Optometric Obstacles, Meet
Dr. Braverman
Jeffrey S. Eisenberg
Senior Editor
Former first lady Rosalynn Carter once said: “A leader takes people
where they want to go. A great leader takes people where they don’t necessarily
want to go, but ought to be.”
Optometrist Howard Braverman faces such a challenge as he becomes president
of the AOA at its 103rd annual Congress. Dr. Braverman assumes office as
the optometric community debates board certification for O.D.s, something
he believes is essential if optometry is to be “an equal player in today’s
health-care arena.”
That’s just one of the major challenges he plans to address in his term.
Dr. Braverman believes optometry faces many others, most notably managed
care and the disparate scope of practice laws among different states.
However, the Hallendale, Fla., O.D. also points out that he’s not one
to run from a challenge. During his career he’s gone from solo practitioner
to assume numerous leadership positions. As incoming AOA president, he
plans to adopt the theme “Accepting Challenges, Making a Difference.”
“I’ve accepted challenges, optometry has accepted challenges,” he says.
“Everything we do is trying to make a difference for the patients we serve
every day.”
The three biggest challenges he sees ahead:
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Certification and re-credentialing. While many debate the wisdom
of having an American Board of Optometric Practice, better known as ABOP,
Dr. Braverman believes in the merits of board certification (see “Point
Counterpoint: Does Optometry Need ABOP?”). Dr. Braverman believes patients,
third-party payers and even legislators expect optometrists to undergo
this ongoing competency testing.
This year’s House of Delegates will vote on whether to reaffirm last
year’s resolution that established ABOP and debate the merits of board
certification. Also, Dr. Braverman hopes to launch an education program
so that O.D.s become more familiar with ABOP.
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Managed care. “I think managed care is the biggest challenge, not
only to optometry but to all health-care professionals,” Dr. Braverman
says. “But I also believe that managed care represents the biggest opportunity
for optometry, because optometry is now in an arena where we are the primary
eye care providers.”
Three years ago the AOA started a managed-care initiative to educate
providers and plans about O.D.s’ role as primary eye care providers. “We
are becoming more successful by working with the managed-care decision-makers,
employers, unions and self-insured plans to make them become aware of the
importance of optometry in this arena,” Dr. Braverman says.
The AOA also was able to get provider non-discrimination language inserted
into the House and Senate versions of managed-care reform legislation.
Dr. Braverman says he wants to make sure that language stays in whatever
bill ultimately passes.
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Uniform scope of practice laws. The AOA must continue working toward
achieving common scope of practice laws between states, and even providing
model legislation, Dr. Braverman says. “An optometry student who graduates
today should not have to practice different optometry depending on the
state where he’s going to practice.”
During his presidency, Dr. Braverman also hopes to encourage continued
support from the ophthalmic industry for such AOA programs as the Practice
Management University, and offer leadership training programs to state
associations.
Along the way, he’ll need to overcome several challenges to get the
optometric profession to where he believes it ought to be.
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Photodynamic Therapy Hits
Limelight
John Murphy
Senior Editor
Since Visudyne (verteporfin) therapy received FDA approval, patients
with macular degeneration have been clamoring for treatment. “Everybody
wants it. The phone has been ringing off the hook,” says Elizabeth Schnipper,
O.D., of Vitreous-Retina-Macula Consultants of New York, one of the centers
involved in the landmark study for photodynamic therapy (PDT).
Dr. Schnipper, who screened patients for the study, says the treatment
has given hope to many macular degeneration patients. She cautions that
optometrists should inform patients about what the procedure can and cannot
do: PDT should halt worsening vision, but it won’t restore lost vision.
Optometrists should certainly learn more about PDT so they can recommend
it as a treatment option, Dr. Schnipper says.
Photodynamic therapy involves a combination of drug and laser treatment.
The drug is injected into the patient’s arm and localizes at the choroidal
neovasculature (CNV). The surgeon uses a laser light to activate the drug,
which destroys the leaking vessels. After the initial treatment, patients
usually require three or four retreatments at 3-month intervals. Patients
must avoid intense light for 48 hours or risk skin damage.
Data for Visudyne and other emerging photodynamic therapies were presented
at the Association for Research in Vision and Ophthalmology (ARVO) annual
conference. Here are some highlights:
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Visudyne (CIBA Vision and QLT PhotoTherapeutics). Compared with
placebo, twice as many patients with predominantly classic CNV lost fewer
than three lines of vision. Investigational studies for treatment of histoplasmosis
and of CNV due to pathologic myopia showed promising results.
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PhotoPoint (Miravant Medical Technologies and Pharmacia Corporation).
Phase III trials of the drug SnET2 (tin ethyl etiopurpurin) have begun.
Phase II trials showed improved acuity in some patients, however the SnET2
studies have recruited patients with better visual acuity and smaller lesions
than the Visudyne study.
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Optrin (Pharmacyclics and Alcon). The phase II study is in gear
to determine the proper dosage of Optrin (motexafin lutetium, also called
Lu-Tex). Preliminary results suggest that the drug provides better pinpointing
of diseased tissue. Pharmacyclics expects phase III trials to begin next
year.
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O.D.s No Longer Sweating Cost-Cutting
Measures
Jessica L. Hogan
Associate Editor
A good economy can blunt the effects of managed care. Three out of
four optometrists don’t sense an urgent need to control costs, and almost
that many—two out of three—say their expenses are minimal or average, our
National Panel, Doctors of Optometry survey reports.
When there is a need to trim expenses, the 104 doctors who responded
still look to themselves first by cutting back their own raises. However,
they’re not doing it as often. The latest survey shows 45% of O.D.s have
done this in the past year, down from the 51% who said that in 1998.
Next favorite way of cutting costs: 41% say they’ve put off capital
investments. That’s down from 1998, when half of respondents said they
held off on this. O.D.s are getting more comfortable slashing marketing
budgets, though; 37% say they’ve cut here vs. 33% in 1998.
In their search for lower costs, O.D.s aren’t turning to e-commerce.
Only 6% of our respondents say they’ve ordered supplies online to control
expenses. Lorie Lippiatt, O.D., of Salem, Ohio, inventories the benefits:
“fast service, less time-consuming for staff.” Others have dealt with slow
delivery and lost packages.
Among expenses, there’s been some reshuffling for the better. This year’s
respondents say that 30.5% of gross goes to their own salary vs. 27% in
1998. It might be coming out of lower costs for optical materials. This
year, optical materials account for 25.5% of gross vs. 29% in 1998.
Staff is taking more home, too. Panelists say salaries account for 18%
of gross vs. 16% 2 years ago. That’s a concern for O.D.s like James Bradley
of Oceanside, Calif. “I can never pay my people what they deserve,” he
says. (See “Staff Raises May be Paying off for O.D.s.”)
Panelists offer these creative cost-cutting ideas:
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Pull Yellow Pages ads and count on referrals from “happy patients.”
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Over-book schedules to counter “no-shows.”
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Drive your 8-year-old Chevy Blazer.
It all comes to down to the words of one doctor, who has this response
when asked which is his most troublesome expense: “I couldn’t pick one.
If you’ve got money, none of them are troublesome. If you don’t, all of
them are.”
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In the News
Eschenbach Optik of America will market and distribute low vision
devices designed by Telesensory Corporation. The two companies have formed
a strategic partnership.
AOA President Harvey Hanlen, O.D., received the first Jake Rosner
Award for Excellence in Ophthalmic Education at EyeQuest 2000 in Chicago.
The award recognizes Dr. Hanlen for the AOA’s Practice Management University.
Neil Gailmard, O.D., accepted the award on Dr. Hanlen’s behalf. Dr. Rosner
was an optometrist who started the EyeQuest conference.
The FDA approved Summit Technology’s LADARVision system for LASIK
treating myopia up to -9.00D, with up to -3.00D of astigmatism. The FDA
also OK’d the VISX Star laser for treating hyperopic astigmatism.
The ClearVision Laser Center in Lakewood Center, Colo., is the first
commercial center to house the Bausch & Lomb Technolas 217 excimer
laser since the FDA approved it. The laser uses true scanning, flying spot
technology.
Intranasal corticosteroids, prescription nasal sprays commonly used
to treat hay fever, do not increase the risk for developing cataracts,
according to a study by U.S. and British researchers in the May Journal
of Allergy and Clinical Immunology. Oral corticosteroids, however,
are associated with an increased risk of cataracts.
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