Taking a Look at Optometric Practice in 2002
From diagnostic equipment to contact lenses and ophthalmic lenses, the new year brings with it some welcome advances.

Trends in Refractive Surgery
Hyperopic correction has gained some ground in recent advances.
BY J. JAMES THIMONS, O.D. F.A.A.O., Fairfield, Conn.

ILLUSTRATION BY ANTHONY CERICOLA

Recent advances in refractive surgery and some of the current Food and Drug Administration (FDA) trials for new technologies offer the primary care clinician a wide array of new options to select from in developing a treatment strategy to maximize patient outcomes.

Treating a growing population

Certainly the area with the greatest number of new options is the treatment of hyperopic patients with laser thermal keratoplasty (LTK), implantable contact lenses (ICLs) and the much awaited, upcoming FDA review of conductive therapy.

The reason for this intensive development is that hyperopia accounts for 52% of the U.S. refractive market. Plus, the aging baby boomer generation has created significant interest in developing non-lens technology to correct this dramatically increasing segment of the population. Currently more than 90 million potential hyperopic patients exist and the majority fall between +0.50D and +3.00D, which is where most of the approved and currently investigated technology has its best application.

Regression by steepening

LTK is a thermal laser procedure that produces controlled burns of the corneal stroma in the mid periphery and creates a ring contraction that induces central steepening. The refractive effect may seem dramatic, but the procedure shows regression in a percentage of patients. This regression has caused clinicians to be more conservative in their decisions as to what level of refractive error is best treated.

Most individuals are comfortable in the +0.50D to +2.50D range and the retreatment rate in this zone is comparable to hyperopic laser-assisted in situ keratomileusis (LASIK).The long-term success of this procedure depends on its ability to decrease the regression of the refractive effect that occurs over time.

Lenses with a future

Hyperopic ICLs have been recently developed to complement the work being done for the correction of high myopia with the Starr, Nuvita and Artisan intraocular contact lenses. This technology is directed toward the +4.00D range and greater -- an area where current applications, such as hyperopic LASIK, have been inconsistent in their outcomes. While still in clinical trials, these lenses hold great promise for a category of patients that has historically challenged the clinician.

The latest surgical trend

Conductive therapy is the latest development in the field of hyperopic treatment. Unlike LTK and hyperopic LASIK, it doesn't use laser energy to create refractive effect. Instead, it uses a contact probe that's placed into the corneal stroma, and radio wave energy to create precise placement and depth treatments. The data from clinical trials shows it to be the most successful and the most stable of all the hyperopic therapy techniques.

Use this device to treat low to moderate hyperopia and astigmatism (+1.00D to +3.00D), and both primary refractive error and consecutive hyperopia.

What else is out there?

The final entrants into this field (both in clinical trials) are Hyperopic Intacs and the new, ultra-thin corneal inlays.

The Intacs system is different from the myopic version in that it implants multiple small elements in the peripheral cornea and produces central steepening. U.S. researchers are currently investigating its clinical application, but the timeline for this research isn't well defined.

The Anamed: Lamellar Implant is a new development in the refractive arena. It uses a technology that allows the creation of an ultra-thin optical device that's placed in the corneal stroma. In theory, this device will create a more stable and improved optical correction than hyperopic LASIK or the thermal/radio wave systems. The obvious issues related to its success are the same that we've seen with other implantable devices: reproducibilty and the level of surgical skill necessary to produce consistent results.

Myopia has been the focus of refractive surgery until now, but from all indications, hyperopic therapy will play a major role in the future of refractive surgery.

Dr. Thimons is the medical director of Ophthalmic Consultants of Connecticut. He's also a clinical professor at the New England College of Optometry.

Ophthalmic Instrument Guide
What's available to help move your practice into 2002.
BY GREGG OSSIP, O.D., Indianapolis, Ind.

Upgrade your equipment to enhance your patient care, ease of examining and profitability. Trade in and trade up in 2002. We'd never trust an old car to travel across the country with our children, yet some of us trust old technologies to save our patients' vision and sometimes even their lives.

If you haven't invested in updating your existing office technology, you owe it to your patients and to yourself to finally take this step. The following is a short laundry list of currently available equipment and reasons why you want these devices on hand when examining all of your patients.

What's new on the must-have list?

If you're thinking that the equipment you bought years ago will hold out for a few more years, think again. Check out these products to learn what your practice has been missing.

Retinal thickness analyzers. Glaucoma doesn't have a fighting chance with this instrument. With it, we can detect early changes and save the vision of many patients.

Corneal topographers. A topographer is an important tool if you do a lot of contact lens fitting or co-manage laser vision surgery patients.

Digital non-mydriatic retinal cameras. These instruments offer a great view of the retina centrally and some even provide a view of the peripheral retina. This instrument is mandatory for tracking diabetics.

Computerized refracting systems. Perform more relaxed and efficient refractions.

Wavefront technology. This technology will change how we refract and will reform the laser-assisted in situ keratomileusis (LASIK) procedure.

Screening fields. Using this instrument helps us be proactive in finding visual abnormalities early.

Hand-held autorefractors/autokeratometers. These devices offer flexibility for patients we see in the office and for those we visit who are living in nursing homes or similar facilities.

Computer systems. It's important to regularly upgrade your computer systems so you can manage your office more efficiently and communicate better with your patients.

3-D animation. Systems that offer 3-D animation help you educate your patients about their eye health and vision correction options. We all know how important patient education is, and with this type of system, doing a satisfactory job of fully informing a patient about his ocular condition is made easier.

Make the investment

In our office, we screen every patient -- young and old -- and we've made many technological investments so we can take care of our patients the way we'd want our eyecare practitioners to take care of us. Worried about the cost of upgrading or purchasing new technologies? Consider that the cost of not having them could be much higher.

Upgrading, replacing and adding instruments to your office is a sound investment. You won't be sorry you took the plunge -- just do it and see for yourself.

Dr. Ossip is in group practice in Indianapolis. He's lectured extensively and has written numerous articles on practice management. You can reach him at gossip2020@aol.com.

New Ideas and Lenses in 2002
Use these four techniques for lens success.
BY CAROL NORBECK, F.N.A.O., Seattle, Wash.

Today's patient expects an excellent eye health examination and a perfect refraction. He also expects you to know about ophthalmic lens products and visual options. Today, we're fitting more baby boomers who are talking to patients who've had laser-assisted in situ keratomileusis (LASIK). You want your patients to leave your office feeling satisfied and eager to be a spokesperson for your practice.

The media and advertisers are increasing patients' awareness of quality options and choices in lens designs. Patients will place their trust in the practice that continues to educate them about all of their options. If you want patients to see you as a modern, educated practice in 2002, consider these suggestions:

• make time for education
• understand lens branding and positioning
• be aware of new products
• don't let price guide you.

Make time for lens education

Lens and laboratory representatives have a lot to teach us and our staffs about new products and how they can improve our patients' lives. It's important to emphasize improving the patient's vision -- not just focus on how much it will cost or the premium that accompanies the lens. Set aside some time to see your representatives.

Laboratory reps can be especially helpful because they represent a variety of products. The selection of your laboratory partner can be critical to practice success. When selecting a laboratory, consider the selection of brands they carry, the education they offer your staff, the quality of their finishing, their speed, their service, and their price and discounts. Trade journals are an excellent source of education; read the ads as well as the articles to learn about new products.

Understand lens branding and positioning

Major lens companies are building strong brand recognition with today's consumer. Brand position creates a minimum quality level in the patient's mind. If a certain company's position enhances your practice image, its brand can be a very useful tool.

In 2002, you'll see major lens identifiers becoming available that the consumers can see. Lens names that appear when a patient fogs the lens and sunglasses with the name on the lens are new options for which the patient is willing to pay a premium. Remember, the patient depends on your recommendations and those of your staff.

Be aware of new products

This is a very exciting time for new lens developments. It's important to make sure that we and our staffs are knowledgeable about new developments.

PPG developed a new material for lenses called Trivex, which incorporates the best features of all the previous materials. It's as safe as polycarbonate, as cosmetic in tinting ability as CR-39, and as visually acceptable as glass. The material is lighter in weight and stronger than polycarbonate with an ABBE rating of about 50. The surface quality is high. Younger Optical and Hoya Optical, which are distributing this material, bring their own expertise to the marketplace.

Coating companies are bringing new expertise to anti-reflective (AR) coatings. Many new and durable coatings exist that are based on controlling the substrate and the coating. Each AR coating leaves a different residual color. This residual color, the number of layers, the amount of reduced glare, and the hardness of the coating are the factors to consider when choosing an AR coating.

The percentage of U.S. patients who wear AR coating is lower than the rest of the world. It would be much higher if we offered every patient the choice of wearing AR-coated ophthalmic lenses.

In 2002, more affordable coating machines and more consumer advertising will make coating faster and more affordable. Don't let your patient find out from his friends that he could have had no-glare vision.

The future of lens design for the office or computer is an area for growth. The "Interview Lens" by Essilor, the "Access Lens" by Sola or the "Office Lens" by Shamir are examples.

Don't let price be your guide. I can't stress this enough. Innovation and research cost money. In optical, as well as in all new products, it's necessary to charge for the research. When a patient asks why a new lens or coating or material costs more, don't be afraid to quote the price for excellence. More often the question, "How much does it cost?" means just that. Too often, we translate the question to, "Can I find it cheaper elsewhere?"

Ms. Norbeck, of CN Consulting, is a professional optician with more than 20 years' experience. She's the founder of Optical Illusions, a three-store optical chain in the Seattle area.

Contact Lens Strategies
Yesterday's lenses are yesterday's. Here's what's new in the field.
BY GREGG OSSIP, O.D., Indianapolis, Ind.

Our patients look to us for the latest, greatest and safest solutions to their vision needs. So let's make a New Year's resolution to say, "Out with the old technologies and in with the new." If we properly educate patients about the benefit of new and improved contact lens materials, they won't abandon us for the O.D. down the street who's still fitting older materials for lower prices.

Fitting materials in 2002

Here's a roundup of contact lens materials that we'll still be using and start to use in 2002.

Thirty-day continuous wear contact lenses. Available in nearsighted and farsighted powers, these lenses offer the patient incredible convenience and the highest oxygen permeability available. They should replace conventional disposable lenses, giving the patient better eye health and the convenience of laser-assisted in situ keratomileusis (LASIK) but with the ability to update their prescriptions every year as they age.

Orthokeratology contact lenses. Also referred to as corneal refractive therapy (CRT) contact lenses, these lenses are available in high Dk permeable materials. Finally -- a safe material with predictable fitting methods to truly reshape your patients' corneas.

Daily disposable contact lenses. Clear, crisp vision and no lens care. Now available in single vision, for distance only, monovision bifocal progressive lenses and toric astigmatic contact lenses are coming soon.

High astigmatic contact lenses. Don't be afraid of those prescriptions with 5.00D to 7.00D of cylinder. If you charge properly, you'll find that patients will happily pay your fees and cooperate with you to achieve the proper fit. You may not mind the fine-tuning process if you're being compensated fairly for your professional time.

Disposable toric contact lenses. A slew of really good toric lenses are now available in easy-to-care-for formats.

Contact lens care systems. Finally new contact lens solutions exist for our noncompliant patients to safeguard their eye health. We have great multipurpose disinfecting and no-rub solutions now available at our disposal that help increase patient compliance with their lens care. Try out these new solutions, and abandon the old ones.

Restoring excitement

We optometrists didn't originally go into this field to dispense disposable contact lenses. Let the new materials and designs help restore some of the excitement of optometry. Your patients will see better, be healthier and enjoy the convenience that these new solutions afford us.

Attend educational conferences about contact lenses. Use the many resources that contact lens companies and this journal provide to help you learn to fit these new lenses.