September 2000 News Review

Kentucky Kids Must Get Eye Exams

1. Get new school shoes.
2. Get hair cut.
3. Pack schoolbag.
4. Go to eye doctor.

“This means that many of the children who would be starting school with an unidentified vision problem will now have that diagnosed and corrected,” says Darlene Eakin, executive director of the Kentucky Optometric Association. “So that when they do start school they will be able to maximize their ability to learn to read, and any other skills that are dependent on good vision.”

Up to 13% of children, ages 0-5, have some type of vision condition, the KOA reports. This increases to 25% after age 5. Even so, only about 14% of American children receive an eye exam, Ms. Eakin says.

Kentucky’s mandatory eye exam (not just a screening) is the first of its kind in the nation. What’s more, it’s part of a larger piece of legislation that stipulates a number of proactive measures for early childhood development, including hearing testing, immunizations, and providing folic acid for women of child-bearing age, among others.

The Kentucky Optometric Foundation, a charitable arm of the KOA, launched a major media campaign to inform parents of the new law. To ensure that eye doctors’ offices don’t become barraged with children and frantic parents, proof of the eye exam isn’t due to schools until January 1, 2001. Plus, parents have several avenues of help available if they can’t afford the exam.

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New Ophthalmic Drug Approvals

Santen Pharmaceuticals’ Quixin (levofloxacin 0.5%) is a topical fluorquinolone antibacterial drop indicated for the treatment of bacterial conjunctivitis. The course of therapy indicated by the FDA is 7 days, although the company has data (in the product insert) that shows effectiveness in 5 days. Dosage is 1-2 drops every two hours for the first two days, then every four hours for the third to seventh days. 

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LTK May Provide Hope for Hyperopes

The Sunrise Hyperion LTK (laser thermal keratoplasty) System is indicated for temporary reduction of +0.75 to +2.50D of hyperopia (with cylinder less than or equal to ±0.75D). Patients should be 40 or older with documented stability of refraction for the prior 6 months. 

Sunrise says correction with the treatment can diminish over time, but some patients retain some or all of their refractive correction. “Now whether that will be over 1-2 years or up to 5 years, we don’t know. We’ll find out more as we get some long-term data as to that effect,” says Paul Karpecki, O.D., of Hunkeler Eye Centers in Kansas City, Mo., where the Hyperion LTK was in clinical trials.

The system uses a holmium: YAG laser and a patented process to shrink corneal collagen. The laser burns two concentric rings of 8 dots in each on the periphery to heat the collagen and steepen the cornea.

LTK has advantages and disadvantages, says Dr. Karpecki. The advantages: it’s fast (about 2.8 seconds per eye); it can be done at a slit lamp; and it could cost less than LASIK. The main disadvantage is the regression of effect. Others include light sensitivity, a burning sensation in the eyes, and an adjustment period if used for monovision. 

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B&L Earnings Down, President Out

“We are deeply disappointed and frustrated to have to reduce our sales and earnings expectations for the remainder of 2000 and for 2001,” says William M. Carpenter, chairman and CEO. The company chalks it up in part to slow sales of its contact lens products. Within that category, B&L’s new products have been taking away wearers from its existing ones, the company says. B&L also cites external factors: the erosion of pharmaceutical prices and a weakening Euro. 

Salomon Smith Barney analyst Dhulsini de Zoysa takes a skeptical view of B&L’s hopes for substantial growth in its cornerstone business: “We realize that it is too early to call it a TKO, but the likelihood of strong growth acceleration in contact lens sales seems slim to us.”

One worrisome indicator in its surgical division is the company’s lag in shifting its manufacturing from traditional non-foldable intraocular lenses to foldable IOLs, says Travis S. Pascavis, a Morningstar Inc. analyst who also tracks B&L stock. Demand has exceeded the company’s ability to make the foldable IOLs. For both its contact lens business and IOL manufacturing, the industry leader should be better able to predict and adapt for demand, Mr. Pascavis says. 

Also, it’s a “strange time” for the company to oust its chief operating officer and eliminate the position just when it seems the company’s biggest issues are those in operations, he adds. “Bausch & Lomb’s [stock] future is blurry, and investors may want to hold off for now.” 

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COPE Says ‘Nope’ to Non-Doctors Who Teach Courses

That doesn’t mean you won’t be able to get credit for those courses. The individual state boards still have that authority to approve them; it’s just that those instructors can’t use COPE as a clearinghouse for that approval. Anyone without an O.D., Ph.D. or M.D. need not apply.

Non-doctor instructors will have to submit courses for approval to each state board. This could prove problematic for courses on practice management, ophthalmic optics and contact lens pathology that many non-doctors have taught at virtually every optometric conference. COPE says the rule will affect about 160 of its 1,600 registered instructors.

Where did the policy come from? COPE chair Barry Schneider, O.D., says one of the 47 participating state boards already had such a policy. “That said, several states also submitted comments expressing concern over a prevailing commercial influence in much of the CE taught by non-doctoral level instructors, which affected the quality of the CE,” he adds. The Association of Regulatory Boards of Optometry — COPE’s overseer organization — made the change at its annual meeting in June. 

Here’s what others say about the new COPE rule:

• Joseph Bruneni. An optician and assistant professor at Southern California College of Optometry — along with serving the Optical Laboratories Association and Polycarbonate Lens Council as a consultant — Mr. Bruneni has lectured at the AOA’s Practice Management University, and specializes in ophthalmic optics. He agrees that a doctor-level instructor is best for some courses. 

“In other subjects, it’s going to be very difficult to find qualified people,” he says. “In all honesty, now a licensed optometrist can get up and speak about anything he wants. The problem is, that includes subjects in which he’s not qualified.”

• Patrick Caroline, C.O.T. This associate professor at Pacific University College of Optometry and Casey Eye Institute in Portland, Ore., has been a popular lecturer on contact lens pathology at many conferences, the American Academy of Optometry and AOA Contact Lens Section meetings among them. He says forcing non-doctors to go to each individual state board to get their courses approved “is not realistic.” Mr. Caroline says he has contemplated  legal action against COPE because its decision severely affects his ability to earn a living.

• Wayne W. Wood, O.D. The conference co-chair  for Vision Expo International says he hopes COPE will consider some “logical exceptions” to the rule (Dr. Schneider says there will be no waivers, though schools will continue to accredit courses as they have through a separate COPE mechanism).

“Instructors should be approved based upon their knowledge and ability to teach, not their degree,” Dr. Wood says. 

“Personally, I’ve learned an awful lot sitting in courses presented by such internationally recognized contact lens experts as Patrick Caroline and Craig Norman, neither of whom is a doctor. Both are fellows of the American Academy of Optometry, though,” he says. 

Dr. Wood acknowledges he is not speaking on behalf of International Expo.

Vision USA Sets Sights on 2001 Volunteers

The bad news: There weren’t enough O.D.s to see another 3,000 people who qualified. To that end, the AOA hopes to recruit a “few thousand” more volunteers for the Vision USA 2001 program, especially in metropolitan areas, says optometrist Roger Pabst, chairman of the Vision USA committee. 

Some 7,400 O.D.s already participate in Vision USA, providing free eye exams to low-income families who have no health insurance. Participating optometrists volunteer to see up to eight Vision USA patients a year. In the last decade, O.D.s participating in Vision USA provided eye care to some 283,000 people. Nine out of 10 of these patients were diagnosed with a vision or eye health problem. 

This year’s goal is to treat 20,000-22,000 qualified patients. “These days, when we deal with reduced fees from managed care, a lot of us look at bottom lines,” Dr. Pabst says. “But it gives you a good feeling to know that you’ve helped someone. Money can’t pay for that feeling.”

Vision USA also plans to increase its efforts to aid children of low-income families. “Fewer than one in six children under the age of 5 has ever had a comprehensive exam,” says Roger Valine, chairman and CEO of Vision Service Plan Inc., exclusive sponsor of Vision USA. 

If you already participate in Vision USA, you will automatically be included in the 2001 program unless you let Vision USA’s national office know otherwise. 

If you’re interested in signing up (you must be an AOA member), contact Carol Glick, Vision USA National Coordinator, AOA, 243 N. Lindbergh Blvd., St. Louis, MO 63141, or call 1-800-365-2219 ext. 261. Registration deadline is October 2.

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New Medicare Schedule Cuts Optometric Fees

This reflects the Health Care Financing Administration’s proposals to refine resource-based practice expense relative value units, changes to geographic practice cost indices, and resource-based malpractice RVUs, among others. Medicare reimbursements, you’ll recall, are based on physician work, practice expenses and malpractice expenses. 

Under the proposed fee schedules, payments would fall 0.42% for code 92004 (eye exam, new patient), 1% for code 92012 (eye exam, established patient) and 0.62% for code 92014 (eye exam and treatment).

Some other proposals of note:

• No change for code 66984 (cataract removal, IOL insertion).

• Addition of the punctal plug to the supplies for code 68761 (close tear duct opening by plug).

• New codes and RVUs that specifically identify ocular photodynamic therapy, which was approved in April for the treatment of age-related macular degeneration.

• Payments for the 99000 series evaluation and management codes would change as follows: 99204, up 0.36%; 99205, up 0.27%; 99213, up 1.09%; and 99214, up 0.66%. There would be no change for codes 99202, 99203, 99211, 99212 and 99215.

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