Looking back at 2016

Before the new year gets too far along, let’s take a brief look at the happenings in the pages of Optometry Times during 2016.

The past year started much like other years: Doctors are worried about financial obstacles and their bottom lines. John Rumpakis, OD, and Bryan Rogoff, OD, began the year identifying problems for optometrists in 2016: increasing deductibles, increased competition from corporate opticals, and patient access to eyecare for the year.

Related: 5 financial challenges ODs will face in 2016
 

Where did we go from there?

Contact lenses

2016 saw the first of the lawsuits against Valeant in the gas permeable contact lens industry. Bausch + Lomb purchased Alden Optical laboratories. B+L also voluntarily recalled its PeroxiClear hydrogen peroxide care system from the market.

Johnson & Johnson Vision Care discontinued its unilateral pricing policy (UPP) in 2016 in an effort to focus their resources “on the doctor-patient relationship and advocate against contact lens deregulation.” Advocacy is a good thing, considering that 1-800 Contacts ramped up its fight against organized optometry at the state and federal levels in 2016.

More devices for myopia control may become available now that the FDA hosted a workshop to address regulation of these devices.

More contact lens content

To infinity and beyond

Our editors had the unique privilege of discussing vision problems in space with astronaut Scott Kelly. The ongoing Fluid Shifts Study is investigating vision problems in space, especially resultant hyperopia.

Related: Understanding vision problems in space

Our profession also heard Buzz Aldrin’s tale of his historic moon trip at the American Optometric Association’s Optometry’s Meeting in June.

Clinical news Zika

The Zika virus captured many national headlines in 2016. The virus has been on the move in Central and South America with new cases confirmed almost daily in Canada, Europe, and United States. Conjunctivitis is a common symptom with the disease, and we discussed this in the March issue.

Diabetes

ODs must become more general health providers; we can no longer simply look at the eye and visual system.

With over 400 million people suffering from diabetes in 2010,¹ and our profession often serving as a portal into the healthcare community, we ODs have a unique opportunity to educate and care for our patients suffering from diabetes, hypertension, and other systemic diseases.

Related: Importance of adherence and follow-up in patients with diabetic retinopathy

Toward that end, Dr. Sherrol A. Reynolds believes optometrists need to take a greater role in helping patients identify and control hypertension and other systemic diseases that are not always associated with the eye.

Demodex

Demodex continued to make the news in 2016. Demodex is a very common condition that ranges from asymptomatic to sight-threatening disease. Ocular demodex has been associated with facial and ocular rosacea as well as meibomian gland dysfunction. Quick recognition and diagnosis and conservative therapy will lower demodex density and improve symptomatology, according to Ben Gaddie, OD, FAAO.

Glaucoma

Dr. Gaddie also educated us on our profession’s expansion toward a broader range of diagnostic and treatment options for our glaucoma patients. More optometrists are writing prescriptions for their glaucoma patients, Dr. Gaddie says, which is a welcome sign.

Dr. Ben Casella feels that FDA approval for an injectable sustained-release prostaglandin analog implant (Bimatoprost SR) could be obtained in a few years which could redefine first-line therapy in glaucoma.

TBI

The effects of concussions have been in the news for a while, and concussion patients are increasingly presenting for care in optometrists’ offices across the country. ODs helping to care for these patients is a good thing, according to optometrists Keith Smithson and Jason Clopton because ODs are the best choice for concussion detection and treatment. They shared the top 10 myths of concussion treatment.

FDA approves CXL

After a long wait, the U.S. Food and Drug Administration approved corneal cross-linking (CXL) in April 2016. This procedure is considered the only method for halting corneal ectasias, including keratoconus. Current FDA labelling indicates CXL for use in patients who are identified with progressive keratoconus. As it is not known if CXL negatively affects reproductive capacity or causes fetal harm, recommendations for CXL should not be made for pregnant women, advises Dr. Jim Owen.

Optometry and online ventures

Although executives from three online refraction companies (Opternative, EyeNetra, and myVisionPOD) say that ODs are a key part of their services, organized optometry's battle with Opternative continued in 2016.

The company’s expansion initiative was beaten back in South Carolina, Georgia, and Indiana. Currently 11 states have passed some form of legislation prohibiting patients from receiving a refraction from an online service such as Opternative.

Related: How to combat 1-800-EYE-EXAM

Yet, in a classic example of two wrongs not making a right, 1-800 Contacts now offers Opternative refraction to its customers. Not long after that announcement, the FTC filed suit against 1-800 contacts, citing the company with anti-competitive behavior.

U.S. House lawmakers are considering a measure that would hold online sellers of contact lenses accountable for deceptive or illegal sales tactics that may threaten patient health. Dr. Carl Spear feels these developments should be a wake-up call to all optometrists to become involved in the politics that can affect our profession

Of course, new apps for eyecare continue to hit the market.

Related: Why patients are choosing eyecare apps over you

A prime example is Simple Contacts, an app that allows your patients to self-report and self-prescribe their contact lenses.

A new contact lens retail site, Hubble, offers contact lens wearers daily disposable contact lenses at a lower price and plans to drive patients into OD offices for exams.

Another area of concern regarding online sales is how we handle that patient who bought his eyewear online but shows up at your office wanting an adjustment. If you haven’t had this happen yet, you will.

We simply have to stop giving away our services and expertise, especially when online eyewear sales are fraught with error. Nearly half (44.8 percent) of the 200 pairs of eyeglasses purchased by the AOA had incorrect prescriptions or safety concerns.²Justin Bazan, OD, FAAO, recommends you develop an eyewear service plan, outlining the difference between online vendors and our service and expertise.

Comanagement

Optometrists continue to learn more about how to better manage their surgical patients.

Jeffrey Whitman, MD, educated us on minimally invasive surgical options for presbyopia, including Kamra corneal inlay (AcuFocus) and Raindrop Near Vision Inlay (ReVision Optics), as well as discussing two devices under investigation.

Kristin Symon, OD, taught that femtosecond laser-assisted cataract surgery can provide better postoperative results, fewer complications, and higher patient satisfaction. The one huge drawback to that procedure for many of our patients is the out-of-pocket costs for the procedure.

Drs. Clark Chang and Jim Owen also discussed new categories of premium extended depth-of-focus intraocular lenses. I hope they perfect these devices soon-I realize I am not too far away from needing cataract surgery!

More on comanagement

Dry eye

Dry eye continues to be an area of interest for optometrists and patients alike.

The biggest pharmacological news in optometry and likely the entire eyecare industry for 2016 was the approval of Xiidra (lifitegrast, Shire).

This approval gives optometrists two choices instead of only one for prescription dry eye therapy. Many eyecare practitioners were waiting for other therapeutic options to better treat their patients.

More on dry eye

Dry eye testing

As more research is conducted, we are discovering even more potential dry eye problems. One study found abnormal osmolarity in 59 percent of 273 contact lens wearers.³ Contact lens wearers with abnormal osmolarity had a greater number of symptoms compared to those with normal tear osmolarity. We know that dry eye is a cause of contact lens dropout; with the numbers presented in this study, the problem may be even larger than we think.

Another important sign of dry eye is inflammation, which can be identified by evaluating MMP-9 with the InflammaDry test from RPS. Combining both tests can aid in your treatment plans. While these CLIA-waived tests are not significantly going to build your revenue, they do enhance your overall patient care.

Politics of optometry

2016 was a political year.

Gov. Chris Christie (R-NJ) pocket vetoed a bill allowing optometrists to participate in third-party medical insurance plans without being required to also participate in vision care plans.

U.S. House lawmakers are considering a measure that would hold online sellers of contact lenses accountable for deceptive or illegal sales tactics that may threaten patient health. The Contact Lens Consumer Health Protection Act of 2016 (H.R. 6157), introduced in September, aims to crack down on illegal sales tactics and make increased enforcement to safeguard public health a priority for the Federal Trade Commission.

Optometry’s own Lisa Shin, OD, from New Mexico spoke at the Republican National Convention in Cleveland and encourages her fellow ODs to get involved in national politics.

With the 2016 presidential election finally over, current speculation centers on the Affordable Care Act (ACA) and its future in a new administration.

Malcolm Gladwell characterized the current state of health care in the United States as a blend of pathologies and policies-“a mystery wrapped in a puzzle”-in the keynote talk at the American Academy of Optometry annual meeting in Anaheim.

And in case the past year (politics notwithstanding) caused you much angst, Tracy Schroeder Schwartz, OD, FAAO, told us how to overcome our stress. I take her at her word-she is the most Type A person I know!

Looking ahead

2016 was an exciting year in our industry. The coming year promises to be just as exciting-and interesting-as this past one.

Read more from Dr. Bowling here

References:

1. Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol 2015;3(11): 866-75.

2. American Optometric Association. A Closer Look at Ordering Eyeglasses Online. Available at: https://www.aoa.org/documents/public/A_Closer_Look_at_Ordering_Eyeglasses_Online.pdf. Accessed 12/10/16.

3. Bowling E, et al. Prevalence of abnormal tear film quality and stability measured by abnormal tear osmolarity among contact lens wearers. Poster presented at: American Academy of Optometry Annual Meeting; Anaheim, CA.; November 10, 2016.