Opening Lines

A 10-YEAR TRADITION KEEPS GOING STRONG

Koch Eye Celebrates by Giving Back

■ Each year on July 29, Koch Eye Associates of Warwick, R. I. closes its seven locations and sends its 140 employees into the community to volunteer their services in an event the practice has dubbed “Koch Eye Cares Day.” Peter A. Koch, C.E.O. of Koch Eye Associates, along with his brother, Paul Koch, MD and sister Patricia Koch, OD, organized this day of giving back is done in memory of the late Peter Koch, MD.

“During his lifetime, our father had a profound impact on everyone with whom he came in contact,” said Peter Koch. “His talents were many, his generosity was unparalleled and his devotion to his family was immeasurable.”

Koch Eye Associates works with The Volunteer Center of Rhode Island, to identify groups that “would welcome Koch Eye Associates and benefit from the resources we could provide. We identified 28 charities and let the employees choose which charity would be most meaningful to them,” said Peter Koch.

“Our employees are very excited about going into the community to work side by side at such notable organizations such as Cornerstone Adult Services, Elizabeth Buffum Chase House, Habitat for Humanity, Rhode Island Community Food Bank, American Cancer Society and A Wish Come True, just to name a few” said Dr. Paul Koch. Typical responsibilities include working with the elderly, reading to children, painting, home construction and gardening.

Dr. Michael Consiglio and Melissa Toppazzini serve lunch at the Johnston Senior Center in Johnston, RI.

This tradition, now in its 10th year, caps off the day with a cookout and party — “a great way to share their stories, experiences and memories for the day,” said Peter Koch.

THOUSANDS SERVED AT FREE EVENTS

Shepherd Eye Center Takes Vision Screenings to the Streets

By Angela R. Zade, Las Vegas, NV

■ Each year, the technicians at Shepherd Eye Center in Las Vegas, NV administer free vision screenings at health fairs throughout Las Vegas. August, September, October and November are Shepherd's busiest months for the screenings.

Last year, Shepherd Eye Center tested nearly 3,000 children through its screenings.

Just before the start of the school year, technicians set up portable Snellen Eye Charts, occluders and alcohol pads at local shopping malls, office lobbies and fire departments to take part in back-to-school fairs. The back-to-school events offer free vision screenings in conjunction with dental care and free immunizations. Technicians spend from 4 to 8 hours conducting the screenings for school-age children to determine whether vision correction is necessary to help them succeed in school.

Last year, Shepherd tested almost 3,000 children as part of the back-to-school initiative hosted every weekend during August. School supplies such as pencils, pens and reams of paper were given away to further assist students, teachers and schools across Las Vegas.

Once students return to school, Shepherd's focus on adult vision. Technicians visit the Las Vegas strip administering vision screenings at employee health fairs inside Caesar's properties, MGM resorts and other independent hotels and resorts. Employee health fairs begin in September and run through November. To assist adults who have difficulty with their near vision, Shepherd Eye gives away reading glasses, along with other useful eye care supplies including lens cleaners and cloths.

Ms. Zade is the marketing director at Shepherd Eye Center.

A SUCCESSFUL 6-DAY TRIP

Variety of Surgeries Performed on Mission to Honduras

■ Elizabeth Holloway, the chief operations officer at Eye Site of Tampa Bay, Clearwater, FL, reports that Herbert P. Knauf, M.D. of Eye Site recently traveled to Honduras on a medical mission.

“We performed a total of 24 corneal transplants, one pterygium excision, one wound revision, and two tarsorrhaphies, and saw many, many patients,” said Dr. Knauf in a staff e-mail.

The 24 corneal transplant surgeries included: four Descemet's stripping endothelial keratoplasties, three Deep anterior lamellar keratoplasties (possibly the first in Honduras), four perforated corneal ulcers with active infections, two old perforations, three with cataract extractions and posterior chamber IOL implantation, three pupilloplasties, four anterior vitrectomies, one secondary anterior chamber IOL implantation and one anterior segment reconstruction.

“The clinics in El Progreso (Centro Cristiano de Servicios Humanitarios Honduras) and San Pedro Sula (Optilens/CVDP) were both very well run, and the operating room staff and clinical staff were great at both places,” said Dr. Knauf. “We worked very hard and even operated until 9:20 on Saturday night!”

A number of organizations donated corneas and supplies to the mission including Tissue Banks International, the Lion's Eye Bank, Bohica Ophthalmics, Bausch + Lomb Surgical and Trinity Surgery Center.

IN BRIEF

Task Force Investigates Collaboration Between MDs and ODs

The American Society of Cataract and Refractive Surgeons (ASCRS) has formed the Integrated Ophthalmic Managed Eye Care Delivery (IOMED) Task Force to investigate ways in which the society can advance an eye care delivery model based on collaboration between ophthalmology and optometry.

The IOMED model encourages arrangements in which optometrists employed by ophthalmologists, as well as optometrists employed by the military or industry, play a key role in the delivery of non-surgical eye care. It addresses the growing demands for service and the pending changes in Medicare and general healthcare delivery. The task force is expected to make formal recommendations to the ASCRS leadership in coming months.

Promising Results for ThromboGenics

A paper in the New England Journal of Medicine (August 2012) reports that a single intravitreal injection of ocriplasmin (ThromboGenics, Leuven, Belgium) resolved vitreomacular adhesion (VMA), releasing traction and closing macular holes in significantly more patients than placebo. Two multicenter, randomized, double-blind Phase III trials with ocriplasmin were conducted in the United States and Europe involving 652 patients with VMA. Both studies met the primary endpoint of pharmacological resolution of VMA at day 28. Secondary endpoints included nonsurgical closure of a macular hole at 28 days, avoidance of vitrectomy (surgery) and improvement in visual acuity.

In July, the U.S. Food & Drug Administration Dermatologic and Ophthalmic Drugs Advisory Committee recommended the FDA grant ocriplasmin approval for the treatment of symptomatic VMA, voting 10-0 that the benefits of the treatment outweight the risks. Effective last October, ICD-9-CM the OCT diagnosis code 379.27 was established for VMA.

Punctum Plug Lowers IOP in Study

Initial study results are promising for the Ocular Therapeutix sustained-release travoprost-loaded punctum plug, which was evaluated for reducing elevated IOP in subjects with open-angle glaucoma or ocular hypertension over a 30-day period.

Prior to insertion of the plugs, mean IOP at baseline for the study group was recorded at 26.3 mm Hg. IOP decreased by 5.5 mm Hg at day three post-insertion, and after 30 days of treatment, mean IOP was 6.5 mm Hg below baseline.

Publication Launch and Wine Tasting

The staff of Ophthalmic Professional invites readers to celebrate its launch at a special reception held on Friday, Nov. 9, 2012 from 6 p.m. to 8 p.m. at the Hyatt Regency in Chicago. (The event is not affiliated with the official program of the American Academy of Ophthalmology.) Sponsored by ThromboGenics, the event will include a wine tasting/food paring hosted by Paul Karpecki, OD, wine sommelier and author of the Ophthalmology Management column “The Wine Observer.” For more information or to register for the event, please visit www.ophthalmicprofessional.com.

CUTTING-EDGE TECHNOLOGY EASILY HANDLES DENSE CATARACTS

Providing Laser Cataract Surgery to the Poor of Peru

By Mark Packer, MD, FACS, CPI

■ Recently I discovered first hand what a difference femtosecond laser technology can make in dealing with some very tough cataracts in Lima, Peru, at the Instituto de Ojos Sacre Cuore (Sacred Heart Eye Institute).

The patients we served were truly destitute, from the outskirts of Lima, which is a vast desert city along the coast of Peru. They were transported by the clinic's minibus from their ramshackle hillside dwellings into the city, and their cataracts were among the hardest rocks I have seen.

During the surgeries, I had a chance to compare a laser system (LensAR) to standard ultrasound in similar cases. Because the pha-cofragmentation does the hard work of cutting up these dense nuclei, the cases are relatively quick and easy. Going after these cataracts with a chopping technique is difficult because they are so leathery, and sculpting takes a significant amount of time.

Over the past couple of years papers at multiple international meetings have reported data that show enhanced outcomes with femtosecond cataract surgery. Most of these papers find incremental advantages of laser when compared to ultrasound systems. These advantages include reduced dispersed energy, less endothelial cell loss, or a tighter spread in postoperative spherical equivalent refractive error. It is ironic that a technology so expensive that it is considered premium in the United States actually differentiates itself most effectively from today's standard of care when used to treat the type of cataract found in the developing world.

[For more information on cataract initiative in Peru, visit www.clintonfoundation.org. Click on the Global Health link to read the article “Improving Vision and Strengthening Incomes in Peru.” For photos from Lima, visit www.facebook.com/pages/Fine-Hoffman-and-Packer/185321559380?ref=tn_tnmn.]

Ruling Places Burden on ASCs for More H&Ps

By Jerry Helzner, senior editor

■ The recent enforcement of a 2009 CMS Medicare ruling has caused consternation for some ophthalmology practices performing surgeries in high volume.

The ruling requires ambulatory surgery center (ASC) patients to have a comprehensive pre-surgical medical history and physical (H&P) assessment completed not more than 30 days before the date of surgery, including touch-ups and therapeutic lasers performed at the facility.

One consultant who specializes in the development and operation of ASCs asserts, “The ASC world was rocked by this ruling. The new H&P standard created a bigger burden and came with increased regulatory surveillance.”

An example of how this ruling has impacted practices can be seen at Barnet Dulaney Perkins, a large statewide practice in Arizona that operates eight ASCs. The practice performs about 3,500 YAG capsulotomies a year and almost 15,000 surgical procedures overall.

Prior to the ruling, patients undergoing a simple YAG procedure following cataract surgery did not require a complete H&P. This has resulted in 3,500 additional H&Ps per year. Access to scheduling these exams has been difficult.

Under the Medicare ruling, the H&P must be performed by a “physician or other qualified practitioner in accordance with state law.” In most states, the only other qualified practitioners, in addition to physicians, are physician assistants (PAs) and nurse practitioners (NPs). It is worth noting optometrists cannot perform H&P assessments.

After consulting with Arizona regulatory authorities and learning the H&Ps must be conducted by a member of the medical staff, Barnet Dulaney Perkins decided that it would be prudent to credential PAs, whose initial responsibilities were to perform the H&Ps. The practice eventually hired four Physician Assistants. Because PAs are considered “physician extenders” and able to perform many surgical tasks under the supervision of a physician, their value to the practice is expected to increase as they undergo further training.

PRACTICE TIPS

Always Be Mindful of the Patient's Complaint

Paul M. Larson, MBA, MMSc, COMT, COE, CPC, CPMA Associate Consultant Corcoran Consulting Group

Take a 5th Friday for Practice Management or “Fun”

Ashlie Barefoot, MBA Practice Administrator Carolina Cataract & Laser Center

A Gentle Touch to Redirect

Jane T. Shuman, COT, COE, OCS President Eyetechs

Create an Annual Strategic Focus

Elizabeth Holloway Chief Operations Officer Eye Site of Tampa Bay