O.D. Scene

THE ENTERTAINING SIDE OF OPTOMETRY

O.D. Scene creator, writer and editor Jack Schaeffer, O.D.

Optometry has adopted and embraced the role of “key” primary care provider. With the responsibility of primary care comes the importance of understanding the role of pharmaceuticals in our practices. This means CE to stay abreast of new drugs and treatments, along with their side effects and consequences of patient usage.

A group of optometric educators specialize in pharmaceuticals to guide the profession in the aforementioned topics. They are Jill C. Autry, O.D., R.Ph., Jimmy D. Bartlett, O.D., and Bruce E. Onofrey, O.D., R.Ph., F.A.A.O., F.O.G.S. You have probably taken a course with one or all of them. Now, you get to see their social side.

Key Opinion Leaders Weigh in…

Jill C. Autry, O.D., R.Ph., Houston, Texas; Jimmy D. Bartlett, O.D., Birmingham, Ala., and Bruce E. Onofrey, O.D., R.Ph., F.A.A.O., F.O.G.S, Houston, Texas

Q: Why did you decide to become an optometrist?

JA: After practicing as a hospital pharmacist for a couple years, I realized I wanted to be more involved with both the diagnosis and treatment of patients. I looked at multiple disciplines. After speaking with local optometrists and doing a little research, I found optometry to be the best fit.

Dr. Bartlett with a Cessna 172 in Bessemer, Ala.

JB: After considering medicine, dentistry and other health and medical careers, I chose optometry, largely [because I was] influenced by my hometown O.D. in Fort Smith, Ark., Dr. Roy Steelman. I was impressed by his professionalism and with optometry’s lifestyle and contributions as a healthcare discipline. Also, I was intrigued by the eye and visual system.

BO: My pharmacology professor, Felipe Benois, at the College of Pharmacy at the University of Illinois Medical Center, also taught ocular pharmacology at ICO. It [optometry] appeared to be an interesting, dynamic profession. When my future wife brought home ICO info, I applied. The rest is history.

Dr. Onofrey biking in Chicago.

Q: Can you describe your practice?

JA: I am one of six partners (three M.D.s/O.D.s) in a referral-based full secondary and tertiary care center. There are also associate M.D.s and O.D.s, as well as optometric residents for a total of 15 doctors. We cover the anterior segment, glaucoma, oculoplastics, cornea, neuro and retina. A total of 95% of our referrals are from area O.D.s who emphasize the co-management of their patients.

JB: For the first three years of my career, I practiced at the James A. Haley Veteran’s Hospital in Tampa, Fla. For the next 34 years, I saw private patients and taught students and residents at the UAB School of Optometry. I am now retired from UAB, but active in CE, writing, advisory boards, etc.

BO: In 2009, after 25 years, I retired from a multispecialty hospital-based group practice, where I was chief of optometry and vice chair of the Eye Department during my last eight years of practice. Since 2009, I have been a tenured professor at the University of Houston College of Optometry, director of the family practice residency program at the Eye Institute and executive director of CE programs. My lecture topics include pharmacology and ocular disease. I also work with students in the FP and referral medical clinics.

Q: Why do you think O.D.s have increasingly prescribed steroids?

JA: Oral steroids can be very beneficial in combatting severe inflammatory reactions. The easy-to-use and dose-friendly methylprednisolone pack, for example, has allowed many O.D.s to gain confidence in using oral steroids in the appropriate setting with the tapering schedule already included.

JB: As the clinical training of O.D.s has expanded to encompass larger numbers of patients seen by both students and residents, our practitioners are now much more comfortable with the clinical responsibilities associated with steroid use.

BO: There has been an improved clinical knowledge, confidence and understanding of their value in inflammatory and mixed-mechanism disease.

Q: How does the current trend of optometry playing an instrumental role in the growth of ocular pharmaceuticals affect drug manufacturers and our profession?

JA: As O.D.s become more medically oriented, topical prescriptions written by our profession will continue to increase. With this escalation, pharmaceutical companies will focus more on resources, such as samples, education, etc., to our offices, to our academic institutions and to our profession in general.

JB: Growth in several of the pharmaceutical product sectors is a direct result of the broad and diversified distribution of O.D.s across the United States. At the primary care level, these practitioners are prescribing allergy medications, antibiotics and medications for glaucoma in ever-expanding numbers.

In terms of it affecting drug manufacturers, these increased numbers are directly related to actual prescriptions, not simply samples. Increased prescriptions translate to enhanced sales for the manufacturers.

A Domincan Republic vacation for the Bartletts.

With regard to the profession, there is a symbiotic relationship among the optometric profession and the ophthalmic manufacturers. The more products we use, the more the companies benefit, which, in turn, offers greater incentives for the manufacturers to support optometry.

BO: We [optometry] have been at the forefront in the utilization of therapeutic agents in the medical management of both anterior and posterior segment disease. The expansion of optometric therapeutic privileges has dramatically improved the access to eyecare services, particularly in traditionally underserved areas. A significant number of O.D.s are now performing high-quality basic and clinical research in all specialty areas of ocular disease: glaucoma research, nutritional supplements and ocular surface disease. These topics represent some of the most popular CE topics.

Dr. Autry with husband Stuart.

With regard to the drug manufacturers supporting O.D.s as principle investigators, nutraceuticals and OSD research have been funded at significant levels by the drug industry. I believe the drug industry recognizes that the best way to get these drugs to patients is by supporting marketing and education to O.D.s.

The effect of this support is increased appropriate utilization of these drugs in the management of patients with disease. Practitioners have learned that there is a need to incorporate a full menu of services to patients to maximize practice diversity and new income sources.

Q: How do you rate the level of pharmaceutical CE today vs. five years ago?

JA: I think the lecturers today are more aggressive in discussing the clinical use of topical, oral and injectable agents, probably because of the increased medicinal knowledge and scope of the audience.

JB: Our profession now has a number of practitioners and educators who have greater levels of experience, as well as academic understanding of pharmacologic issues. In general, I am fairly impressed with what I hear from speakers at optometric CE meetings.

BO: The depth and diversity of CE has steadily improved. In the past, there may have been only a few individuals presenting lectures in each specialty area (i.e. contact lenses, etc.). Today, the number of qualified specialty lecturers have grown exponentially. More individuals have gone through residency training, military experience and medical-based practices. This has produced many clinically seasoned individuals who are more than willing to share their expertise with their colleagues. Their clinical expertise knowledge of current research has led to a very high quality of current CE programs.

Dr. Bartlett and wife Cindy on the Great Wall of China.

Q: What do you see as the most challenging aspect of pharmaceutical issues and optometry?

JA: Without a pathology-driven residency or internship, many O.D.s are reluctant to prescribe oral drugs to their fullest potential. Becoming comfortable prescribing certain medications comes with examining, prescribing and following multiple and varied patient encounters.

JB: As a primary eyecare discipline, the optometric profession is responsible for a broad understanding of both topical and systemically administered medications for ocular conditions, not to mention the potential adverse ocular effects of medications prescribed by other practitioners. It is a tremendous challenge to have all that knowledge at one’s fingertips.

BO: Attempting to overcome the politics on a state-by-state basis results in an illogical patchwork of therapeutic privileges. I would prefer a more uniform definition of our profession. One that encompassed an “as taught” definition of optometry. The law that was recently passed in Louisiana should be the model for these national privileges.

Q: Where do you see the future of optometry in FDA pharmaceutical-related clinical studies?

JA: Clinical studies are very time consuming because they require meticulous testing, examinations and paperwork. Therefore, most non-academic clinical institutions hire a testing coordinator for the studies. Unless the process becomes less intensive, I believe optometry’s role outside the universities will remain limited.

JB: I think there is ample opportunity for strategically situated O.D.s to participate in phase IV (post-marketing) studies. Phase II and III studies, however, should probably be limited to academic faculty optometrists who have the facilities, staff and other infrastructure (IRB support, etc.) to efficiently participate at a productive level.

Dr. Autry and Cooper zip lining.

BO: I feel the FDA has been reluctant to allow optometrists to act as principal investigators in studies related to glaucoma and anti-infective agents. We have had good participation in OSD and nutraceutical development (OTC drugs).

Q: Who (O.D. or non-O.D.) has shaped your optometric career the most?

JA: Edward C. Wade, M.D., of Texas. I trained under him as an intern, a resident, and I am now a partner in his practice. We work together to take care of both surgical and non-surgical patients.

JB: John Amos, O.D., former UAB of School of Optometry dean. He was my mentor during my early career at UAB, and I always respected him for his understanding and embracing of the “medical model” as early as the mid-1970s.

Dr. Onofrey and wife Cindy in a Rome, Italy hotel.

BO: First, my residency director, William L. Jones, O.D., gave me the opportunity and preparation I needed to become a better clinician. Second, I worked with several very talented physicians at Lovelace Medical Center, in New Mexico, who were very generous in sharing their expertise.

Q: Who are your family members, and what do you do for fun?

JA: My husband, Stuart, and I have been married almost 20 years. We have two boys, Cooper and Bowman, ages nine and eight, respectively, who keep us very busy with school, sports, etc. Also, we have one very spoiled Chihuahua, Scooter, who even travels with us.

For fun, I like to garden, exercise, travel and spend time with friends and family.

Dr. Onofrey lectures at Lotus College of Optometry in Mumbai, India.

JB: My wife, Cindy, and our three sons. The oldest, Andrew, is a third-year ophthalmology resident at Texas Tech University. Our middle son, Kenton, is in graduate school in mental health counseling at UAB, and our youngest, Harrison, is beginning graduate school at Vanderbilt University for a Ph.D. in mechanical engineering.

For fun, I enjoy traveling with my family. We have been extremely fortunate to travel to numerous destinations around the world, such as China and Australia. I also like aviation and personal financial planning. In 2013, I became certified in financial planning from the Terry College of Business, University of Georgia.

BO: I grew up in Joliet, Ill. with a younger brother and sister. My family consists of my wife Cindy and our Doberman Dash.

For fun, I am a private pilot and scuba diver. My favorite physical activity is bicycling. I love long rides. Also, I am a very bad, yet happy golfer. And, I love to work on a few cars that I own: a 1955 Porsche Spyder and a 1985 Porsche 911 Targa. I occasionally drive in road rallies and enjoy the track with an instructor.

Q: What is your favorite book, movie, band and adult beverage?

JA: Book: “The Bridges of Madison County”; Movie: Good Will Hunting; Band: Eagles; Adult Beverage: Margarita on the rocks.

JB: Book: “Good to Great: Why Some Companies Make the Leap… And Others Don’t”; Movie: Titanic; Band: Temptations; Adult beverage: I don’t drink. I like unsweetened ice tea with lemon.

BO: Book: “The Manhattan Project: The Making of the Atomic Bomb”; Movie: Groundhog Day; Band: The Beatles; Adult Beverage: Maker’s Mark old fashioned.

Dr. Autry and all her boys at Amelia Island, Fla.