Volume 7, Issue 3 December 2008

A Quarterly Publication for the Veterinary Community from Eye Care for Animals

A Letter From Our Editor

Veterinary Ophthalmologists, 3 board continuously make an effort to offer you and eligible Veterinary Ophthalmologists, and your clients the most comprehensive care 13 residents in comparative , possible. We constantly look for the latest and as we grow we continue to train and advancements in veterinary ophthalmology attract industry leaders. Most recently: to serve you and your clients’ pets to the fullest. Several of our doctors continue to be Dr. Keith Collins of Animal Eye Specialists • active in clinical research and we would like in Pewaukee, Wisconsin merged with Eye to take this opportunity to introduce you to Care for Animals. some members of our doctor team and their • Dr. Marcella Ashton of Tucson, AZ, research interests. Dr. Matt Fife of Las Vegas, NV, Dr. The ECFA doctor team maintains a Andrew Greller of Springfield, VA, Dr. strong presence at scientific meetings and Heather Kaese of Pewaukee, WI, and symposiums in order to provide the newest Dr. Amy Knollinger of Salt Lake City, advances in the ophthalmic medical sciences UT, successfully completed the board at our clinics. Additionally we strive to equip certification examinations and became our hospitals with the latest in ophthalmic Diplomates of the American College of technology to provide state of the art Veterinary Ophthalmologists in October services to your clients and patients. Two Sara Calvarese, DVM, DACVO of 2008. ECFA locations, Wheeling, Illinois (Dr. Eye Care for Animals Steve Sisler) and Pasadena, California, Eye Care for Animals is one of the few (Dr. Allison Hoffman) perform retinal private practice ophthalmology groups in To Our Valued Colleagues: reattachment surgery. Dr. Hoffman spends the country to offer an American College one day each week working alongside For over 27 years, Eye Care for Animals of Veterinary Ophthalmology (ACVO) leading human retinal surgeons to further has continued to lead the highly specialized accredited ophthalmology elevate the standard of care in the field of and ever expanding field of veterinary program, which allows us to continue veterinary vitreo-retinal surgery. ophthalmology. This would not have been to attract highly motivated and qualified We are also pleased to be able to possible without our relationship with you, individuals. Our residency program offers offer endoscopic cyclophotocoagulation the in the communities we participants an organized educational at Wheeling (Dr. Steve Sisler), North serve. We see ourselves as an extension of program as well as an excellent caseload Scottsdale (Dr. Jennifer Urbanz), Tustin your practice. Currently we have 30 locations that provides the residents with the wide (Dr. Douglas Esson) and Albuquerque (Dr. in 12 states and are consistently striving to variety of experiences that will be necessary Gavin Kennard). This technology provides expand into underserved markets. We see to complete board certification and become the latest and most effective surgical care for ourselves providing the highest quality well-rounded veterinary ophthalmologists. patients affected with glaucoma. Use of the medical and surgical ophthalmic care for Eye Care for Animals continually endoscopic diode laser allows the surgeon to your patients. We aim to provide your accepts applications for the veterinary (continued on page 2) practice with continuing education to ophthalmology residency program. Our new 2008 residents are: increase your ability to provide quality ophthalmic care to those patients that either • Dr. Micki Armour, Tustin, CA INSIDE THIS ISSUE: do not need a referral or financially cannot • Dr. Paige Evans, Leesburg, VA afford a specialist. • Dr. Emily Moeller, Tustin, CA Our hospitals take pride in the fact that • Dr. Kirsten Steele, Wheeling, IL Letter From Our Editor...... Pg 1-3 our staff is comprised of board-certified • Dr. Neal Wasserman, Phoenix, AZ What’s New...... Pg 4 ophthalmologists, residents, skilled and CERF Corner...... Pg 5 trained ophthalmic technicians, and In addition to the growth happening client care representatives. Eye Care for within our staff, our facilities continue to Memo to Managers...... Pg 6 Animals currently boasts 26 board certified expand our treatment options so that we may

Eye Care for Animals One THE OCULAR OUTLOOK

A Letter From Our Editor Esson and Paige Evans are involved on Eli the howler monkey, who can now in a large retrospective study of feline see again and is enjoying an increased accurately target and destroy the ciliary cataract management and surgery. The quality of life. processes. Direct visualization of the size of our group provides a large case Dr. Paul Gerding may soon be intraocular structures eliminates many of pool to draw from, lending significant performing cataract surgery on Ramar, the complications associated with older, statistical credibility. Feline cataract a Gorilla from the Brookfield Zoo. less accurate trans-scleral techniques. surgery is not commonly performed and Dr. Heather Kaese, continues to Dr. Douglas Esson, in conjunction with through this study, our doctors hope to work closely with researchers at the New World Medical Inc., has worked on identify the most ideally suited treatment University of Minnesota to characterize the development of a range of glaucoma and management protocols for these the inheritance of uveitis in the Appaloosa implant and drainage devices. These unique animals. The preliminary data horse. This disease afflicts hundreds of devices are designed specifically for was presented at the 2008 meeting of the horses each year resulting in blindness, the veterinary market, utilizing the ACVO, dispersing the knowledge gained loss of use, and sometimes death. The experience gained in the human world to allow smaller practices to benefit from research goal is to identify susceptibility to offer comparable care to that which a this data and increase the quality of genes in hopes of developing a test person affected by these diseases would service which they provide to their own to determine if a horse is genetically enjoy. Dr. Scagliotti of the Tustin office referral cases. predisposed to develop uveitis. provides highly specialized consultations Drs. Joanna Norman and Kristina in neurologic and orbital diseases of Narfstrom, DVM, PhD, Dip ECVO small animals. Your clients’ pets can (University of Missouri) – a recognized now receive the same level of technical leader in the field of veterinary retinal care that you would! Our doctors work disease – are working together to closely with veterinary imaging centers develop new and effective retinal electro- to allow for more precise diagnoses and diagnostic techniques. The collaboration custom treatment plans to promote the was formed to further identify and best possible outcome for your clients characterize emerging disease patterns and patients. in select groups of patients. The preliminary data from their studies was also presented at the 2008 ACVO meeting. Typically the electroretinogram (ERG) is used to evaluate retinal function prior to cataract surgery or in the face of Photo courtesy of Rolling Dog Ranch Animal Sanctuary suspected retinal disease such as Sudden Aquired Retinal Degeneration (SARDS) Drs. Kelli Combs and Allison Hoffman or Progressive Retinal Atrophy (PRA). have utilized ultrasonic biometry and We take pride in our electro-diagnostic retinoscopy in order to asses and services and appreciate the opportunity potentially improve the refractive error to better educate our clients as to the and hence quality of vision in canine As a group we feel a fundamental nature of their companion’s disease and patients undergoing pseudophakic obligation to continue to push the prognosis. cataract removal. Dr. Combs’ diligent boundaries of medical science through Dr. Nicole MacLaren continues to enjoy work will contribute to the quality of our involvement in consulting, research and develop exotic animal ophthalmology vision and care which we are able to and development, and interaction with – most recently in association with the offer your patients. This work was private and academic institutions. doctors of the Salt Lake City Zoo. Dr. also presented at this year’s ACVO Current ECFA & collaborative MacLaren and a team of doctors and conference. research initiatives include: technical staff donated their time and Dr. Lynsey Smith is currently Drs. Gwendolyn Lynch, Douglas services to perform cataract surgery investigating the potential benefits of Xalacom™ with regards to the veterinary Editor’s box ophthalmic market. Xalacom™ is one of a host of emerging drugs with potential veterinary applications and represents an extension of the highly successful Ocular Outlook Xalatan® (a synthetic prostaglandin analogue which is typically administered Editor: Sara Calvarese, DVM, DACVO once daily and significantly decreases Managing Editor: Julie Gamarano intraocular pressure via its effects on uveoscleral or “alternate” outflow). Eye Care for Animals welcomes your comments on the Ocular Outlook. Exploring the use of new medications will allow us to apply the most up to Please e-mail your feedback to [email protected] date medical therapy to all of the cases or call Julie at (480) 424-3947 extension 6911. we treat. (continued on page 3)

Two Eye Care for Animals THE OCULAR OUTLOOK

Dr. Tina Fife came to us with a strong ciliary bodies of blue vs brown eyed from the COPLOW laboratory at the research background and continues to patients. This data will facilitate accurate University of Wisconsin, are performing work closely with the Braun Biological patient selection and laser protocols a large-scale retrospective study in Center and industry leader Dr. Glen when surgically treating patients order to investigate the etiology and Gum, PhD. Dr. Fife is involved in affected with glaucoma. Although pathophysiology of Golden Retriever several projects and most recently pigment distribution is obviously Uveitis (GRU.) This frustrating, painful completed work which may help pave different between these groups of eyes, and potentially blinding disease affects the way towards sustained release interestingly, the distribution within the golden retrievers across the United States ocular implants for more effective and aqueous–producing epithelial cells is and newer and more effective treatment user-friendly treatment of diseases similar. This data was generated using strategies will hinge on improved requiring long-term medications. advanced histological techniques as well understanding of its mechanisms. The Frequent medication application is as spectrophotometry and will form the unparalleled facilities and experience often challenging for our clients and we core of future clinical studies regarding of the COPLOW lab and the extensive strive to work closely with specialized laser-setting protocols. The data from caseload of Eye Care for Animals will ophthalmic compounding pharmacies in this first study was presented at the 2008 facilitate this study. Early signs of GRU order to provide the most user-friendly ACVO annual convention. include conjunctival hyperemia, uveitis formulations to maximize quality life for Dr. Calvarese is now practicing in our and glaucoma and the disease is typically patients and their owners. rapidly expanding Upland & Palm Desert bilateral in presentation. At this time, the Drs. Reuben Merideth and Nancy Park practices and she and Dr.Esson continue greatest chance of long term success is have completed what may be the largest to offer clinical support and training represented by early referral. retrospective review of canine cataract to students at the Western College of In addition to his work with surgery to date. Using data generated . COPLOW, Dr. Esson currently also from approximately 300 patients from 5 consults for CORL, a collaborative team clinics in Arizona, Drs. Merideth and Park of internationally recognized vision were able to identify potential risk factors scientists founded on providing world- for complications, the most successful class vision research support for industry. techniques, and the best post-operative Please feel free to visit their website at: care regimens. This data was presented http://www.vetmed.wisc.edu/research/ at the 2008 ACVO meeting. Again, our CORL/index.php. He also contributes significant patient volume as the largest to the Center for Vision Research, a national provider of veterinary ophthalmic group committed to fostering interactive care will allow us to share this information research among scientists of different with our colleagues. units of the University of Florida having Our Culver City facility continues to a common interest in vision research. expand and our doctors work closely with Please feel free to visit their website at: other veterinary specialties including http://www.eye.ufl.edu/aboutcvr.shtml. , oncology and critical care, Drs. Esson and Armour have com- Dr. Esson presented some of his in-vivo offering complete patient care services. pleted a clinical trial of viscoelastic MR imaging data at this year’s meeting In this office, Dr. Christin Chapman has devices, similar to those used in human in Gainesville in December. It is hoped completed in vitro research assessing ophthalmic surgery, which facilitate that this research will contribute to the use of canine serum in the treatment complicated intraocular surgery. They the development of newer and earlier of malacic (melting) corneal ulcers. are working closely with local biotech detection techniques for human patients, Along with Drs. Douglas Esson and J. companies to develop newer and more as well as veterinary patients, affected Glenn Songer, Ph.D., FAAM, DACVM at effective (as well as cost-effective) by glaucoma. Dr. Esson works closely the University of Arizona, Dr. Chapman products for the veterinary market. with the Advanced Imaging Group in investigated the growth of bacteria in The findings of the viscoelastic study Tustin, CA, an on-site center offering diabetic and non-diabetic serum and this were presented at the ACVO meeting the latest in MR & CT diagnostics and data was presented at the 2008 ACVO in Boston. the very highest levels of patient care meeting. Dr. Jason Clark in conjunction with Dr. for your referral. Please visit them at Drs. Tiffany Blocker and Matt Fife Ellison Bentley, DACVO (University of http://www.avmi.net/. recently completed a review of canine Wisconsin) researched the Comparison We sincerely thank you for continuing conjunctival mast cell tumors. Their of Topical Nalbuphine and Oral Trama- to give Eye Care for Animals the retrospective study determined that dol for the Treatment of Corneal Pain. opportunity to serve your patients and early surgical excision represents the Drs. Micki Armour, Douglas Esson, their families, and especially for allowing most ideal course of action when faced Emily Moeller and Julius Brinkis are us to be part of your medical team. with this disease. Drs. Blocker and Fife currently involved in a large study to will publish their findings in the Journal investigate the potential efficacy of TPA With Warmest Regards, of Veterinary Ophthalmology. (tissue plasminogen activator) as an Drs. Sara Calvarese, Doug Esson adjunctive therapy to reduce the risk Sara Calvarese, DVM, DACVO and Kimberly M. Newkirk, Ph.D, of post-operative ocular hypertension Upland Eye Care for Animals DACVP, (University of Tennessee) following phacoemulsification. Addi- 909-949-9200 have completed a study investigating tionally Drs. Armour, Esson, and Dick the distribution of pigment within the Dubielzig, DVM, DACVP, DACVO Eye Care for Animals Three THE OCULAR OUTLOOK

What’s new at Eye Care for Animals?

Congratulations!

Dr. Marcella Ashton Dr. Matthew Fife Dr. Andrew Greller Dr. Heather Kaese Dr. Amy Knollinger Tucson, AZ Las Vegas, NV Springfield, VA Pewaukee, WI Salt Lake City, UT

for attaining diplomate status in the American College of Veterinary Ophthalmologists.

Congratulations!

Dr. Joanna Norman Dr. Rustin Sturgeon Dr. Amy Thompson-Hom Arizona & Overland Park, KS Chicagoland, IL New Mexico

for completing their residency in comparative Ophthalmology.

Recent Openings Pewaukee, Wisconsin welcomes Dr. B. Keith Collins, DACVO & Dr. Heather Kaese, MS, DACVIM, DACVO South County, California welcomes Dr. Paul Barrett, DACVO & Dr. Reuben Merideth, DACVO

Coming Soon Avondale, AZ; San Diego, CA; Houston, TX

These new locations allow us to continue providing your communities with state of the art medicine and compassionate care.

Four Eye Care for Animals THE OCULAR OUTLOOK

CERF CORNER

Imperforate Lacrimal Punctum

Patient evaluation for Canine Eye Registration Foundation (CERF) examinations includes evaluation of anterior segment structures including eyelids, third eyelid, conjunctival tissues, cornea, and intraocular structures Andrew Grellar, VMD, DACVO Eye Care for Animals including the iris and lens, typically with a slit lamp biomicroscope to improve magnification. The posterior segment (retina and optic nerve) is also evaluated for inherited disease using binocular indirect ophthalmoscopy. An array of diverse congenital abnormalities of the nasolacrimal system exist in many species, but are relatively rarely seen during a CERF examination. The most common condition we see is an imperforate lacrimal punctum. This condition is defined as a developmental anomaly resulting in failure of opening of the lacrimal duct located at the medial eyelid margins. This condition is most often seen in American Cocker Spaniels, Bedlington Terriers, Golden Retrievers, miniature and toy Poodles, and Samoyeds. The lower punctum is more frequently affected than the upper. This condition is most often characterized by epiphora and tear staining at the medial canthus, although very young animals may be asymptomatic until tear production increases with age. This condition may be discovered during a CERF examination as an absence of the opening of the nasolacrimal puncta and is confirmed when there is the inability to cannulate or place a probe in the punctal orifice. The inheritance of this condition is not fully defined and breeders are given the option as to whether or not they want to breed affected dogs since vision is not usually impaired with this condition and quality of life appears to be good. Treatment for this condition usually involves excising the conjunctiva overlying the puncta and temporarily suturing in-dwelling fine catheters for 7-21 days. Using combination topical anti-inflammatory/ antibiotic medications and keeping an e-collar on the patient may help to keep this new orifice open and prevent stricture as the conjunctival epithelium heals. In some cases obstructions of the nasolacrimal system are located in other parts of the nasolacrimal duct which may necessitate other diagnostic tests and may not be amenable to surgery. In cats, the most common cause of nasolacrimal punctal obstruction is not congenital, but rather scarring of the puncta due to feline herpesvirus conjunctivitis and this condition may not be reversible.

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Six Eye Care for Animals for Care Eye

customer service! customer

Careful planning and preparation is key to weathering an economic storm. Remember, responsible fiscal management equals great great equals management fiscal responsible Remember, storm. economic an weathering to key is preparation and planning Careful

By implementing these cost containment tips you can help to reduce your Practice overhead and help ensure your financial stability. stability. financial your ensure help and overhead Practice your reduce to help can you tips containment cost these implementing By

• Utilize applicable on-line learning to reduce training costs. training reduce to learning on-line applicable Utilize

• Turn off office lights in the evening. the in lights office off Turn

• Automate processes to gain efficiencies. Automate processes/review current procedures for greater efficiency. greater for procedures current processes/review Automate efficiencies. gain to processes Automate

• Share space with other entities if/when appropriate. if/when entities other with space Share

• Consider offering non-traditional work experiences such as work from home. from work as such experiences work non-traditional offering Consider

unnecessary expenses. unnecessary

• Increase “safety” throughout the work place. Adopt workplace processes that reduce the likelihood of injuries or other related related other or injuries of likelihood the reduce that processes workplace Adopt place. work the throughout “safety” Increase

where cost savings can be achieved. achieved. be can savings cost where

• Outsourcing may result in cost savings! Utilize cost benefit analysis worksheets to help benchmark current costs and determine determine and costs current benchmark help to worksheets analysis benefit cost Utilize savings! cost in result may Outsourcing

discounts with vendors. with discounts

• Consolidate buying power. Negotiate deeper discounts when purchasing in volume/bulk. Renegotiate contractual terms and and terms contractual Renegotiate volume/bulk. in purchasing when discounts deeper Negotiate power. buying Consolidate

• Monitor, reduce, or eliminate overtime. eliminate or reduce, Monitor,

• Offer staggered shifts to cover those long days without overtime. overtime. without days long those cover to shifts staggered Offer

consider updating your policy to allow 32 hours per week for full time status. time full for week per hours 32 allow to policy your updating consider

employees. If your policy is such that full-time employees must work a minimum of 40 hours per week to qualify for benefits, benefits, for qualify to week per hours 40 of minimum a work must employees full-time that such is policy your If employees.

• Reduce staff hours when client appointments or production is down. Consider reducing the hours of both part-time and full-time full-time and part-time both of hours the reducing Consider down. is production or appointments client when hours staff Reduce

those expense percentages and keep them in line! in them keep and percentages expense those

, lab fees, labor costs payroll overhead, equipment, and so on. Monitor Monitor on. so and equipment, overhead, payroll costs labor fees, lab , supplies) & (drugs inventories as, such components cost

• Develop benchmarks for key cost components of running the Practice. Keep an eye on key key on eye an Keep Practice. the running of components cost key for benchmarks Develop

Eye Care for Animals for Care Eye

drive improvements. drive

Chief Operations Officer Operations Chief • Develop a corporate scorecard scorecard corporate a Develop to evaluate performance and and performance evaluate to practices) best for (benchmarks

Karen Webster, MBA Webster, Karen are some helpful cost containment tips to consider as we enter the New Year: New the enter we as consider to tips containment cost helpful some are

weathering an economic slowdown in the months ahead is possible with proper planning. Here Here planning. proper with possible is ahead months the in slowdown economic an weathering

Due diligence in managing the Practice is imperative during challenging economic times and and times economic challenging during imperative is Practice the managing in diligence Due

projecting and preparing for a slight decline. decline. slight a for preparing and projecting

moment, consumer spending on pet care remains strong; however some veterinary specialists are are specialists veterinary some however strong; remains care pet on spending consumer moment,

revealed that at least 25% ($10.8 billion) of all consumer pet spending is on veterinary care. At the the At care. veterinary on is spending pet consumer all of billion) ($10.8 25% least at that revealed

billion – that’s up from $41.2 billion in 2007 and $38.4 billion the year before. Recent surveys also also surveys Recent before. year the billion $38.4 and 2007 in billion $41.2 from up that’s – billion

by the American Pet Products Association projected consumer spending for 2008 at $43.4 $43.4 at 2008 for spending consumer projected Association Products Pet American the by

Pet owners spend billions of dollars on their animal “kids” each year. In fact, a recent study study recent a fact, In year. each “kids” animal their on dollars of billions spend owners Pet

How To Weather An Economic Downturn Economic An Weather To How

Down Economy?!? Cost Containment Tips: Tips: Containment Cost Economy?!? Down

Will Consumer Spending On Pets Change In A A In Change Pets On Spending Consumer Will

S R ANAGE M TO O M E M THE OCULAR OUTLOOK OCULAR THE