH 19–SUNDAY, MARCH 22 EXHIBITION: FRIDAY, MARCH 20–SUNDAY, MARCH 22
JAVITS CENTER | NEW YORK, NY | VisionExpoEast.com | #VisionExpo
PROUD SUPPORTER OF:
magenta
cyan
yellow
black
ES558669_OP0215_037_FP.pgs 01.23.2015 19:39
ADV
38
InDispensable
FEBRUARY 2015
|
Via Spiga debuts new styles
Zyloware recently expanded the Via Spiga Eyewear Collection with five new optical styles,
three of which are seen below, and two sun-
glasses. These are inspired by Via Spiga’s latest
trends including sporty styling, stones, studs,
and animal prints. Snap-in logo nosepads are
a special feature of the frames with a plastic
core that prevents oxidation and discoloring
in a shape for comfort and feminine styling.
Via Spiga Graziella is a rectangularshaped frame with sheet metal accents
on the metal front. The temple features a
studded faceted rectangular plaque with
the Via Spiga logo. The wide zyl temples
allow for a comfortable fit for the wearer.
The black frame features a spotted black
and grey tortoise zyl temple.
Via Spiga Frederica has a full rim zyl front
in a rectangular shape, and the zyl endpiece
features a diamond-shaped shield. This frame
has metal temples that have a two-toned look
and feel. The black turquoise frame has a black
zyl front and milky light blue layer on the inside
with tortoise zyl temple tips infused with turquoise blue. The multi crystal stripe color frame
features shiny brown temples with brushed tan,
and finishing with dark brown zyl temple tips.
Via Spiga Raffaella is a full rim zyl frame
in a square shape. The Tortoise frame features
zyl green marble temples with a metal and laser
accent. The black frame incorporates an eyecatching mosaic pattern with a chic black metal
and laser accent.
Costa introduces Cortez sunglasses
DAYTONA BEACH, FL—Costa’s new Cortez sunglasses offer a large fit with a wrap shape, meant
to block glare from entering from the sides.
The linear venting system alleviates lens
fogging, and the temple tips feature open
magenta
cyan
yellow
black
slots for a retainer cord.
The frames are built of co-injected molded
nylon with sturdy integral hinge technology.
The hypoallergenic rubberized interior lining
and nose pads keep the sunglasses comfortably in place.
Cortez frame color options include blackout, tortoise, shiny black, Realtree
Xtra camo, crystal bronze, and
white with a blue Costa logo.
All Costa sunglasses can be
customized in its full array of
patented color-enhancing po-
larized 580 lenses. Costa’s 580 lens technology
selectively filters out yellow and high-energy
ultraviolet blue light. Filtering yellow light enhances reds, blues and greens, and produces
better contrast and definition while reducing
glare and eye fatigue. Absorbing high-energy
blue light cuts haze.
Costa’s 580 lenses are available in either
glass or impact-resistant polycarbonate.
Lens color options include: gray, copper,
amber, sunrise, blue mirror, green mirror, and
silver mirror. Cortez is also available in customized Rx sun lenses.
ES557514_OP0215_038.pgs 01.22.2015 05:04
ADV
February 2015 / OptometryTimes.com
Go to:
39
products.modernmedicine.com
Products & Services
SHOWCASE
PRODUCTS
Search for the company name you see in each of the ads in this section for FREE INFORMATION!
magenta
cyan
yellow
black
ES558687_OP0215_039_CL.pgs 01.23.2015 20:33
ADV
40
Marketplace
February 2015 / Optometry Times
PRODUCTS & SERVICES
DISPENSARY
magenta
cyan
yellow
black
ES558685_OP0215_040_CL.pgs 01.23.2015 20:33
ADV
Marketplace
February 2015 / OptometryTimes.com
41
PRODUCTS & SERVICES
CONFERENCES & EVENTS
PRACTICE MANAGEMENT
Advertisers Index
American Academy of Optometry
New Jersey Chapter
Advertiser
13t h Annual Educational Conference
April 22-26, 2015
Myrtle Beach, South Carolina
Alcon Laboratories Inc
Tel: 800-862-5266
Web: www.alcon.com
Hilton Embassy Suites at Kingston Plantation
Dr. Mark Friedberg, M.D.
Founding Editor of the
Wills Eye Manual
16 HOURS
COPE CE
Dr. Alan Kabat, OD., F.A.A.O.
Registration: $475.00
One, Two or Three Bedroom Suites
Accommodations Include a Daily Breakfast Buffet
and Evening Cocktail Reception
PACK YOUR CLUBS!
Golf details to follow.
For Accommodation and Additional Information, contact:
Dennis H. Lyons, OD, F.A.A.O.
QUIKEYES ONLINE
WEB-BASED OPTOMETRY EHR
• $99 per month after low cost set-up fee
• Quick Set-Up and Easy to Use
• No Server Needed
• Corporate and Private OD practices
• 14 Day Free Demo Trial
• Users Eligible for 44K incentives
www.quikeyes.com
Phone: (732) 920-0110
E-Mail: [email protected]
CLASSIFIED WORKS!
Content Licensing for Every
Marketing Strategy
Page
CVTIP, CV2, CV4
Allergan Inc
Tel: 714-246-4500
Fax: 714-246-4971
Customer Service: 800-433-8871
Web: www.allergan.com
15
Bausch + Lomb
Tel: 800-227-1427
Customer Service: 800-323-0000
Web: www.bausch.com
7, 11, 12
Beaver Visitec
Tel: 781-906-7941
Web: www.beaver-visitec.com
27
Cooper vision
Web: www.coopervision.com
CV3
Heidelberg Engineering
Tel: 800-931-2230
Fax: 760-598-3060
Web: www.heidelbergengineering.com
17
Lacrivera
Tel: 855-857-0518
Web: www.lacrivera.com
31
Nova Bay Pharmaceuticals
Web: [email protected]
19
Thrombogenics
Tel: 732-590-2900
Web: www.thrombogenics.com
Marketing solutions fit for:
Outdoor | Direct Mail | Print Advertising
Tradeshow/POP Displays | Social Media
Radio & TV
TTI Medical
Tel: 800-322-7373
Web: www.ttimedical.com
29
Vision Expo
Web: www.visionexpoeast.com
37
Vistakon
Web: www.acuvueprofessional.com
Leverage branded content from Optometry Times to
create a more powerful and sophisticated statement
about your product, service, or company in your
next marketing campaign. Contact Wright’s Media
to fnd out more about how we can customize your
acknowledgements and recognitions to enhance your
marketing strategies.
9
22, 23
This index is provided as an additional service.
The publisher does not assume any liability for errors
or omissions.
Call Karen Gerome
to place your
Products & Services ad at
For information, call Wright’s Media at
877.652.5295 or
visit our website at www.wrightsmedia.com
magenta
cyan
yellow
black
800-225-4569, ext. 2670
[email protected]
ES558686_OP0215_041_CL.pgs 01.23.2015 20:33
ADV
42
Q&A
FEBRUARY 2015
Dori Carlson, OD
|
Former AOA president, owner of Heartland Eye Care of Park River and Grafton, ND
North Dakota, leadership, weight lifting, and ice
How does your practice differ from your colleagues in different areas of the
country?
We end up taking care of a
lot of different things, which
makes the day more interesting. I really don’t have anyone to refer to—my husband
and I and our associates tend
to be the go-to folks.
How did you get interested in optometry
leadership?
I got asked to do a few
things, I saw a need. To be
really honest, I was frustrated with our therapeutic bill and limitations on
what we were able to do and
prescribe when I moved to
North Dakota. When I did
my residency in the VA,
I treated glaucoma, there
weren’t a lot of limitations
within the normal range for
that time period. When I
moved to North Dakota, suddenly I couldn’t prescribe
medications for glaucoma,
and when I worked part-time
across the border in Minnesota, I couldn’t even prescribe an antibiotic. So I
found myself calling local
ophthalmologists and being
frustrated that because I
moved across a state I didn’t
know how to do something
I did on a daily basis beforehand. It was more geography than anything else, so
I wanted to get involved because I wanted to get that
changed. As they say, one
thing leads to another.
What advice about leadership do you have for
other women in the profession?
Do something that scares
you. By doing that, you grow
magenta
cyan
yellow
black
Q
What one thing
did you learn
from AOA
leadership?
Oh, I’ve changed as a
person. My leadership
skills are much better. I used to be terrified of public speaking.
That was a baptism
by fire, and now I’ve
learned what speaking style works for me,
so I’ve gotten past
that. I think that I’m a
little more forthright
and definitely stronger
as a person for having gone through that
experience.
as a person and as a leader.
I cannot explain how much
it’s brought to the practice
or my life in general. When I
look back at the times I had
to speak in public prior to
coming onto the AOA board,
I shake my head laughing,
I wish I could go back and
re-do some of those. You
learn what your speaking
style is, and what works for
one person doesn’t work necessarily for another. Obviously, the more comfortable
and more prepared you are,
the easier it is to deliver a
message.
What’s one thing your
colleagues don’t know
about you?
Only my close friends know
this, but I love weight lifting. Three times a week I go
to the gym, and I lift weights
for an hour. I started weight
lifting with videos at my
house, and then a woman
opened a fitness gym with
group fitness classes and I
signed up. Ever since, I’ve
been going to her classes
pretty regularly, which has
been a blast.
Where do you see the
future of optometry?
I think optometry has a lot
of positive things going for
it. As changes happen, and
the jury’s still out with what
will happen with the Affordable Care Act, I think we’ve
got our toe in the door for access to patients much better
than what we had before. If
you look at the other aspects
of health in general, the increasing number of diabetics,
increasing number of macular degeneration, they’re
going to need care. The number of ophthalmology residents are not increasing to
accommodate that care, so I
think there’s incredible opportunities for optometry if
optometry wants to embrace
them
this little family-owned resort that we go to, they usually cut a hole in the lake.
You sit in a sauna at about
108°F until you can hardly
stand it anymore. Then
you’re finally ready to run
out on to the lake ice and—
for safety reasons there’s a
ladder so you don’t just jump
into the hole—but go down
on the ladder and put your
body into this freezing cold
water. You wear wool socks
or tennis sandals or something so your feet don’t stick
to the ice. The worst one was
a 30 mph wind and it was
below zero—it was pretty
chilly out there! No, we had
not been drinking. You know
it’s for the photo opportunity
to claim that you did it.
—Vernon Trollinger
What’s the craziest
thing you’ve ever
done?
I’ve jumped in a
hole in the ice in a
lake with the polar
plunge! We go crosscountry skiing every
winter. As part of
Photo courtesy Dori Carlson, OD
To hear Dori’s full
interview, listen
online:
optometrytimes.com/
DoriCarlson
ES556393_OP0215_042.pgs 01.21.2015 00:20
ADV
All eyes deserve clariti.
clariti 1 day—now available for practices everywhere.
The world’s first and only family of silicone hydrogel daily
disposable contact lenses designed for every patient
type—sphere, toric and multifocal.
High Oxygen
Transmissibility
High Water
Content
Low
Modulus
UV
Protection
Afordable
Upgrade
Now you can prescribe all of your patients with healthy,
comfortable, afordable silicone hydrogel 1 day lenses—
which will make all eyes very happy indeed.
To learn more, contact your CooperVision representative
today or visit CooperVision.com/practitioner.
magenta
cyan
yellow
black
ES558330_OP0215_CV3_FP.pgs 01.23.2015 03:38
ADV
THIS IS WHY our daily disposable multifocal
contact lens is designed to perform at every distance and
refreshes with every blink—no matter what the day may bring.
PRECISION PROFILE Design
WITH BLINK-ACTIVATED MOISTURE
DAILIES® AquaComfort Plus® Multifocal
NEAR
IN
E
T E R M E D I AT
contact lenses are designed to deliver clear
binocular vision and refreshing comfort.
D I S TA C E
N
PRECISION PROFILE
DESIGN
Smooth, uninterrupted
transitions from near
to intermediate,
to distance.
Visit myalcon.com
BLINK-ACTIVATED
MOISTURE
Moisture is released
with every blink,
which helps result
in a stable tear flm.
SUCCESSFUL WEAR
Clear vision and comfort
throughout
the day.
Featuring the same
Precision Profile Design as
AIR OPTIX® AQUA Multifocal—
the #1 multifocal contact lens.1
PERFORMANCE DRIVEN BY SCIENCE™
Reference: 1. Based on third-party industry report, 12 months ending March 2013, Alcon data on file.
See product instructions for complete wear, care, and safety information.
© 2015 Novartis 1/15 DAM13014JAD-A
magenta
cyan
yellow
black
ES558314_OP0215_CV4_FP.pgs 01.23.2015 03:38
ADV