Quick Hits

Alcon’s plans for Google’s smart lens technology

Potential for diabetes patients and presbyopes.

By Zack Tertel, Senior Associate Editor

With its collaboration with Google to develop smart contact lens technologies, Alcon hopes to develop applications for monitoring blood-glucose levels in diabetes patients and accommodative IOLs, says an Alcon executive.

“We are in the early stages of our collaboration but anticipate smart lens technology may unlock ground-breaking new research that will allow all of us, including ophthalmologists, to better identify, manage and prevent ocular diseases,” says Franck Leveiller, PhD, vice president of vision care R&D for Alcon.

Google and Alcon announced the agreement that allows Alcon to in-license Google’s smart lens technology for all ocular medical uses, including disease management.

“We expect to gain key learnings from these projects and, as they develop, to examine and pursue other innovative opportunities that fit within our strategic plan,” Dr. Leveiller says.

Dr. Leveiller could not speculate as to what might be next for smart lens technology but expressed the potential for an expanded role in the future.

A closeup of how Google technology would appear on a contact lens.

“We look forward to applying our expertise in physiology and visual performance of the eye, clinical development and evaluation and commercialization of contact and IOLs to realize the full potential of smart lens technology,” Dr. Leveiller says.

Louisiana’s ODs get lasers, but not without a fight

An insider explains effort to keep procedures in surgeons’ hands.

By Bill Kekevian, Senior Associate Editor

Baton Rouge pediatric ophthalmologist Pamela Williams, MD, fought tooth-and-nail against the recent legislation that authorizes optometrists to perform some surgical procedures. “It was a tough year for us to try to battle this,” she says. “This was years in the making.”

In 2013, a similar bill, which permits optometrists to perform lid procedures, Nd:Yag capsulotomies, and SLT/ALT glaucoma treatments, was put on hold. It was revived this year and, after passing 25-12 in the state senate, was signed into law by Gov. Bobby Jindal despite protests to his office from the groups such as the AAO, AMA and the American College of Surgeons.

Gov. Bobby Jindal signed the bill expanding ODs’ privileges.

The training period for optometrists to learn these surgeries, according to Dr. Williams, would likely last for 32 hours in total, divided evenly between laser procedures and lid surgery.

“You can’t learn surgery over the weekend,” Dr. Williams says. “Surgical proficiency is acquired through years of medical education and clinical training. The foundation begins in medical school and continues through a surgical residency.”

Dr. Williams says she spent many hours trying to get legislators to vote against the bill, which she calls “dangerous.” She even testified against the bill in a Senate Health and Welfare committee hearing and presented evidence indicating patients prefer surgery be left to the most highly trained individuals, but to no avail. The committee’s chairman, she notes, is Sen. David Heitmeier, OD, an optometrist.

Dr. Williams says that she and many other ophthalmologists worked hard to educate the legislators. “They were willing to listen, but in the end what they really wanted was a compromise, not realizing that what they were compromising may be a patient’s vision,” she says.

Louisiana is now the third state, after Oklahoma and Kentucky, to allow these procedures.

Now that this legislation has passed, she says, patients may be confused about the quality of care a medically trained professional can provide. Patients, she says, may simply expect “anyone who wears a white coat and is called doctor” can perform surgery with equal abilities.

Moving forward, Dr. Williams and her colleagues are focused on “strategies for stopping additional expansion,” she says. “I’m not sure we can reverse what’s happened, but we can try to stop optometry from gaining more ground. This is a patient safety issue. I feel strongly the person most qualified should be performing these procedures.”

How vision loss contributes to falls, depression in seniors

Physicians have a role in reducing vision-related health risks.

By Karen Blum, Senior Contributing Editor

Falls and depression are common among older adults with vision loss, but both can be more complex than they appear, experts reported at the Focus on Eye Health meeting Prevent Blindness America hosted in Washington, D.C.

About one in three adults age 65 or older fall annually, and the risk for those with vision impairments is much greater, said Bernard A. Steinman, PhD, of the University of Massachusetts, Boston. Falls are the leading cause of injury and injury-related deaths among older people and accounted for $30 billion in health-care costs in 2010, he said. Previous falls may make individuals fearful of participating in daily activities and reduce their physical activity, placing them at even greater risk of additional falls.

Vision loss is only one of several factors that contribute to falls, Dr. Steinman said. Others include behavioral risks like not paying attention; environmental risks such as inadequate lighting or clutter; and intrinsic factors associated with vision impairment, including diabetes, arthritis, cognitive impairment and drug side effects.

Ophthalmologists can help reduce patient falls by continually assessing their eyewear prescriptions, identifying other health risk factors for falls and making appropriate referrals to occupational therapists, orientation and mobility specialists and others whom can facilitate home safety. The website www.stopfalls.org has resources for clinicians, patients and families.

Depression and vision loss

When it comes to depression in this population, clinicians often assume it’s due to vision loss, but that’s not always the case, said Alan R. Morse, JD, PhD, president and CEO of the Lighthouse Guild in New York. Vision loss generally does not impact depression, but it can affect the functional vision a person needs for daily activities. Individuals have their own thresholds for when vision loss affects functioning, he said, though depression occurs in about 11% of people with self-reported vision loss.

Clinicians can keep patients motivated by discussing treatment and rehabilitation options as early as possible, and encouraging them to stay physically and socially active, Dr. Morse said. “If depression isn’t improved after rehabilitation, referral for mental health treatment is essential,” he said.

Drugs used to treat depression, including selective serotonin re-uptake inhibitors and tricyclic antidepressants, have the potential to cause vision loss, he said, so clinicians need to monitor patients carefully.

If you’re unsure whether a patient has depression, refer the person to a mental health professional, but remember that rehabilitation often can be of significant help, Dr. Morse advised. “It’s far better that the patient gets a consult and finds out what they have will resolve with effective rehabilitation and they will feel better in a few months than not to make the referral and cause them unnecessary suffering or have something tragic happen,” he said.

FDA denies recall of excimer for LASIK

Latest maneuver after ex-chief scientist’s change of heart.

Morris Waxler, PhD, the former FDA chief scientist who recommended approval of excimer laser LASIK back in the 1990s since turned ardent LASIK critic, was dealt a setback by his former employer last month when it denied his citizen’s petition to call for a voluntary recall of the excimer devices.

Since he left the FDA, Dr. Waxler has headed Help Stop Lasik (www.helpstoplasik.com) and has gathered testimonials of people who have claimed to have been harmed by LASIK. He filed his petition with the FDA in January 2011.

FDA public affairs officer Jennifer Rodriguez confirmed the FDA’s denial. The petition requested the FDA withdraw premarket approval of all LASIK excimer lasers and issue a Public Health Advisory with the voluntary recall.

“The information and references cited in the petition did not provide a basis for withdrawal of premarket approval or issuance of a Public Health Advisory with a voluntary recall of the excimer lasers used in LASIK procedures,” Ms. Rodriguez noted in an e-mail.

The FDA has not found any evidence of any new safety issues with the devices, she stated.

Why ASCs evade ACOs’ sights

Though ophthalmic centers should be well positioned when the focus does come around.

By René Luthe, Senior Editor

Accountable care organizations (ACOs) have so far focused on managing chronic conditions and reducing hospital stays and readmissions in their mission to shrink healthcare costs, but experts say it won’t be long before they turn their attention to surgery, according to a case study and survey in the journal Health Affairs (2014;33:972-979).

When ACOs turn their focus to ophthalmology, though, the specialty may find itself better positioned than others. “Ophthalmic ASCs, working closely with leading surgeons and practices, have emerged as models for delivering high quality and extremely efficient surgical care. ACOs … and more traditional payers are well served to focus on the value our members represent,” says Ralph Chu, MD, president of the Outpatient Ophthalmic Surgery Society (OOSS).

Bruce Maller of BSM Consulting told the OOSS Perspective 2014 at ASCRS 2014 that ophthalmic ASCs “must be both strategic and proactive to effectively position as payers’ best choice, and to demonstrate the ability to work with ACOs and other payers in true partnership.”

Surgery comprises about 50% of hospital expenditures, the Health Affairs authors noted, so “even if ACOs are able to achieve their goals in chronic disease management, overlooking the role and cost of surgical care may negate those savings.”

The authors studied four ACOs in 2012 and surveyed 30 Medicare ACOs and found that few included surgery in strategic plans for the first year. In fact, none of the ACO quality metrics address surgery.

One likely reason for the delay is that it’s difficult for an ACO to determine how to share savings with surgeons, as well as other specialists vs. primary care physicians, the authors noted.

Convert cold Internet callers into warm bodies

tip of the month

Individuals who respond from Internet searches or advertising by calling the office are different because they are still not convinced and unconverted shoppers, and Internet shoppers are notorious no-shows. Lori Waltz, a healthcare practice trainer and consultant who blogs at Healthcare Success Strategies (www.healthcaresuccess.com) offers this guidance for converting those callers into patients and actually getting them in the door.

• Recognize that inbound calls from advertising or Internet searches are not yet convinced. A phone conversation is an excellent opportunity to engage the person, build rapport, provide answers—and most importantly—to make a committed first appointment.

• Callers want assurance that they are making the right choice of a doctor who can answer their medical needs.

• Answering the phone requires skills, training and practice. This first interaction between the caller and the office sets a lasting impression. Properly handled, the caller feels engaged and connected with what will be the right medical resources and provider.

• Give new callers a high priority in the schedule. Get first-time, new patients into the office for a first appointment as soon as possible. Fickle or not, prospective patients can be wary of taking any new steps, or be uncertain about their selection. Providing a quick and convenient appointment helps the patient sooner and demonstrates an impressive level of service. Often, a same-day or next-day appointment will effectively take the person entirely out of their search mode.

Ms. Waltz’s complete article can be found at http://tinyurl.com/InternetCallers.