NEW IN DIGITAL RETINAL PHOTOGRAPHY P. 14 • RADIATION RETINOPATHY TREATMENT P. 48 EHR IN THE GLAUCOMA PRACTICE P. 60 • VALUE-BASED MEDICARE PAYMENT DEMYSTIFIED P. 20 WILLS EYE RESIDENT CASE SERIES P. 79 • RISC AND REWARD WITH INHIBITORY RNAS P. 56 Review of Ophthalmology Vol. XXII, No. 8 • August 2015 • Retinal Imaging • Next-Gen AMD Drugs • Radiation Retinopathy Treatment StrategiesReview of Ophthalmology Vol. XXII, No. 8 • August 2015 Retinal Imaging • Next-Gen AMD Drugs Treatment • Radiation Retinopathy August 2015 reviewofophthalmology.com ANNUAL RETINA ISSUE • Retinal Imaging: The State of the Art P. 28 • Your Next AMD Drug P. 38 • Diabetic Retinopathy and Macular Edema P. 44 001_rp0815_fc.indd 1 7/24/15 2:57 PM Imaging With Depth-of-fi eld. Just Dandy. What if none of your slit images or video had blurry edges? You would have a Haag-Streit, of course. Invest in one and submerge yourself into our extreme world of depth of fi eld. Visit haag-streit-usa.com to learn about our entire range of slit lamps and imaging systems. 80O.787.5426 haag-streit-usa.com © 2015 Haag-Streit USA. All Rights Reserved. RO0715_Haag Slit .indd 1 6/26/15 10:42 AM REVIEW NEWS Volume XXII • No. 8 • August 2015 A New Approach to Preserving Photoreceptors After RD Researchers at the Massachusetts Eye nifi cant increase in the immune sys- ence Translational Medicine. and Ear/Harvard Medical School De- tem’s alternative complement path- Today’s state-of-the-art surgical partment of Ophthalmology have tak- way following retinal detachment techniques are highly effective at en a fi rst step in solving the problem and that this pathway facilitated physically reattaching the retina, and of preserving photoreceptor cells and early photoreceptor cell death after if surgery is timely, a positive visual avoiding irreversible vision loss in pa- injury. Injured photoreceptors lose outcome often results. Even so, pa- tients following retinal detachment. important proteins that normally tients often complain of permanent Degeneration of photoreceptors is protect them from complement-me- vision loss accompanied by changes a primary cause of vision loss world- diated cell death, allowing for selec- in color vision. “Studies in both wide. Identifying the underlying tive targeting by the alternative com- humans and animal models have causes surrounding photoreceptor plement pathway. Additionally, by shown that photoreceptor cell death cell death is paramount in order to blocking the alternative complement is induced as early as 12 hours after develop new treatment strategies to pathway, through both genetic and detachment, indicating that early prevent their loss. Retinal detach- pharmacologic means, photorecep- intervention could potentially pre- ment and subsequent degeneration tors were protected from cell death. serve photoreceptors and improve of the retina can lead to progressive “When photoreceptors in a detached the visual function of patients who visual decline due to photoreceptor retina were removed from their pri- undergo reattachment surgery,” says cell death. Since photoreceptors are mary source of oxygen and nutrients, Dr. Connor. “Our research provides non-dividing cells, their loss results we found an increase in complement a new role for complement in retinal in irreversible visual impairment factor B, a key mediator of the al- detachment, and suggests that inhi- even after successful retinal reat- ternative complement pathway that bition of the alternative complement tachment surgery. leads to photoreceptor cell death,” pathway may be good therapeutic New research led by Kip M. Con- says Dr. Connor. “For the fi rst time target to prevent the initial photore- nor, PhD, a researcher and assistant these results provide evidence that ceptor cell loss. professor of ophthalmology at Mass the alternative complement pathway “What makes this research so excit- Eye and Ear, and colleagues analyzed exacerbates photoreceptor cell death ing is the potential impact it can have innate immune system regulators in and that inhibition of the pathway on our patients. Working closely with the eyes of human patients with reti- is protective,” said Kaylee Smith, a our colleagues in the clinic, we identi- nal detachment and correlated their member of the Connor Lab and con- fi ed a challenging issue, went back to fi ndings in an experimental model. tributing author on the manuscript. our laboratories to uncover a cause, They discovered that there was a sig- Their fi ndings were published Sci- and now have knowledge that may help us to develop therapies that will Five Years After EHR Adoption, 41 Percent ROI help to preserve our patients’ vision.” Switching to an EHR in 206 has netted one ophthalmology practice roughly $1.2 million over a fi ve-year period, according to a new report published in July’s Ophthalmology. Ini- tially, the practice’s costs increased due to the hiring of IT staff, software maintenance and NEI Study: scanning paper records. Eventually process changes driven by the EHR led to effi ciencies that lowered the staffi ng needs related to medical records, transcription, billing, check-out and appointment scheduling. The system also acted as a revenue-driver by enabling EHR Microglia and RP meaningful use incentive payments, increasing productivity in the later stages and making Microglia often play a benefi cial role by claims submission faster and more accurate. (For a more extensive look at EHR in ophthal- helping to clear dead cells and cel- mology practice, see p. 60.) lular debris and protect the central August 2015 | reviewofophthalmology.com | 3 0003_rp0815_news.indd03_rp0815_news.indd 3 77/24/15/24/15 22:49:49 PPMM Ophthalmic Product Development Insights Aki Tobaru, Hiro Matsuda, PhD, & Matthew Chapin • Ora Inc., Andover, Mass. REVIEW signifi cant business deal, as a proper initial Tips for Doing Business and Collaborations in Japan meeting is crucial for both parties and n prior columns we have discussed For example, when visiting with a Japanese helps to kick off a successful project. development strategies, fi nancing and company, the fi rst step should be for the The exchange of business cards is Ibusiness issues related to developing main contact persons from both parties considered a formal ritual. In the Japanese culture, offering a business card is quite new products, particularly geared towards to greet each other, and continue with the personal, as it represents the “face” of the the new entrepreneur. Global strategy is exchange of business cards. As a nod to individual. Giving a business card is equiva- another important issue to consider early seniority, the main contact person from the lent to providing someone with a signifi cant in business planning. As Japan is one of host company should introduce the other amount of information about yourself. It is the top markets outside the United States, members of the group, starting with the representative of the individual personally in this installment of Development Insights most senior personnel. During the meeting, the highest ranking person will likely make and professionally, and of the company. we will explore some elements related to During a business card exchange, Japa- Japanese business culture and customs opening remarks, followed by his or her second-in-command, who will then begin nese will present it with both hands, and that may be useful to consider as business prefer to receive business cards the same and development relationships are sought the meeting. While the meeting is proceed- ing, conversation can take place as it plays way, as it is a sign of respect. Additionally, after and formed in Japan. the card should be delivered face-up and There are many opportunities for entre- facing the recipient so he or she may read preneurs and start-up companies to ex- the card, with introduction of name plore global or regional partnerships and title. Finally, be sure to leave with pharmaceutical and biotech the card unmarked—it is companies in Japan, pursue not appropriate to write assets and engage inves- anything on a business tors from within Japan, card in front of the or try to bring products individual. being developed in the One fairly common United States into Japan. mistake by made by Historically there has in foreigners surrounds general been a signifi cant the use of the word lag between drug approvals “san.” Those unfamiliar in the two countries. Today, with Japanese culture may there is more focus on reduc- believe that using san at the ing that time-lag, which may involve end of a fi rst name is very polite engaging with global or regional Japanese and formal. However, san is rarely used in partners early in the process. Japan is a this manner among the Japanese. Among unique country, with a culture different out; however, great care should be taken to avoid interrupting any speakers. In Japan, friends and colleagues in Japan, san is from any other. Here, we will focus on most commonly used at the end of an three key concepts: respect; formality; and this is considered one of the highest forms of disrespect to the speaker, and signals individual’s last name. For those unac- long-term relationships. These customs tie customed to Japanese formalities, the together an underlying theme of respect a lack of listening and understanding by the person who interrupts. Straightforward best way to show formality is to use a title and building trust, moving toward a long- such as doctor, mister or miss until the term relationship that is important for the discussions are appropriate; however, it is recommended that you acknowledge points person indicates that you may use just his entrepreneur/developer who is forging a or her last name; and then it is appropriate new relationship in Japan. made by your Japanese partners before you introduce your ideas. This demonstrates to use the last name with san.