Specialized Optometry 10 Paths to Practice Differentiation

28 MEGATRENDS: Specialized Optometry 10 Paths to Practice Differentiation

SPORTS VISION SENIOR CARE NEURO-OPTOMETRY

AESTHETICS DRY EYE VISION THERAPY PEDIATRIC

LOW VISION MYOPIA CONTACT LENSES

BY MARGE AXELRAD, ANDREW KARP, MARK TOSH AND BRIAN DUNLEAVY

NEW YORK—We are living in an age of specializa- infusion of energy is attracting ODs looking to out a little something different from the guy down tion. Today we can get virtually anything we want add a new dimension to their general practice, the street. To be successful at a specialty, though, from a business whose only business is deliver- or even create an entirely specialized practice, as you need to ask yourself three questions: What ing a certain type of product or service, whether many ophthalmologists have done. Those who do you want to do? What are you good at? And, it’s a vegan restaurant or Victoria’s Secret. choose to specialize do it as a way to distinguish what’s the need in your community? If you can Optometry, like many medical professions, themselves and differentiate their practices. find something that intersects all three, that’s is being reshaped by the specialization trend. Despite specialization’s appeal, most ODs re- your pot of gold.” Modern living has changed the way we use our main generalists, believing that going broad To better understand what’s driving the spe- eyes, and many optometrists, particularly those rather than deep is a more practical strategy for cialization trend in optometry, Vision Monday in private practice, have responded by develop- success. Yet both approaches can co-exist com- looked at 10 types of specialty practices: sports ing specialties to address specific patient needs. fortably in a practice. In fact, ODs who specialize vision, neuro-optometry, pediatric, senior care, Some specialties, such as pediatrics and low vi- typically do so within the context of a general dry eye, vision therapy, low vision, contact sion, have been long established in optometry, practice. lenses, myopia, aesthetics. The optometrists we while others, like dry eye management and “There’s a lot of ways you can approach the spoke with explained why they find their -spe neuro-optometry are more recent additions. Yet practice of optometry and be successful,” noted cialty rewarding, personally and professionally. all seem to be benefitting from the advent of dry eye specialist Whitney Hauser, OD. “However, They discussed how they have maximized that new technologies and treatment methods which even in a general eyecare practice that’s focus is specialty to expand their scope of practice, grow are bringing exciting changes to vision care. This primary care, there’s still an opportunity to carve their patient base and boost revenue. n 29 COVER TOPIC

on the vision system can be readily analyzed, and VISION THERAPY benefits of a Shaw design are the graphically dis- played before the lens is ordered. Helping Young Patients Specializing in vision therapy has proved to be Overcome Visual Challenges rewarding for him, both personally and professionally. “When you’re doing vision therapy, every case ision therapy is a well-established field is different,” said Dr. Bonilla-Warford. “It’s a lot more challenging. You have to go a lot more in-depth and encompassing behavioral and develop- Dr. Nathan Bonilla-Warford and his wife Cristina think about the patients in a different way. But you V mental vision care as well as neuro-op- Bonilla-Warford, who is a licensed optician, practice tometric rehabilitation. The advent of new tech- manager and vision therapist. also get to see patients many times over the course nologies and treatment methods in recent years of treatment, and get to know them extremely well, has added an important dimension to the field. bought his Florida practice, Bright Eyes Family Vi- as well as know their parents. Knowing how much The College of Optometrists in Vision Develop- sion Care, in the mid-1990s that Dr. Bonilla-Warford of a positive impact you’re having on them makes ment (COVD), a non-profit, international membership began implementing it with patients, particularly every day a lot more interesting and challenging. It’s association of eyecare professionals provides board children. “We found a neighborhood within the definitely a lot of fun.” certification for optometrists and vision therapists Tampa Bay area that was family oriented and chil- Dr. Bonilla-Warford said vision therapy has been who offer specialized vision care services to develop dren-centric, and that was important to grow the a practice builder. “If people are coming to you be- and enhance visual abilities and correct many vision vision therapy program,” he explained. “It’s a very cause they have a particular problem and have been problems in infants, children, and adults. important part of the practice growth.” referred by a professional, they are much more likely Bright Eyes Family Vision Center’s vision thera- or willing to pay out of pocket for your specialized Nathan Bonilla-Warford, OD, FAAO, FCOVD py program treats conditions such as amblyopia, expertise, and less concerned about what type of Bright Eyes Family Vision Care strabismus, depth perception and suppression. Dr. vision plan they have. We have a pretty big segment New Tampa and Westchase, Florida Bonilla-Warford employs the latest technologies in- of our patient population who will pay out of pocket Dr. Nathan Bonilla-Warford’s interest in the field cluding Vivid Vision, a virtual reality Vision system and either try to get reimbursement on their own took root early in his career, when he began to re- created for treatment of various binocular vision and not use their benefits. That’s directly related to alize vision therapy’s potential benefits and study problems. Vivid Vision uses the Oculus Rift virtual having specialty services that people want. it seriously. “I fell in love with vision therapy and reality platform to provide therapeutic activities. “We made the choice early on to participate as binocular vision,” he said. One of the approaches Bright Eyes uses to treat little as possible in medical plans. We do take Medi- Although he gained a considerable amount of amblyopia is the patent-pending Shaw lens, a digi- care. It streamlines everything. People just give us knowledge about vision therapy, it wasn’t until he tal, binocular lens system. The lens’s exact effect cash, we deposit it directly and everybody’s happy.” —Andrew Karp Adding a Touch of Specialization to a General Practice

lthough many optometrists prefer to not to special- eyes into alignment. increase in using digital devices, Dr. Fries fit the patients A ize and instead orient themselves toward family “Neurolenses are with neurolenses. practice, some still incorporate elements of specialization our first real venture “For someone who doesn’t have a purely neuro-opto- into their practice. A good example is Timothy D. Fries, into that type of metric practice, it fit into the daily flow of a regular private OD, MBA, who owns and operates three locations in rural specialization,” said practice very well and was easy to implement. I didn’t have areas in Central Ohio. “It’s tough to specialize in that type Dr. Fries, who began to teach my staff a whole new specialty or hire new staff of market, we do “a little bit of everything,” he explained. prescribing the lens- that was only going to do one type of specialty. “We see patients as young as six months and as old as es to patients to relieve their eyestrain, backstrain, neck “We’ve seen referrals come from primary care doctors 104, as well as everyone in between.” strain and back pain. “I’ve seen an increase in the number and neurologists, not to mention word of mouth referrals, Recently, Dr. Fries took a step toward neuro-optometry of patients with these symptoms, and patients are finding which have just gone through the roof. I see the need for when he discovered neurolenses, a uniquely designed pre- them more bothersome than ever before.” us to incorporate more of these options for our patients,” scription lens that adds a contoured prism to bring the After determining that the symptoms were caused by an said Dr. Fries. n

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NEURO-OPTOMETRY Neuro-Optometry, a Rewarding Specialty for Optometrists

he Neuro-Optometric Rehabilitation tions with visual rehabili- have imagined until her son suffered a brain injury, Association (NORA) defines neuro- tation services designed and related vision consequences, when he was a to improve their quality one-year-old. Her son’s condition prompted Dr. Dan- optometry as a customized treatment T of life. In fact, visual re- iel to attend her first NORA meeting. “I was just regimen for patients with visual deficits habilitation is essentially blown away,” she recalled. “Everything they were caused by physical disabilities, traumatic the entire focus of her talking about wasn’t taught in optometry school 30 brain injury (TBI) and other neurological professional practice. years ago, but I knew these services would help my problems. It is a part of the rehabilitation “My husband and I son recover.” process for visual/perceptual/motor disor- run a group practice with Her son, who is also autistic, is 22 now and do- ders like acquired strabismus, diplopia, two other optometrists, ing well. He’s non-verbal, but his visual skills have and three of us practice improved sufficiently to allow him to use an assis- binocular dysfunction, convergence and/ neuro- and developmen- tive technology text-to-speak program to communi- or accommodation paresis/paralysis, oculo- Dr. Susan Daniel finds neuro-optometry “very tal optometry in addition cate, to write and to be more independent. motor dysfunction, visual-spatial dysfunc- rewarding” and encour- to primary-care optome- Now, with NORA, Dr. Daniel is encouraging oth- tion, visual perceptual and cognitive defi- ages other optometrists try, while my husband fo- er optometrists to take on the neuro-optometry cits, and traumatic visual acuity loss. to make it a specialty. cuses entirely on primary specialty. NORA provides clinical courses to teach Treatments used include medically neces- care services,” explained optometrists the skills needed to provide neuro- Dr. Daniel. She operates Daniel & Davis Optometry optometric rehabilitation for their patients. Op- sary non-compensatory lenses and prisms in Carlsbad, Calif. with her husband, Christopher portunities to learn with lectures and workshops with and without occlusion and other ap- Davis, OD. are also provided by the Optometric Extension propriate medical rehabilitation strategies Dr. Daniel now spends much of her time at her Program (OEP), the College of Optometry in Vision like patching one eye or part of the visual clinic and at an area hospital in the acute rehabili- Development (COVD), the American Optometric field of one eye to resolve double vision. tation unit (she has hospital privileges), working Association (AOA), residency programs and other Neuro-optometrists often work closely with with patients who have suffered traumatic brain continuing education. neurologists, physical medicine and rehab injury (TBI, such as concussion) or stroke as well As most neuro-optometry patients pay cash for as those with special needs and autism who are the services, the specialty can be quite lucrative. In physicians, nurses, physical and occupa- diagnosed with strabismus, diplopia, binocular fact, Dr. Daniel noted, the specialty helped Daniel tional therapists, speech-language patholo- dysfunction, accommodation dysfunction, oculo- & Davis Optometry navigate the 2008 recession, gists, neuropsychologist, and audiologists. motor dysfunction, visual perceptual-motor and when revenues from conventional eye exams and visual-spatial dysfunction. eyeglass and contact lens sales declined. Susan Daniel, OD Dr. Daniel often works alongside and in coordi- “The revenue generated from a two-hour reha- Daniel & Davis Optometry nation with occupational therapists, physical ther- bilitation consultation is more than four primary- Carlsbad, California apists and other rehabilitation medicine special- care eye exams,” she explained. “These patients Susan Daniel, OD, started specializing in neuro- ists on visual rehabilitation. She frequently uses are looking for care not provided by many other optometric rehabilitation 18 years ago for very lenses, tints, selective occlusion, compensatory eyecare professionals. They want their visual prob- personal reasons. Today, she is the president of prism, yoked prism and vision therapy to help lems solved and they’ll pay for that. But, of course, Neuro-Optometric Rehabilitation Association Inter- these patients perform day-to-day tasks, improve it’s more than that. You can make such a difference national (NORA), a society of rehabilitation pro- their posture, ability to walk, depth perception in the lives of your patients with neuro-optometric fessionals dedicated to providing patients with and visual comfort. rehabilitation. It’s very gratifying.” stroke, brain injury and other neurological condi- It’s a direction for her career that she would never —Brian Dunleavy

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SPORTS VISION Taking Sports Vision to the Major League Level

ports vision optometry has been de- enthusiasts, such as Acuvue Oasys with Transitions. fined as the practice of examining an During exams, he performs dynamic vision testing individual patient’s visual system and with systems like RightEye, Neurotracker, Senaptec S and Binovi, and “trains” athletic patients using ensuring that it is maximized for performance technologies like VIMA or Senaptec Strobe Training in the athletic arena. This includes, but is not glasses, EQ Trainer, and Vizualedge. limited to, advising athletes on the most ap- In addition, Dr. Smithson treats vision issues propriate method of refractive correction for related to post-concussion syndrome—a major is- the sport(s) they play, discussing ocular health sue in all levels of sports these days—like double and safety and measuring ocular strengths vision or blurred vision. He and his colleagues at the practice have also created sportsvisionpros.com and weaknesses in the context of the sports and performancevision.academy to educate ECPs, they play (such as visual reaction time). allied health professional partners and others—in- A sports vision screening typically includes cluding athletic trainers, coaches, parents and the evaluation of visual acuity, ocular alignment, athletes themselves—on sports vision testing and eye teaming and depth perception, peripheral vision solutions. Keith Smithson, OD, celebrates in the locker room awareness, eye movements, motivation, and These services have brought additional patients following a recent victory by the Washington Nation- into his practice, and the specialty serves as a key visualization, with particular focus on the vi- als in the Major League Baseball playoffs. driver of patient volume and practice revenue. Hav- sual demands of the athlete’s chosen sport(s), ing the relationship with the local sports teams cer- such as the need to aim for a specific target Clearly, when it comes to sports in the nation’s tainly helps from a marketing perspective as well, or the performance of near and/or far tasks. capital, he has all the bases covered, so to speak. and adds to his credibility as a sports vision spe- “I would say an overwhelming amount of my prac- cialist. However, Dr. Smithson is quick to emphasize Keith Smithson, OD tice is in some way related to my affiliation with that the most important aspect of his sports vision Northern Virginia Doctors of Optometry sports,” said Dr. Smithson, a lifelong athlete who practice is the impact it has had on the care he Washington, D.C. decided to explore sports vision as soon as he provides all of the patients he sees. Sports vision is hardly a new specialty in the graduated from the Pennsylvania College of Optom- “I shy away from calling sports vision a specialty practice of optometry. However, Keith Smithson, etry in 2000. “I saw [the specialty] as a way to in- because I truly believe all of my colleagues can do OD, a partner at Northern Virginia Doctors of Op- tegrate two things I loved: optometry and sports.” most of what I do every day with just a little bit more tometry (NVDO), a five-location practice in the Indeed, in his day-to-day practice at NVDO, Dr. time and attention to the needs of athletes, without Washington, D.C. area, has taken it to the Major Smithson passes along the expertise he has gleaned any additional investment,” said the former chair of League level. Literally. working with the pros to athletes of all ages who the American Optometric Association’s Sports and Dr. Smithson is the director of Visual Perfor- are seeking an “extra edge” in performance through Performance Vision Committee. “Many sport vision mance for Major League Baseball’s Washington vision enhancement. He also conducts visual and concepts, such as peripheral awareness, visual re- Nationals and the team optometrist for the NBA’s perceptual testing for children experiencing diffi- action time, eye tracking, contrast sensitivity and Washington Wizards, the WNBA’s Washington culty in school, and for adults with computer vision depth perception are also relevant when driving, Mystics, the NWSL’s Washington Spirit, NFL’s eye strain or focusing problems. multi-tasking at work and simply performing at our Washington Redskins and D.C. United of MLS. He The products he dispenses include sport-safe peak in a visually demanding world.” also serves as sports vision consultant for the and sport-active frames and contact lens options NHL’s Washington Capitals. with features and benefits geared toward athletic —Brian Dunleavy

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SENIOR CARE Serving Needs of Older Patients May Be the Key to a Successful Practice

enior vision optometrists typically patient interaction and a more profitable one, too. And the ability to bill a patient’s medical insurance specialize in the diagnosis and man- for the necessary diagnostic testing provides us the agement of vision loss associated S ability to provide full scope of services and gain with ocular diseases that often impact the some added financial benefit to the practice.” eye health and vision of patients 65 years Because dry eye is more prevalent among older of age and older. These include those diag- adults, for example, its diagnosis and treatment nosed with age-related macular degenera- have become an important growth area for Marcia- tion (ARMD), cataracts, diabetic retinopathy, no Family Optometric. The office is equipped with retinal photography, OCT and computerized dry eye glaucoma, retinal detachment and dry eye. technologies to “provide whatever services our se- In some states, optometrists may be nior patients need,” Dr. Marciano noted. actively involved in managing the care of And, as a referral center for many corneal special- patients with these conditions. However, in Dr. Mark Marciano examines a senior patient at his ists in their local area, the practice has also been West Palm Beach, Florida practice, where medical increasingly involved in dispensing scleral contact others, their role may be limited to address- eyecare, including emergency and senior services is ing the vision needs of these patients, pre- an important component. lenses for those with corneal diseases, such as keratoconus and pellucid marginal degeneration or scribing eyeglasses with special tints and/or penetrating keratoplasty resulting from past refrac- prisms to help them compensate for vision ed in the popular retirement locale of West Palm tive surgery, such as LASIK, PRK and RK. loss and/or dispensing low-vision aids such Beach, Fla., serving older patients has become key “There are not too many optometrists who have as magnifiers. to the practice’s success. According to Mark T. Mar- taken the time to learn the nuances of fitting spe- ciano, OD, approximately 35 percent of the patients cialty contact lenses,” explained Dr. Marciano, who Mark T. Marciano, OD seen by the practice come for “medical eyecare,” also serves as mayor of nearby Palm Beach Gar- Marciano Family Optometric including emergency and senior services. dens, Fla. “Becoming an expert in these lens op- West Palm Beach, Florida “Virtually all senior patients that we see want tions has positioned our office as the local ‘go-to’ The American Optometric Association (AOA) recom- to maintain an active, happy and healthy lifestyle, clinic for patients with special needs.” mends annual eye exams for everyone 60 years of and their vision and ocular comfort is a big part of The practice is looking to attract another col- age or older. That’s significant, given that, based that,” noted Dr. Marciano, who owns the practice league to specialize in the dispensing of low vi- on U.S. Census data, this age group is expected with his wife, Brandee Owens Marciano, OD. “Pa- sion devices for patients with AMD and glaucoma. to make up 21 percent of the total population by tients who are a bit older, with more complex visual “There is such a need for low vision services and 2030, up from 15 percent currently. and ocular needs aren’t looking for the cheapest many of our colleagues are not trained to offer vi- From an eyecare perspective, the AOA notes, price or the quickest service. This demographic sion devices for these patients,” Dr. Marciano ex- older patients are likely to present with significant wants to be treated with respect and given the ad- plained. visual-health needs, due to high-myopia and/or equate amount of time to discuss their problems “Low vision devices can greatly improve the in- presbyopia or the presence of ocular diseases such and are looking to have their providers spend a few dependence of our patients, which can truly help as age-related macular degeneration (AMD), cata- extra minutes listening and providing sound medi- people. It can also provide another method of racts, diabetic retinopathy, dry eye or glaucoma. cal advice that can solve these problems. subspecialty which most practices don’t engage in. Many of their vision problems can be traced to “This demographic is often in a better financial This can increase patient referrals and offer another other health issues associated with aging. position to pay for services that can improve their profit center.” For Marciano Family Optometric, which is locat- lifestyle, which ultimately creates a more rewarding —Brian Dunleavy

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DRY EYE A Dry Eye Specialty Can Reap Rewards for ECPs

ptometrists who specialize in dry “gatekeepers” for families as the eye focus on the management of primary decision-makers with re- O the symptoms associated with one gard to doctor choice. Furthermore, dry eye sufferers of the most common ocular diseases—that are often frustrated with the con- is, the inability to produce sufficient tears dition and its symptoms. Studies to maintain proper lubrication of the eye. have noted high rates of depres- As a condition, dry eye may be caused by sion and anxiety* among these allergies, contact lens wear or the pres- patients, many of whom “think nothing can be done about it,” ence of ocular diseases, including diabetic Dr. Whitney Hauser says practices need to be “all noted Dr. Hauser, who serves retinopathy. in” when testing dry eye patients. as Dry Eye Clinical Development Since the advent of the Dry Eye Work- “There’s a lot of ways you can approach the consultant at the Eye Specialty Group, an ophthal- shop, which published the second revision practice of optometry and be successful,” she mic surgery center in Memphis, and as director of of its guidelines in 2017, numerous stud- said. “However, even in a general eyecare practice Clinical Affairs for Keplr Vision, which operates 80 ies on the appropriate assessment and that is focused on primary care, there’s still an op- eyecare clinics across 19 states. (At Keplr, she is management of dry eye have changed the portunity to carve out a little something different in the process of crafting a “dry eye protocol” for scope of practice for those who specialize from the guy down the street. To be successful the company’s network of doctors.) So, optometrists who can successfully treat the condition in the discipline. at a specialty, though, you need to ask yourself three questions: What do you want to do? What and its symptoms have an opportunity to build a Artificial tears are perhaps the most are you good at? And, what’s the need in your long-term doctor-patient relationship—one that is well-known dry eye treatment, but op- community? If you can find something that inter- likely to boost bottom line results through ongo- tometrists may also prescribe nutritional sects all three, that’s your pot of gold.” ing dry eye services as well as future eyeglass and supplements that help encourage tear de- For many, dry eye may just be the prize at the contact lens sales. velopment and advise patients on vision- end of the rainbow. A study published in 2017 To be successful, though, Dr. Hauser emphasiz- correction solutions that may further im- in the American Journal of Ophthalmology esti- es that practices considering a dry specialty need mates that more than 16 million American adults to be all-in—and that means doing the “internal prove their condition. have the condition, but experts like Dr. Hauser marketing” (educating staff on the condition and feel that, if anything, the number is actually far setting the parameters for how the practice will Whitney Hauser, OD greater, given that it often goes undiagnosed. treat it) before investing resources in any new Eye Specialty Group And, the prevalence is only likely to increase due equipment or products. Memphis, Tennessee to the ageing of the American population as well Once the practice is committed, The Dry Eye Although Whitney Hauser, OD, started her ca- as increases in contact lens wear and the use of Workshop Report can provide a roadmap for set- reer in eyecare working in an ophthalmology digital devices (dry eye is just one facet of so- ting up the diagnostics and providing guidance practice, she believes treatment of dry eye be- called “digital eye strain”), among other factors. on the most effective treatment options, she said. longs within the domain of optometry. That’s According to Dr. Hauser, dry eye is the ideal Dr. Hauser is also founder of Signal Ophthalmic why she has made the condition the focus of practice builder because women between 40 Consulting and DryEyeCoach.com, both of which her work, both as a practitioner and as a con- and 60 years of age are at increased risk for the are focused on helping ECPs set up a dry eye sultant to colleagues interested in establishing condition. This is significant, as research - sug specialty. a dry eye specialty. gests these individuals often serve as health care —Brian Dunleavy

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MYOPIA Specializing in Myopia Is a Big Commitment for ECPs

yopia refers to blurry eyesight caused International Myo- myopia for a better visual outcome for the child. by nearsightedness, or the inability pia Institute. The Still, according to Gary Gerber, OD, a co-founder M of the eye to focus on objects at a institute cited a and chief myopia eradication officer at Treehouse particular distance away. High myopia refers to recent study that Eyes, said that while treating myopia will become nearsightedness of a higher degree than aver- estimated, on aver- increasingly important across eyecare “bringing any age, 30 percent of specialized service into a primary care practice isn’t age, usually above -6.00 diopters (worse than the world is cur- for everyone.” 20/400 uncorrected vision). As much myopia is rently myopic, and He added, “After the obvious requirements of in- progressive in nature, there is always concern by 2050, almost creasing the requisite specialized clinical skills and in myopic patients that their condition will lead 50 percent will be training, added costs of necessary technology, staff- to higher and higher powers of myopia, hence myopic. That’s a ing, [among others], the most important factor to “high” myopia. Gary Gerber, OD. staggering 5 billion consider is the willingness to commit and be pre- pared to deal with the challenges of the specialty Peer reviewed research suggests which meth- people, the institute noted. affecting a doctor’s core practice. ods have the best chance of stabilizing chang- Indeed, a recent Sydney Myopia Study found “For example, virtually every area of specializa- ing vision due to progressive myopia. Overall, 31 percent of 17-year-olds were myopic, double tion requires more time than a typical primary care Orthokeratology (ortho k) has been shown to the prevalence reported by the Blue Mountain Eye visit. Not properly addressing this in advance can have the greatest effect. Orthokeratology is Study more than a decade ago. But in the future, cause your primary care practice to suffer. Not al- one of a class of therapies known as vision even nations which have little myopia today, will be locating enough resources to staff training and shaping treatments. OrthoK involves wearing severely affected, according to the institute. specialized systems is another [issue to] watch out. While the hot spots of myopia are East and All of this said, practices willing to go ‘all in’ with orthokeratology lenses (ortho k lenses) during Southeast Asia (where a few countries have a myo- whatever specialty they choose, are more likely to sleep, which gently reshape the surface of the pia prevalence rate of 80 percent to 90 percent). succeed vs. those who dabble.” cornea of the eye. Upon removal in the morn- Yet, myopia prevalence is growing worldwide, and Dr. Gerber also noted that the Treehouse Eyes ing, clear vision is achieved which often lasts the U.S. has reported a prevalence of 42 percent, program allows doctors to bring myopia manage- the entire day into the evening. Options such which is almost double the prevalence 30 years ment into their practices with a proven system that as OrthoK, cornea refractive therapy including ago, according to the institute. addresses these challenges. “Doctors working with us report the program has allowed them to bring paragon crt (vision shaping treatment) are par- The potential consequences of this myopia trend are severe. Uncorrected refractive error (URE) will a comprehensive myopia management program— ticularly helpful when seeking to improve eye- increase substantially, cataract and glaucoma-frac- clinical excellence through social media strategy sight in children, and reduce change in vision, tion attributable to myopia likely to increase, blind- and everything in between—in a more efficient, specifically myopia in children. ness and vision impairment due to myopic macular cost effective and highly profitable way than if they degeneration (MMD) and myopia retinopathy in attempted to do it themselves,” he said. Gary Gerber, OD adults will increase substantially. “In fact, many of our doctors report previous at- Treehouse Eyes Research from the Brien Holden Vision Institute tempts to launch a program themselves and realiz- Bethesda, Maryland and its collaborators show that there are better ing early on, ‘This is way more work than I thought It’s becoming increasingly clear, as shown by ways to manage the onset and progression of myo- it’d be. There’s got to be a better way.’ Treehouse mounting medical evidence, that myopia rates pia. Clinical trials involving children with myopia Eyes is the solution for those doctors.” are expanding around the world, according to The show it is feasible to diminish the progression of —Mark Tosh

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LOW VISION The Growing Opportunity for Low Vision Optometry

he American Foundation for the said Dr. Wolynski. He employs advanced devic- Blind offers two definitions of low es such as Orcam, a compact, computer-pow- T vision. The first is related to visual ered device that clips onto the patient’s glasses acuity: Low vision is a condition caused and can read text and recognize images and the by eye disease, in which visual acuity Ocutech Falcon, an autofocus telescope. is 20/70 or poorer in the better-seeing Because in-office consultations with patients eye and cannot be corrected or improved can be time consuming, some optometrists refer with regular eyeglasses. (Scheiman, to the field as “slow vision.” But Dr. Wolynski Scheiman, and Whittaker) believes that is a misperception. “I might spend The second is a functional definition: an hour-and-a-half with a patient, but they’re Low vision is uncorrectable vision loss paying for my time,” he contended. “You can that interferes with daily activities. It is bill it through medical insurance through time better defined in terms of function, rath - codes, although I don’t take any medical plans, er than [numerical] test results. (Massof Dr. Wolynski says new technologies have put low I just take straight payment. And patients buy and Lidoff). vision “on the fast track.” something, whether it’s magnifying device or a Optometrists who specialize in treat- pair of glasses. ing low vision patients can offer a wide putting together a fitting set including various For instance, a lot of patients come in wear- range of solutions, depending upon the magnifiers and other technologies. Next, he ing progressives. Why are they wearing progres- degree of vision loss experienced, includ- put the word out to local ophthalmologists sives, which inherently have some distortion? ing many new technologies. And with the that he was looking for low vision patients. They should be wearing bifocals or single vi- number of low vision patients growing They began referring patients, and soon op - sion. So right away, we’re helping somebody. exponentially as a result of the aging tometrists in the area did, too. Then there are certain filters and sunglass lens- population, the need for optometrists One reason for these doctor-to-doctor refer- es the might need. It adds up.” who specialize in low vision is greater rals is that some patients, upon learning they Word-of-mouth referrals contribute signifi- than ever before. have a potentially blinding eye condition, are cantly to the growth Dr. Wolynski’s low vision wary at first of going to an established clinic practice. “My patients, even the ones who Bryan Wolynski, OD known for treating blind and low vision pa- aren’t visually impaired, look at it like your Owner, Glasses On First tients. “People don’t like to hear they’re going helping in the community. Often they’ll say, I New York City blind. That’s why some doctors under-refer to have a grandmother, aunt or brother who could Dr. Bryan Wolynski was in private practice for us,” Dr. Wolynski said. “Patients feel more com- use your help.” about 10 years before he began to consider fortable coming here.” Starting a low vision practice doesn’t require developing a specialty in low vision. “I was Dr. Wolynski smooths the way with a pre- a substantial investment, said Dr. Wolynski. doing routine optometry, including contact liminary phone call, and presents patients with “You begin by just talking with patients and lenses, and I thought, there’s got to be more an information packet when they arrive, which having a few magnifiers and other devices on to this.” lets them know what to expect from low vision hand,” he advised. “It doesn’t take much mon- After an initial involvement with Florida’s treatment, including the cost of assistive de- ey to put together a little kit with magnifiers Miami Lighthouse, he started building a low vices they may require. or devices. Any optometrist can do basic low vision practice within his New York City lo - “Low vision is really on the fast track these vision.” cation, Glasses on First. The first step was days, especially when it comes to technology,” —Andrew Karp

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38 Specialized Optometry

CONTACT LENSES Contact Lens Segment of Eyecare Is Often an Untapped Revenue Stream

ccording to the FDA’s website, contact Farr West, Utah, his two-doctor, 15-support staff because our contact lens patients are more com- lenses are a primary choice for many practice “loves fitting contact lenses.” He added, pliant with their annual exams,” he added. A people with vision correction needs. “Many patients desire glasses-free options and Contact lenses provide flexibility and conve- contact lenses can offer them Katie Andrews, OD, FAAO nience, and there are many different lenses freedom to pursue their dreams. Campus Eye Center available for a variety of needs and preferences. We find that contact lens pa- Lancaster, Pa. Contact lenses can be used to correct a variety tients understand the health of Contact lenses are also an impor- of vision disorders such as myopia (nearsight- their eyes better than spectacle tant part of the practice at Cam - edness), hyperopia (farsightedness), astigma- lens only patients. pus Eye Center in Lancaster, Pa. tism, and presbyopia (poor focusing with read- “I think this is because of the Katie Andrews, OD, FAAO, said ing material and other near vision tasks). extra emphasis we stress on she sees a large number of pedi - There are two general categories of contact ocular health during the con- atric patients, who are first-time lenses—soft and rigid gas permeable (RGP). All tact lens evaluation process. contact lens wearers. “These pa- contact lenses require a valid prescription. Soft Contact lens patients return to tients are perfect candidates for contact lenses may be easier to adjust to and our clinic for their yearly exams daily disposable lenses due to are more comfortable. Newer soft lens materi- at a more frequent rate. They the high oxygen permeability of als include silicone-hydrogels to provide more typically purchase more from us the lenses and ease of use,” she oxygen to the eye. Rigid gas permeable contact and seem to be more loyal.” Katie Andrews, OD, FAAO. explained. “Many of my patients lenses (RGPs) are more durable and resistant to Dr. Whipple also noted this have high prescriptions and/or deposit buildup, and generally give a clearer, his office tries to keep things simple -for con resolved refractive amblyopia, so the contact crisper vision. tact lens patients. “We recognize that they want lens fitting can be a life changing experience convenience and a good price. We offer both of for children with high refractive error.” Ian Whipple, OD those by, first, pricing our lenses competitively Her practice also has a “specialized aspect” Vision Source of Farr West and, secondly, we do the shop- within the contact lens segment because she Farr West, Utah ping for them. That is, we give has “numerous aphakic patients that I have The opportunity to expand the every patient a custom contact been fitting since they were a few months contact lens segment of eyecare lens quote that shows their out- old.” often goes unnoticed by ECPs, of-pocket expenses in a per-box She added, “I find that patient education according to a recent industry price after discounts, rebates, is the best way to keep patients returning for white paper. Research indicated and insurance savings.” their annual contact lens checks and purchas - that only 30 percent of eyecare Farr West has been utilizing ing lenses directly from the practice. Our of - practitioners proactively rec- CLX for ordering and fulfilling fice also prepares an invoice of the price of ommend contact lenses while subscriptions for about a year, purchasing contact lenses through the prac- 43 percent of vision-corrected which enables the patient to re- tice with the rebates that come directly from patients are open to contact order online directly from its of- the companies versus the price on some of lenses. According to one doctor, fice. The convenience of this ser- the online vendors. By specifically writing this learning that statistic “changed Ian Whipple, OD. vice makes all the difference for out for patients they are often shocked that the way I practice.” some patients, Dr. Whipple said. it is cheaper to purchase lenses through the But there are exceptions, of course. Accord- “We really stress eye health during our exams practice than [via other options].” ing to Ian Whipple, OD. of Vision Source of and it seems that the message is getting through —Mark Tosh

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health awareness program of its Optometry Cares refer. In fact, after she opened her Glasses Menag- PEDIATRIC Foundation to build knowledge on the topic and erie practice cold, some 28 years ago, it was Dr. help parents find practitioners. The AOA’s recently Chous’ willingness to speak to local ophthalmolo- Helping The Youngest Patients issued evidence-based clinical practice guideline is gists, pediatricians, school nurses, teachers and See Clearly and Look Good another important resource, Comprehensive Pediat- others to start to build awareness and develop ric Eye and Vision Examination. her own specialty. As she learned about vision aking care of children’s vision needs is therapy, the proper billing and coding and how to a specialty area is taking on new mean- Linda Chous, OD handle little ones of all ages for examinations and T ing in 2020, as awareness of the connec- The Glasses Menagerie, Minneapolis, Minn. treatment, her visibility and activities in her state tion between vision and learning starts to only Dr. Linda Chous, and nationally grew. Dr. Chous is a past president gradually build among parents and just as new a graduate of the of the Minnesota Optometric Association and has research about myopia comes onstream. A child’s Southern California served on the American Optometric Association eyes go through rapid changes, especially in the College of Optom- (AOA) clinical practice guideline evidenced based first six years of life. But fewer than 15 percent etry, first remem- optometry and health promotions committees. of preschool children receive an eye exam by a bers hearing a She is a published author and recently received professional, according to the Centers for Disease young child tell her the Women in Optometry Theia Award for Inno- Control and Prevention. And while vision screen- mother, when she vation and the AOA President’s Award, among ings have become ubiquitous in schools across learned she need- other recognitions. Dr. Chous has provided vision the country, they aren’t enough. School vision ed to wear glasses, care services to St. Paul area school districts for screenings miss up to 75 percent of children with that she wanted Linda Chous, OD screening developmentally disabled children. She vision problems. And 61 percent of the children red ones and was was also a consultant to the Sight and Hearing found to have eye problems through screenings quite upset to hear that the practice didn’t have Association and the Minnesota Department of never visit the doctor or get help. any of those. “I also remember instinctively want- Health and Human Services. In addition to run- The American Optometric Association (AOA) ing to help that little girl and others like her to ning her own practice, she works on committees recommends scheduling a baby’s first eye exam feel more comfortable and have access to the for the American Optometric Association and Na- around six months of age. The group established best choices.” She also recalls knowing of a lim- tional Association of Vision Care Plans. InfantSEE (https://www.infantsee.org/) as a public ited number of colleagues to consult with and —Marge Axelrad

AESTHETICS Optometrists sometimes tie aesthetics services the issue? In my opinion, it’s impossible to separate into those that they already provide, such as for specializing in dry eye care from also specializing in Addressing Wellness Treatments, dry eye. Dr. Jennifer Lyerly, Triangle Visions Optom- ocular aesthetics.” etry, shared in a recent Review of Optometric Busi- She notes the importance of education in this Cosmetics and The Eye ness article, “The key to elevating ocular aesthet- nascent but growing specialty. “If you want to jump- ics as a true specialty to put beside dry eye or start learning more about the most common ocular esthetics optometry, which offers cosmetic glaucoma care is to treat it as a science. The way surface irritants in cosmetic products, check out improvements and wellness treatments to we practice ocular aesthetics overlaps very much Vampires on the Vanity by ophthalmologist, Laura A the eye area, is a relatively newer specialty with our dry eye specialty. When we are treating Periman, MD, and become a member of the col- area, but one being embraced by many as a practice dry eye, addressing the cosmetic products and laborative OD/MD community on the Ocular Surface enhancement to provide patients with additional ser- procedures our patients use, and the side effects Facebook forum OSDocs. In addition, Advanced vice. Men and women both are seeking treatments to they may cause, is an essential foundation build- Ocular Care has done an excellent job featuring ar- improve the appearance of their eyes and eyelid skin. ing block to their dry eye treatment.” ticles from the leading ocular aesthetic and anti-ag- And patients increasingly expect their eye doctors to Dr. Lyerly points out, “If I treat their dry eye, ing eyecare specialists around the country. Bridgitte be experts about anything having to do with their but ignore the ocular surface offenders they are Shen Lee, OD, Leslie O’Dell, OD, and Whitney Haus- eyes and the skin surrounding their eyes. using on a regular basis, am I really fully treating er, OD, are optometrist-thought leaders in the field.” —Marge Axelrad

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