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Tips and News You Can Use

Study Says Aspirin Helps Prevent Diabetic Retinopathy
Researchers Trace the Disease to Microscopic Clots.

A new study conducted by researchers at The Schepens Eye Research Institute in Boston concludes that the early and regular incorporation of aspirin in the treatment regimen of diabetic patients can help prevent diabetic retinopathy.

Retinopathy is the most common complication from diabetes and is the leading cause of blindness in the United States for people ages 20 to 74.

The researchers, led by Mara Lorenzi, M.D., associate professor of ophthalmology at Harvard Medical School and director of the Center for Diabetic Retinopathy at Schepens, found that in diabetic patients, the narrow capillaries that nourish the retina become marked by hundreds of tiny blood clots that impede normal blood flow. As these microscopic clots grow more numerous, the retina becomes starved for oxygen and nutrients, and eventually produces growth factors that stimulate abnormal growth of new blood vessels. In this advanced stage of retinopathy, the proliferating blood vessels bleed, cloud vision and destroy cells in the retina, causing blindness.

Because the formation of miniscule blood clots constitutes the first stage of diabetic retinopathy, the researchers suggest that a daily dose of aspirin in the 80 to 325 milligram range can help prevent the aggregation of platelets and clotting in retinal capillaries.

"The treatment would need to be started early on, because even small and transient blood clots have the potential to do damage on retinal vessels," Dr. Lorenzi said.

Dr. Lorenzi noted that aspirin is only one of several possible interventions in preventing diabetic retinopathy.

"Aggressive control of high blood glucose before retinopathy develops is the first line of defense," she said. "Controlling high blood pressure is another preventative step."

The research team's findings appeared in the June issue of the journal Diabetes.

Fees for Three CPT Codes Increase
RVUs are Raised.

The federal government's Centers for Medicare and Medicaid Services (formerly HCFA) has accepted the recommendations of the American Academy of Ophthalmology (AAO) and increased the relative value units (RVUs) for three key ophthalmic codes.

The changes came after a federally mandated 5-year review of the appropriateness of the work values assigned to specific physician procedures. The new RVUs will be part of the 2002 Medicare Fee Schedule.

The changes apply to CPT codes 67218, 92018 and 65855. The work RVU for code 67218 for treatment of retinal lesions will increase from 13.52 to 18.53 units, resulting in a payment of $191.67. The new fee reflects complexity not previously considered in valuing the service.

Code 92018 for an eye exam under anesthesia will be valued at 2.5 RVUs, adding an additional $37.87 to the payment for the procedure.

In addition, the global period for trabeculoplasty (CPT 65855) has been reduced from 90 days to 10 days, enabling you to bill for all visits outside of the 10-day global period. The AAO successfully argued that complications during the 90-day period are often due to unrelated, pre-existing problems.

The AAO said it's pleased with the increases, but is still working to win RVU adjustments for additional ophthalmology procedures.

The Press Takes Aim at LASIK
A Rash of News Stories Have Spotlighted Bad Outcomes.

A Georgia ophthalmologist says his seven offices will no longer perform LASIK because he can't guarantee the safety of the procedure.

In Arizona, a 31-year-old airline captain is grounded for life after LASIK leaves him with irreversibly impaired night vision.

And in Philadelphia, a woman wins an $800,000 judgment against a vision correction chain after LASIK leaves her with permanent double vision.

These stories, and others highlighting the potential dangers of LASIK, have recently been prominently featured in newspapers around the country, including USA Today, the New York Daily News, the Macon (Ga.) Telegraph and the Arizona Daily Star. Though the articles also quoted LASIK defenders, the overall effect was to create concern about the procedure.

"I haven't seen a positive article about LASIK in the past year," says Laura Johnson, executive director of the LASIK institute in Boston. "These stories are difficult to combat because any rebuttal sounds very defensive."

Johnson says she has talked to several refractive surgeons since the articles appeared and, while they're answering more questions from prospective LASIK candidates, they've not seen a dropoff in procedure volume. Johnson says the questions now being asked by the public on the LASIK Institute's own Web site specifically relate to the issues raised in the media.

LASIK procedure volume dropped sharply in Canada about a year ago after the media in that country widely reported the Canadian Medical Association's warning that the procedure sometimes caused severe night driving problems.

AAO Cites Causes of Summer Eye Injuries
Most Mishaps Can Be Prevented with Eye Protection.

If you're like most ophthalmologists, you're seeing a number of patients who've suffered summer eye accidents. Because people spend more hours outdoors during this time of year, the likelihood of eye injury is greatly increased.

The American Academy of Ophthalmology (AAO) says this is a good time to remind your patients that the most ordinary activities can cause severe eye damage. That's why it's important for people to wear eye protection while engaging in such activities as mowing the lawn and using a bungee cord to secure a bike, surfboard or camping equipment to a vehicle.

According to the U.S. Eye Injury Registry, most summer eye injuries are a result of:

• stones, twigs or other debris thrown up from a lawn mower or trimmer
• bungee cords snapping while an individual is strapping an object to a car (A snapping bungee cord can travel at 60 miles an hour. Three recent bungee cord injuries that resulted in the loss of an eye have been reported.)
• baseball and paint ball games
• unsafe toys, such as water balloon slingshots and BB guns
• fireworks or sparklers
• car battery jumper cables
• household chemicals used without eye protection
• sun damage to unprotected eyes.

The AAO suggests you advise patients that having a good pair of sunglasses and a pair of protective goggles readily available in the home and/or car are low-cost investments that can pay big dividends in terms of preventing summer eye injuries.

IN THE NEWS

Partnership. Allergan and Inspire Pharmaceuticals will work together to develop and commercialize two therapeutic treatments for dry eye, Inspire's INS365 Ophthalmic and Allergan's (cyclosporine ophthalmic emulsion 0.05%) Restasis. Both drugs are currently in Phase III clinical trials. INS365 Ophthalmic increases the lubrication in the eye by stimulating natural tear and mucin production. Restasis decreases the underlying inflammation associated with dry eye.

STAAR recall. STAAR Surgical has voluntarily initiated a recall of all Model CQ-2005V three-piece collamer intraocular lenses. The recall stems from a packaging failure, which could breach the sterility of the lens.

ISTA drug. ISTA Pharmaceuticals has completed the enrollment of 680 patients for its North American Phase III clinical study of Vitrase, a drug for the treatment of severe vitreous hemorrhage, primarily resulting from diabetic retinopathy.

B&L leaders. Bausch & Lomb has completed its regional leadership structure by naming Mark M. Sieczkarek corporate senior vice president and president --Americas Region and Alan H. Farnsworth corporate senior vice president and president -- Europe Region.

Distribution center. Essilor of America, Inc. has opened a new distribution center in Columbus, Ohio. The highly automated center now distributes all Essilor lens products, including polycarbonate lenses manufactured by Gentex Optics, a subsidiary of Essilor International.

New unit. Topcon Corporation has formed a new business unit, Topcon Medical Systems, Inc., that will be solely dedicated to advancing the company's ophthalmic equipment and systems business. The unit is headquartered in Paramus, N.J.

Grunwald honored. Henry A. Grunwald, former editor-in-chief of Time Inc. Publications, received Lighthouse International's first annual Henry A. Grunwald Award for Public Service. Grunwald's book, Twilight: Losing Sight, Gaining Insight, was recognized as providing new understanding to thousands of people afflicted with age-related macular degeneration. The award will be given each year to an individual who raises public awareness of the issues associated with vision impairment and the value of vision rehabilitation.

REFRACTIVE SURGERY UPDATE

LASIK pricing. John J. Klobnak, chairman and CEO of Laser Vision Centers, Inc., the largest provider of excimer lasers in the United States, said he believes the price war in laser vision correction is now over. Klobnak noted that Laser Vision was able to maintain profitability throughout "this period of turmoil." LASIK pricing pressures have recently eased with the closing of a number of so-called "discount" laser vision correction centers.

B&L gets approval. Bausch & Lomb has received FDA clearance to market its new Zywave aberrometer (left) , which uses wavefront technology to determine the unique features of any eye and to identify abnormalities throughout an individual's optical system. Bausch & Lomb says the approval is a significant step in the company's plans to create a platform of personalized vision solutions, including customized LASIK.

Hyperion LTK sales. Sunrise Technologies International, Inc. says it has shipped 138 Hyperion LTK systems for the treatment of hyperopia since receiving FDA approval to market the device about a year ago. Sunrise also recently received $1.1 million in additional financing from International Mercantile Holding Group.

Growth trend. LCA-Vision reported that its laser vision correction centers performed 22,490 procedures in the quarter ended June 30, compared to 13,888 in the year-ago period. The average price per procedure was $933, an increase of $36 from the previous quarter.