HOYA Creates Learning Center for ECPs

HOYA Vision Care Announced the creation of the HOYA Learning Center with new positions added to support the growing needs of Independent eyecare professionals. Customer needs are ever evolving and the HOYA Learning Center at the outset will address four specific needs–technical and medical education, practice development, new media optics and dispensing.

The mission for the HOYA Learning Center is to help Independent eyecare professionals of all experience levels have access to the information they need to stay ahead of the curve in a rapidly shifting and ultra-competitive market.

Complimentary training will be available in multiple formats including in-person, instructor-led webinars and self-directed web-based training programs. Training can be customized to meet the needs of each practice and each individual so all can meet their respective goals.

Meet the Growing Challenge: Treating Macular Degeneration

Our aging population is providing more cases of macular degeneration. Serve this growing need by discussing UV protection and lifestyle changes, and by providing early detection and early treatment. Technology is advancing; educate yourself on improved detection and treatment options.

With the Baby Boomer generation (those between 1946-1964) aging into senior citizens, macular degeneration is increasingly being diagnosed.  Taking steps to prevent and treat macular degeneration is the right thing to do, but it also is a great practice builder as you are providing services vital to the health of your community.

Institute Screening for all Patients

Patients who have a family history of macular degeneration are the most susceptible to this disease, but with the occurrence of it so common today, you should screen all patients. Take a baseline digital retinal photo and then review the image with patients letting them know if and where you see potential for disease inside their eyes. Point out details such as their optic nerve, the blood vessels and macula. Create a policy to photograph the retina at each annual exam (similar to a dentist requiring an x-ray annually), and, more frequently if they have diabetic or hypertensive retinopathy, AMD or a retinal hole, tear or degeneration that should be monitored more frequently. That way, everyone is screened and that creates an ideal opportunity to discuss prevention of potentially blinding eye diseases, like AMD and glaucoma with annual eye examinations, good nutrition and protecting the retina from UV damage. You can charge for the photo taken and advise the patient there will be a charge. You can participate with Medicare and Horizon BCBS for medically based eyecare. The billing code is 92250 and the diagnosis would be 362.57 (drusen) or 362.51 (dry AMD).

You shoulde explain the effect that ultra violet radiation has on this part of the eye and why it is important for patients to protect their eyes from the sun with quality sunwear.

Educate Nutrition and Personal Habits

In addition to explaining the importance of sun protection, you can point out how smoking triples the risk of developing AMD.  Explain the importance diet plays in prevention. For instance, according to the Mayo Clinic, eating kale, spinach, broccoli, peas and other vegetables, which have high levels of antioxidants, including lutein and zeaxanthin, may also reduce the risk of macular degeneration.

Talk Supplements

In addition to protecting eyes through the use of quality sunwear, a better diet and avoiding smoking, you should recommend that all patients, and especially those who are 50 and over, or those with a family history of macular degeneration, take MacuHealth, a macular degeneration-focused nutraceutical. The script has a toll-free number patients can call; it is $75 for a 90-day supply. Macuhealth is only available through a Doctor of Optometry or Ophthalmology or by dialing the toll-free number on the Rx pad. It is NOT available in drugstores or on other web sites.

Educate that in an Era of Electronic Screens, All Are At Risk

More research needs to be conducted in this area, but evidence is beginning to emerge that the blue light emitted from electronic devices like laptops and mobile devices, along with the light emitted from compact fluorescent (CFL) lightbulbs, increases macular degeneration risk. This is one more reason to take precautions regardless of your age or family history. Explaining the possible role these modern forms of light play in increasing macular degeneration risk, you can also emphasize the importance of annual comprehensive examinations in protecting eye health.

Serving the Changing Visual Needs of Women Patients

Providing eyecare that serves the needs of women who are pregnant or experiencing other hormonal changes meets a vital need and projects a family-friendly message.

Women sometimes have eyecare challenges that differ from men due to the hormonal changes that they experience during pregnancy and at other times in their life such as through the use of contraceptive pills and during menopause. High-quality artificial tears and switching to a new silicone hydrogel daily replacement lens will become important to prevent excessive inflammation or irritation.

Many of your patients will experience similar symptoms due to hormonal changes. Here are some key points to consider about keeping women’s eyes comfortable through hormonal changes including pregnancy.

In Exam Room: Educate and Reassure Patient

In order not to assume anything, do not address pregnancy eyecare concerns until a woman has told me she is pregnant or asks about it on her own before then. Reassure the patient that pregnancy usually doesn’t cause major issues with eye health, but for those issues you do see, it usually has to do with contact lens intolerance due to hormonal changes in the tears and ocular tissues (most likely) or minor prescription changes that may or may not be permanent. The biggest concern is the development of gestational diabetes and potential diabetic retinopathy.

It’s good to let them know, however, that breastfeeding may extend the issues, but regardless, the benefits for the baby’s eye development through breast milk are fantastic! There are significant brain development advantages to breast milk. It is common for baby formulas to advertise that their brand offers all the necessary nutrients for eye and brain development. Breast milk is even better than those formulas as it naturally contains all of those nutrients. Since 30 percent of our overall brain function is dedicated to vision, the same nutrients in breast milk that enhance brain function also, therefore, are beneficial to the infant’s vision.

Added Precautions Recommended for Pregnant Patients

Don’t dilate pregnant or nursing women unless there is a prominent need to do so to adequately check the health of the eye (for instance, diabetes, risk of retinal detachment, or any other sight-threatening condition). In those cases, have them use punctal occlusion to limit systemic absorption. Rarely, you would come across situations of red eye/infections.

Conceptive Pills Also Cause Hormonal Changes

Even before women become pregnant, they may be experiencing eye discomfort related to the kind of birth control pills they are taking. If a woman has a sudden change in experiencing dry eye, or notices a pattern of dryness throughout the month, that is a flag to ask questions about what type of birth control she is on (it seems to be better with monocyclic brands than tricyclic because the monocyclic pills provide a steady dose of hormones whereas the tricyclic pills change hormone levels weekly and can be more problematic for SOME women).

Opportunity to Begin Education About Pediatric Eyecare

Become active in the InfantSEE program. Tell your pregnant patients about the program as a “gift to them and their baby” as the comprehensive exam is complimentary. As long as the baby is developing normally, they should have an eye exam in the first six to 12 months, again between ages 3-4, and every year thereafter. If there is a problem, there will be more exams scheduled. You should have a bulletin board in your office dedicated to taking pictures with the infants and then posting them up (with parents’ permission). It’s a great conversation piece and helps to educate others about the program.

Make sure you have the HIPAA Marketing Release Form signed before using marketing materials featuring patients.

Perennial Allergy Relief: A Practice Builder

Spring brings seasonal allergies, but it also is important to provide eyecare for patients with perennial allergies unrelated to seasonal changes. You will be rewarded with loyal patients who let others know of your services.

Allergies related to the change of season in the spring and fall is so common that many think exclusively of it when the topic of ocular allergies comes up. Providing for seasonal allergy patients is essential, but don’t overlook another segment of allergy suffers–those with allergies unrelated to these common factors. Here are key points to keep in mind to serve patients with allergies that don’t go away with the passing of spring or fall.

May Be a Systemic Reason for Allergies

Most nonseasonal, ocular allergies are associated with dust or dust mites, animal dander or mold. Another chronic ocular allergy called vernal conjunctivitis worsens in warm weather, but is not due to typical seasonal triggers such as pollens. Instead it is an IgE mediated mechanism found in some patients who also have a family history of other atopic diseases such as asthma, eczema or hay fever. GPC (giant papillary conjunctivitis) may also result as a form of ocular allergy to long-term buildup of deposits on contact lenses worn for a prolonged period of time. Acute reaction to some forms of cosmetics is also not uncommon.

Bill Medical, Rather than Vision, Insurance

The amount of reimbursement varies from one insurance company to the next, but you would generally receive approximately $90 to $110 for the initial visit and $39 to $65 for each follow-up visit. You should typically see the patients an average of three times to diagnose, begin treatment and follow up until their symptoms are resolved and they are stable, and then again several months later to make sure they are still OK.

A Potentially Significant Group of Patients

The more severe cases are chronic allergies. Chronic allergies often can be inherited and/or the patient has a history of hay fever, asthma or eczema. Patients are typically younger–early 20s or younger. It is more common in males than females. Many of these cases are children. Practicing in the tropics also had an impact with warm weather often worsening the symptoms. Long-time contact lens wearers who wore extended wear lenses without frequent replacement, who then developed GPC, also were common. Middle-age females would account for most of the cosmetic reactions leading to allergies.

Know the Signs of Non-Seasonal Allergies

Most of the time these patients would come in complaining of discomfort and show clinical signs such as moderate to severe injection, minimal to moderate lid edema or just heaviness of their eyelids. Other common signs of  this form of allergies include mucus discharge, itching and/or burning eyes. At times these patients also would experience concurrent rhinitis. Other times they would complain of contact lens intolerance and come in wanting a new contact lens prescription thinking that is what they need.

Prepare to Treat Non-Seasonal Allergies

There is no special equipment beyond the typical instrumentation needed to diagnose this form of ocular allergy. Most of the examination can be done directly and with the aid of a slit lamp. Corneal dyes are often used to aid in the examination.

Understanding the pathology and clinical picture of these conditions and the differential diagnoses is important. Along with taking advantage of ocular allergy learning opportunities at conferences, keeping up with the related medical literature is also extremely helpful.

Educate Your Patient

Helping the patient understand what is happening to their eyes and explaining both the realistic short- and long-term expectations are what most patients want, in addition to the most rapid relief possible. This will provide the patient piece of mind. If there is something the patient can do to improve their situation and prevent issues in the future, such as more frequent replacement of contact lenses (like daily replacement), then explain why this change is necessary and how a change in their contact lens routine may lead to greater comfort.

Post-LASIK Education: Let Patients Know They Still Need You

Providing ongoing care for post-LASIK patients keeps them in your practice and ensures that they receive the services and products they need.

LASIK has become a common procedure improving the lives of many of those who undergo it, but many of those same patients don’t realize that they still need to visit their eye doctor annually. In addition to co-managing pre- and post-operative care for LASIK patients, ODs need to educate these patients about why they still need to visit for a comprehensive exam each year. Education also is needed about which products, such as sunwear, are still beneficial, and why a successful LASIK procedure doesn’t mean a patient won’t need to address presbyopia.

Vision and Eye Health Could Change

Although patients can now see well, they need to be examined on an annual basis. For those getting close to presbyopia, they may need reading glasses in the near future and need to continue monitoring their eye health for such issues as glaucoma, cataracts and macular degeneration. Other LASIK patients are very non-compliant and literally disappear after their surgeries, either showing up rarely or never again.

Monitor and Treat LASIK-Related Dry Eye

Many LASIK patients are people who have had dryness issues that affected their ability to wear contact lenses and require treatment methods for anyone who has dryness including lubricants, Omega 3 supplements and punctal plugs when necessary.

Educate On Added Need for Sunwear and Driving Eyewear

LASIK patients are more prone to glare problems after surgery, especially at night. Many patients have LASIK with a monovision modality, so their eyes are unbalanced for distance vision and these patients can often benefit from night driving eyeglasses, as well, that balance both eyes to distance.

Monitor Eye Health Long-Term

Continue to monitor post-LASIK patients for the same medical eyecare problems that can affect anyone such as glaucoma and cataracts. Also monitor the cornea for any signs of a condition called ectasia, which is an abnormal thinning and bulging of the cornea. Since the surgery leaves the cornea thinner, this can happen, although it is uncommon.

Anticipate the Rare Poor LASIK Outcome

In most of these cases, the problems were not medical, but a result of a patient with unrealistic expectations. Some patients who had the oldest refractive surgery, radial keratotomy (RK) have had massive shifts in their refraction over the years, ending up extremely hyperopic. In addition, their best corrected visual acuity is often not correctable easily to 20/20 vision.

Generate Post-LASIK Patient Referral

Ask for referrals of the patient’s friends, family and co-workers who may be interested in LASIK surgery. Often, the patient’s happiness and enthusiasm is highest right after the surgery, so this is a good time to ask for referrals. The referred patients will not necessarily be excellent candidates for surgery, but will then continue coming to our office for their eyeglasses and contact lens needs.

How Many of Your Patients Know What Digital Eye Fatigue Is?

You have some digital eye fatigue syndrome education to deliver to patients. 72% of patients are not even familiar with the term “digital eye fatigue,” according to The Vision Council’s VisionWatch Digital Eye Fatigue Syndrome report. Those patients with children will also need an education on the impact of the condition on their children’s eyes, as 37% of patients with children say they are not concerned about it. Interest in digital eye fatigue syndrome in children, however, may be growing. 47% say they are somewhat concerned about the condition affecting their children and 16% say they are very concerned.

1)  Review your verbal communication to patients. Record and listen to your case presentation. Make sure you are not talking over the heads of your patients. The more complex your sentences and the more syllables in your words, the less likely patients are to understand what you are trying to communicate. 2) Review all written communications from your practice to patients. Check your web site, your treatment protocol handouts, your recall communications; make sure everything is built to communicate in a clear an effective manner. Simplify.

Now, does it really surprise you that 72% of patients are not familiar with the term “digital eye fatigue syndrome?”  Wouldn’t this be better communicated to patients as: “Do your eyes get tired when you spend time reading on your tablet or phone?”

Open a New Office or Buy an Existing Practice?

Once an OD decides to dive in and own a practice, one of the next decisions they need to make is whether to plunge into the pool of opening a practice or to buy an existing practice.

Practice and Building Owner

One of the advantages of owning the building is the possibility for expansion. After checking local zoning laws, it may be possible to add a second story to the building and reap the rental income from other medical or business professionals on the second floor.

Keys to Purchasing a Practice and Office Space:

-Take your time and shop around.

-Consult with a financial advisor for tips, resources and advice.

-Have a lawyer draw up a contract for purchase.

-Set up a business plan for the practice.

-Staff changes may be needed to put your vision into action.

-Advertise to let everyone know you’re the new doctor in town.