Practice Pulse
Tips, Trends & News You Can Use

BANISHING BLINDNESS
Boston Scleral Lens Helps Blind See

At the Boston Foundation for sight, Dr. Perry Rosenthal and his colleagues are helping blind people see again, according to ABC News.

Dr. Rosenthal has developed the Boston scleral lens, a large and porous plastic lens that fits over the cornea without touching it and creates the smooth surface that damaged corneas lack even after surgery. People who are blind from corneal damage or diseases can achieve 20/20 vision, and those who have undergone corneal transplants but don't yet have perfect vision can see better, too.

Dr. Rosenthal and his team custom make each lens by computer; nearly 400 patients now wear the lenses. They cost $5,500 per pair, but the non-profit foundation doesn't turn away anyone who can't afford the price. In fact, it subsidizes about 60% of its patients.

For further information, visit www.bostonsight.org.

COMPLIANCE TOOL
CIBA Vision Launches "4 Healthy Eyes"

CIBA Vision has introduced a new program to help you encourage compliance among your Focus Night & Day lens patients.

The "4 Healthy Eyes" program provides compliance pledge forms you can use to provide patients with compliance information and to get them to promise they will follow their prescribed wearing regimen. The form also encourages them to sign up to receive a brief monthly e-mail or text message reminding them that it's time to change their lenses. For patients who don't have computers or cell phones, the program includes wallet cards that can be mailed. You don't have to do any of the work; a third party sends all the messages.

SCANDAL AT ADULT HOME
Ophthalmologists Accused of Performing Unnecessary Surgery

The New York Times reports that the New York State Department of Health has begun to investigate some 50 eye surgeries performed by an outside ophthalmologist at the Leben Home for Adults in Queens.

According to the article in the newspaper, the mentally ill patients, many of whom didn't understand the procedures but were bullied into giving their consent, underwent cataract surgery or laser surgery for glaucoma or retinal tears.

The patients had had no complaints about their vision and their families were never notified of the impending surgery as the law requires. The ophthalmologist who performed the procedures had never previously examined the patients.

Operators of adult homes have complained that the state pays them too little, and, the newspaper alleges, make up the difference by charging rent or fees to outside medical providers and guaranteeing them a large supply of patients in return. Fees are then billed to Medicaid or Medicare, who rarely question them.

In the case of the Leben Home, this practice has cost the government more than $25,000.

Web Site Helps You See as Others Do

If you've ever wondered how your colorblind patients view the world, visit www.vischeck.com. The Web site provides vivid simulated versions of colorblind vision and, more importantly, a "Daltonization" algorithm by which red-green colorblind persons can enhance their ability to read documents and computer displays and to see pictures.

The site also provides valuable information and background facts. 

EXECUTIVE SEARCH
ARBO Seeks New Executive Director for Board

The Association of Regulatory Boards of Optometry (ARBO) Board of Directors invites applications and nominations for the open position of executive director, with a start date effective no later than September 1, 2002. Interested persons can obtain full information about ARBO and its programs from the organization's Web site at www.arbo.org. According to ARBO, the person assuming this position will experience both professional challenge and personal satisfaction. ARBO is willing to consider relocating to accommodate its new executive director.

To submit a letter of interest, or a nomination, include a current CV in your correspondence to:

Dr. James Hartzell, chair Executive Director Search Committee
2628 Beaver Avenue
Des Moines, IA 50310-3997
Fax: (515) 274-4144

LAWSUIT SETTLED
Three Internet Retailers Give In

Three Internet contact lens retailers, 1-0-1Contact.com, iwearcontacts.com and contactlenses4u.com have agreed to a court order that bars them from buying, distributing, marketing, advertising or selling Ocular Sciences products.

All three companies have also agreed that they won't use any Ocular Sciences trademarks, give the impression that their products originate from Ocular Sciences or substitute other companies' products for Ocular Sciences products.

Ocular Sciences sued the three companies back in January.

Eyewear for the Needy

You all know about the overwhelming need for eye care in other countries, but you don't hear too much about efforts to combat the problem. Cole National recently stepped up to the plate and has launched a notable effort to help less fortunate individuals in other countries to see.

Last month, Cole National's Pearle Vision stores brought in special Shared Sight collection receptacles to encourage individuals and groups to donate their old eyeglasses, readers and plano and prescription sunglasses to people in need. The centers collect the donated eyewear and send it to New Eyes for the Needy, based in Short Hills, N.J. This organization recycles and distributes the eyewear to charities, medical missions and hospitals in more than 30 countries around the world.

Well-known O.D. Passes Away

The founding director of the Indiana University optometry program, Henry Hofstetter, O.D., Ph.D., passed away last month. Dr. Hofstetter was known internationally for his contributions to optometric education and was nominated International Optometrist of the Year in 1991 for his "profound influence upon the visual welfare of mankind."

An Arizona court awarded $4 million to a former United Airlines pilot who lost his job after suffering ill effects of laser-assisted in situ keratomileusis (LASIK) surgery. The pilot claims that the surgery destroyed his night vision. A unanimous jury verdict led to the award.

The pilot's attorneys argued that his physicians failed to accurately measure the size of his large pupils in dim light. The surgeon who per formed the procedure says that the pilot's pre-op pupil measurement isn't related to the postoperative night vision damage.

Attorneys for the defendants haven't decided if they'll appeal.

CORRECTION

It was brought to our attention that we made an error in "Eye Drops Work as Well as Patches" (April, pg. 14). The sentence, "With drops, parents only place one drop in the child's amblyopic eye . . ." should read, ". . . in the child's good eye."

Eye On MANAGED CARE
Old Headaches, New Headaches

Recently I received inquiries from practitioners asking me to review their managed care provider agreements and plan documents. I was struck by wording in some of the documents from these HMOs, vision plans and other third-party payers. Issues that seemingly fell out of favor years ago show up again. We'll examine a few of these in the first of this two-part article.

The same old song and dance

The following issues illustrate the importance of reading and understanding everything that a third-party payer sends to you -- not just the provider agreement.

Often collateral documents (provider manuals, frequently asked questions [FAQs], etc.) contain problematic provisions that you may not see before signing the provider agreement. Problematic policies, protocols and positions can affect your ability to participate profitably and comfortably in third-party care. Let's look at some examples.

From one vision plan's FAQ document (read this carefully):

Question: Can a member choose a frame that's not included in the (Name) Collection?

Answer: Yes. However, because the Collection is a large selection of frames with value for the member; was developed in a cost-contained, quality-focused format and was provided to you at no cost, we expect that selection outside the Collection will be minimal.

All the buzz-words are there: value, cost contained, quality focused. And the plan's literature describes how your practice will benefit by joining.

Of course, this plan expects a discount from the exam fee normally charged to your cash patients. And that's okay. The reason for discounting the fee is that you're supposed to get more patients and recover some of the discount on patient-elected frame and lens upgrades.

Certainly, some practices work successfully with this type of managed vision care program. These practices have staffs who are skilled at identifying patient needs and cosmetic desires. They sell up to meet them. If it's done properly and professionally, there's nothing wrong with selling up.

Some plans facilitate selling up by giving your staff freedom to provide any frame a patient wants and allowing you to charge upgrades at the difference between usual and customary (U&C) and the frame allowance, or at a nominal discount from U&C, or at a viable, published upgrade schedule. With this plan, patients may choose any frame in your dispensary, but it's expected that they'll rarely go outside the plan's covered selection. It's implied that your staff should help the patients choose these frames only.

Why should anyone expect your staff to "default" patients toward a limited selection of covered frames on which there are no upgrade fees? It's an inefficient use of staff resources during frame selection and contributes little to the bottom line.

The plan would say you're not being ordered to direct patients to the covered frames, but you might reasonably perceive an implied risk if you don't. If many of the plan's enrollees pay out-of-pocket for non-covered frames, you might be perceived as an outlier and become a candidate for audit.

Directing patients

Another plan's provider manual states that the patient's benefit form will indicate if the patient is entitled to a frame and it will describe the patient's frame allowance. You should try to stay within this allowance when assisting the patient in selecting a frame.

This is even more specific. Again, why direct patients to the covered frames?

When evaluating a vision plan, ask yourself, "Can I justify participation based solely on the reim-
bursements for covered services and the assumption that many patients won't upgrade?" Upgrades are essential for survival in these vision plans, and I'd think carefully about any plan that tries to make upgrades rare exceptions.

Be vigilant

The return of these old headaches proves that you must be vigilant in managed care dealings. Aerosmith's tune, "It's the same old song and dance" keeps running through my head. Don't let it run through yours.

O.D. NOTEBOOK

PEOPLE AND PROMOTIONS

Prio names advisory board members. PRIO Corporation recently announced the formation of its 2002 Advisory Board, which consists of 13 optometrists. Members of the Board are: Lance Anderson, O.D., Hillsboro, OR; Ken Burke, O.D., Woodbury, CT; John Chatelain, O.D., Houston; Maggie Corbin, O.D., Ashland, OH; Robert Davis, O.D., Pembroke Pines, FL; Mark Hansen, O.D., Muscatine, IA; Cary Herzberg, O.D., Aurora, IL; Pia Hoenig, O.D., Santa Rosa, CA; Charles Newell, O.D., Woodbury, CT; Gary Osias, O.D., San Leandro, CA; Robert Reed, O.D., St. Joseph, MI; Phil Smith, O.D., San Diego, CA; and Brian Tracy, O.D., Sacramento, CA.

Ocular Sciences fills new position. Ocular Sciences appointed Diethart Reichardt to the new position of president of Ocular Sciences Europe, with direct responsibility for all sales and subsidiary business units in Europe, as well as distributor networks throughout Europe, Africa and the Middle East.

Ocu-Ease hires vp. Clay Kowarsh has recently joined Ocu-Ease Optical products as the company's new vice president of sales and marketing. Mr. Kowarsh will develop an exclusive, limited distributor network to accommodate the expanding line of Custom

COMPANY NEWS

ProSoft contact lens recognized. CIBA Vision's ProSoft teal-tinted contact lens for tennis was named the official contact lens of the United States Professional Tennis Association. The organization's membership is comprised of more than 12,000 tennis instructors.

Reaching out a helping hand. The optometric Web site, www.seniordoc.org, has a Student Match Program designed to link private practice O.D.s in every section of the United States to students and recent graduates who wish to practice in their community. If you would like to volunteer some time to show a student or recent grad your practice and answer their questions about your home town and the "real world" of optometry, consider signing up for the "Student Match" program at www.seniordoc.org/match.php.

Oakley plans expansion. Oakley plans to add seven new locations operated by its wholly owned sunglass specialty retailer, 45-unit Iacon, with mall developer Taubman Centers in Taubman malls in California, Colorado, Florida, llinois, New Jersey and Nevada. Iacon will open both kiosks and in-line stores under its Sunglass Designs, Sporting Eyes and Occhiali da Sole retail names over the next year.

GOOD NEWS FOR AMD PATIENTS
Visudyne Covered in Canada

Health and Long-Term Care Minister Tony Clement announced last month that Ontario will provide more than $20 million in funding for the treatment of wet age-related macular degeneration (AMD) with the drug verteporfin (Visudyne). The government of Ontaria will now cover the Visudyne treatment as an insured service under the Ontario Health Insurance Plan. The Ministry of Health will provide hospitals with the funds to administer this program retroactive to April 1.

It is expected that an average of 1,200 people across the province will benefit from this treatment each year.

Think you've seen just about everything possible on the auction block at eBay? Well think again. The myriad categories available to choose from have just widened. Looking for a 35-mm camera? How about pottery or pet supplies? Sure, you'll find them on ebay, but would you ever imagine looking for -- or even finding -- a list of laser-assisted in situ keratomileusis (LASIK) leads on eBay? Well they're there -- proof positive that there's no limit to what people will try to sell. But we've known that -- remember when 1-800-Contacts first began selling contact lenses via the Internet?

Clear Vision Club (CVC) claims to be a consumer advocate to the LASIK consumer. According to the organization, it aims to educate, motivate and promote LASIK surgery through a free membership (based on candidacy criteria), an informative Web site and back-end educational e-mails, which the consumer has requested. CVC's eBay page explains its screening criteria and claims to have leads for all areas of the country. The cost? Fifty dollars, although bidding for the item was closed at the time of publication. The page is available on eBay for a limited time only, so if you or a colleague are interested in looking into this, you might have to search the eBay Web site a bit to find this and/or similar offers.