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WHEN USING AN AUTOREFRACTOR, BE ON THE LOOKOUT FOR THIS ALIGNMENT ISSUE
Identify angle kappa patients before surgery
By Sue Corwin, CO, COMT
■ For those who use an autorefractor, have you ever noticed that sometimes it looks as though the patient’s pupil is not in the middle of the measuring screen, yet the patient says she’s looking directly at the target?
Well, the center of the patient’s pupil usually lines up with the patient’s visual axis—the place where the central vision of the fovea is located. If these two do not line up, this difference between the center of the pupil and the center of the vision is called the angle kappa.
This is an important concept for several reasons.
1. When a patient has a cataract extraction with IOL implant, the surgeon centers the IOL implant on the center of the pupil. If the center of the pupil is not the center of fixation, that is if the patient has a high angle kappa, the patient will not be looking through the center of the lens. This is not so much a problem with a single vision lens, but it can be a problem with a multi-focal lens. The patient could be looking through one of the “rings” of the multifocal lens, which creates visual disturbances and an unhappy patient.
2. In refractive surgery, if a patient has a large angle kappa and the laser treatment is centered on the pupil, higher order aberrations can be induced. The patient may then complain of “halos” and “ghosting.”
3. When eye muscles are checked on a baby or child, the examiner often shines a penlight in the eyes to see if the light reflex is in the center of the pupil. If the patient has a large positive angle kappa, the patient will look like their eyes are turned out.
4. Hyperopes are more likely to have a positive angle kappa than myopes.
The angle kappa can be measured with a topography/wavefront instrument or with a major amblyoscope.
LEADERS IN THE FIELD TO SPEAK AT ANNUAL MEETING
Six ACE programs curated by Ophthalmic Professional contributors
■ The 2014 ACE (Annual Continuing Education) Program, presented by JCAHPO and ATPO will be held at the Chicago Hilton, Oct. 17-20. Running concurrently with the AAO, the program offers hundreds of educational opportunities, including some lead by contributors to Ophthalmic Professional. Here are just a few:
1) Marguerite McDonald, MD, FACS, who spoke to OP about dry eye therapies in January, will present a course titled Dry Eye Disease in Surgical and General Populations on Friday, Oct. 17 at 11:30 am.
2-4) Frequent contributor Sergina Flaherty, COMT, most recently contributed an article on the basics of tonometers. She will lead a course on the introduction of slit lamp microscope use on Friday, Oct. 17 at 11:30 am.
In addition, she’ll lead a course on techniques to troubleshoot returning patients on Saturday, Oct. 18 at 3:00 pm.
Finally, she’ll host a lecture and hands-on workshop on the use of manual and automated lensometers on Monday, Oct. 20 at 1:50 pm.
5) Laurie K. Brown, COMT, OCS, OSA, COE who was featured on the cover of our premiere issue, is one of a nine-person panel in a sub-specialty session on practice management, as is OP’s co-editor Jane Shuman, COT, OCS, on Friday, Oct. 17 at 12:40 pm.
6) Hans K. Bruhn, MHS, wrote a two-part series on liability for OP this year. At the ACE program, he’ll present a course on identifying and managing the behaviors of unhappy patients and professional liability on Sunday, Oct. 19 at 8:00 am.
IN BRIEF
■ This summer, Kerry Solomon, MD, at Physician’s Eye Surgery Center in Charleston, SC, performed the first two charitable cataract surgeries as part of the new ASCRS Foundation’s network, Operation Sight. Operation Sight is a network designed to provide cataract surgeries to working poor who fall outside insurance and social safety nets. For more see: www.operationsight.org.
■ Eye examinations may reveal a build-up of a protein associated with Alzheimer’s disease, according to several research trials presented at the Alzheimer’s Association’s International Conference. The studies show beta-amyloid, a protein which begins to build up years before typical Alzheimer’s symptoms present, can be seen in the retinas of patients who have taken a curcumin supplement and using retinal amyloid imaging. For more from the association, see: http://tinyurl.com/ln7mlby.
■ Acute migraine headaches may be stopped or often reduced in intensity with beta blocker eye drops, the widely available glaucoma medication that costs as little as $4 per bottle, according to John C. Hagan III, MD and Carl V. Migliazzo, MD, both of Kansas City, Mo. The pair have published a study of seven acute migraines patients treated over a multi-year period. For the study, see: http://tinyurl.com/pe7nbpy.
5 LINKS TO IMPROVED PATIENT CARE
Eye care tips for the back-to-school season
By Bill Kekevian, Senior Associate Editor
■ With summer on its way out and autumn breezing in, it’s time to consider a host of new threats to ocular health. How will your patient’s habits and activities this time of year impact their eyes? Here are five fall-focused tips you can pass on to patients.
1) Keep eyes from extreme cold – If your patients are planning to sit outside and take in a football game, even if it’s a high school bout, they may come prepared with a blanket, earmuffs and some hot cocoa, but chances are they’re not considering possible eye damage. However, cold temperatures may aggravate conditions such as dry eye, according to OSHA. The article at the link below reads: “Injuries incurred from exposure to extreme cold range from eye pain and blurred, decreased, or double vision to severe sensitivity to light and even vision loss. Overexposure to glare can cause snowblindness, a corneal injury that leads to redness, swelling, or a dry, scratchy feeling in the eyes.” Goggles or tinted lenses can help protect eyes in these chilly conditions.
2) Sports injuries – For patients who don’t simply watch from the sidelines, ocular injuries resulting from sports are common. For instance, the National Eye Institute says, “One in 18 college athletes will sustain an eye injury.” Patients who are caring for younger children may be interested to know eye injuries are the leading cause of childhood blindness and that most eye injuries in children 11 to 14 occur while playing sports.
3) Higher education – The AAO reports a record 21.7 million students will attend a U.S. college or university this fall. To keep their eyes healthy, the AAO recommends these additional tips: Don’t shower or swim in contact lenses. Go outside — staying indoors increases the risk for nearsightedness. Wash your hands. Give your eyes a break.
4) Be aware of allergic irritants – To some, falling leaves and “scarf weather” are romantic scenes. To allergy sufferers, autumns golds and browns are more of a threat. For the eye, the signs of allergies are often watery, itchy eyes. Warn patients who suffer from seasonal allergies that windy days can kick up pollen and other irritants.
5) Avoid costume contacts – Patients may want to look their scariest on Halloween, but the damage cheap costume lenses can do to their eyes is a real horror. Encourage them to forego this accessory.
Changes to MU that you need to know
By Jeff Grant, president & founder, Healthcare Management & Automation Systems
■ The Department of Health & Human Services released the much anticipated final rule in August. The new rule offers significant flexibility of Meaningful Use reporting and attestation in 2014.
The new rule doesn’t change the length of the reporting periods in 2014, which, because of a previous change to the rules, allows everyone to use a calendar quarter in 2014 instead of a full calendar year (first year attestors may use a 90-day reporting period not tied to a calendar quarter).
However, because of the new rule, providers who have had issues upgrading to 2014 edition CEHRT will be allowed to continue to use 2011 edition CEHRT or a combination of 2011 edition and 2014 edition CEHRT for attesting to meaningful use in 2014. Figure 1 should help clarify your options.
Figure 1: CEHRT Systems Available for Use in 2014
| If you were scheduled to demonstrate: | You would be able to attest for Meaningful Use: | ||
|---|---|---|---|
| Using 2011 Edition CEHRT to do: | Using 2011 & 2014 Edition CEHRT to do: | Using 2014 Edition CEHRT to do: | |
| Stage 1 in 2014 | 2013 Stage 1 objectives an measures* | 2013 Stage 1 objectives and measures*— or— 2014 Stage 1 objectives and measures* |
2014 Stage 1 objectives and measures |
| Stage 2 in 2014 | 2013 Stage 1 objectives an measures* | 2013 Stage 1 objectives and measures*— or— 2014 Stage 1 objectives and measures* — or— Stage 2 objectives and measures* |
2014 Stage 1 objectives and measures* — or— Stage 2 objectives and measures |
| * Only providers that could not fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability | |||
Additionally, the Final Rule specifically states that if you haven’t been able to implement a 2014 Edition CEHRT, you could go back to an earlier quarter this year (Q1 or Q2) and be able to attest with your 2011 Edition CEHRT. Even if you are using a 2014 Edition CEHRT and were scheduled to meet Stage 2 this year, you are allowed to use Stage 1, 2014 rules instead (which does not include the core measure requiring you to electronically send 10% of your summary of care for transitions of care) if you can’t get direct e-mail addresses from providers to whom you refer patients. Note that you need some documentation to support this option, such as a letter or e-mail from the other provider stating that they don’t have a direct e-mail. OP
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