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Four to Join Optometry Hall of Fame Four to Join Optometry Hall of Fame Three will be inducted posthumously: Meredith W.
Morgan, who played a key role in establishing the School of Optometry at the University of California, Berkeley; Charles F. Prentice, considered "the Father of Optometry"; and Charles Sheard, a contemporary of Dr. Prentice and the
first O.D. to publish a list of tests for examining the human eye at both distance and near. Inductions will take place in October at the East-West Conference in Cleveland. Laser Refractive Procedures Have Doubled in the Past Year • Laser Vision Centers' case volume was up 127 percent in May 1999 vs. May 1998. • TLC The Laser Center achieved 153 percent growth, with more than 90,600 procedures in its fiscal year ended May 31, up from
35,800 the previous year. • Vision Twenty-One reports first-quarter 1999 procedures up 213 percent vs. the same period last year.
Overall the ocular technology market is "exploding," according to an investment report by health- care analyst David Gruber, M.D., of U.S. Bancorp Piper Jaffray. For instance, the stock price for refractive laser manufacturer
VISX Inc. rose 295 percent in calendar year 1998. The report also predicts that in 2001, the visual correction market will be worth about $5.6 billion. The overwhelming majority of laser refractive procedures in the United
States are LASIK. Dr. Gruber's report optimistically predicts that LASIK procedures worldwide will increase to 2.1 million in 2001, compared to an estimated 695,000 in 1998. Irving Arons, whose Spectrum Consulting company tracks
the laser refractive market, estimates the numbers of U.S. procedures will more than double this year to 950,000. About 85 percent will be LASIK cases. Mr. Arons says LASIK's "wow" factor—what patients exclaim as they hop off the
operating table often with 20/20 vision—promotes word-of-mouth marketing. That patient tells two friends, they tell two friends, and so on. It's that critical post-op window that's most effective for word-of-mouth marketing,
explains David Harmon, whose Market Scope business also reports on the laser refractive industry. Mr. Harmon illustrates that the patient who goes back to work soon after the LASIK procedure has nothing but good things to say, and
"wows" his or her co-workers and friends. That didn't happen with PRK, he says, and that's why people weren't lining up for the surgery like the industry first predicted. At that time in the mid-90s, people didn't know anyone who
had the procedure done. Now, patients come in and say, "I know umpteen people who've had it," reports Frederic Kremer, M.D., a laser refractive pioneer and the only surgeon with an FDA-approved LASIK laser. Dr. Kremer explains that
since the average patient now knows "a bunch of people" who've had the operation, he or she is comfortable that this is a safe procedure. The boom in the market won't continue forever though, Mr. Harmon predicts. Most of the
recent growth is attributable to new surgeons and new lasers filling out the market, not a tremendous boom at existing and established centers. Growth will continue, he figures, but it will slow down, and will plateau in several
years at about 2.5 million procedures a year.
The Newest Breed of Doctor: Board-Certified Optometrist At the 102nd annual AOA Congress in San Antonio
last month, the House of Delegates waded through four hours of sometimes contentious debate to authorize creation of the board, or "A-bop," as outgoing AOA President and board certification champion John A. McCall Jr., O.D., calls
it. ABOP would be modeled on the American Board of Family Practice, the board-certification body for family practitioners, Dr. McCall told the AOA delegates. Board certification would be voluntary for O.D.s. To become ABOP
certified, you'll need to first pay a sign up fee that covers a 10-year period, and obtain 50 hours of transcript-quality, board-approved continuing education in that time. Enrollments commence in January 2000. As an incentive
to get doctors to sign up in the first year, the sign-up fee will be $300 in 2000 and $400 in 2001 for the 10-year period. The fee after that will be $500 for the 10 years. The next step is for AOA President Harvey P. Hanlen,
O.D., to appoint a board, which will then go to work drafting guidelines for board certification. Dr. Hanlen says the goal is to have guidelines in place by mid-year 2000, and to begin passing out certifications late in the year.
He hopes to see 3,000-4,000 doctors sign up the first year. Board certification aims to provide measures for expertise, education and training, and AOA membership would not be a requirement for certification. Dr. McCall told
the AOA delegates that setting up the board is a proactive response to the demands of insurance plans and hospitals. "This is a shot across the bow," he said. "Managed-care companies understand board certification." Board
certification aims to provide measures for expertise, education and training, Dr. McCall said. And, while he acknowledged board certification creates an "equal bar" that cuts across all 51 sets of optometric laws (the states plus
the District of Columbia), it's not about reciprocity. "Reciprocity has to do with state licensure," Dr. McCall said. "This has nothing to do with state licensure. We wouldn't envision this ever having to do with reciprocity or
licensure." During floor debate, Leslie Walls, O.D., M.D., a board-certified family practitioner, said the intent is not to make optometry like medicine, and that there would be no requirement for O.D.s to complete a residency in
order to get board-certified. Scott Kinetz, O.D., president of the Wisconsin Optometric Association, appealed to delegates who had railed against board certification. He told the assembly that while the burden of gaining
credentials from different optometric organizations can be draining, he supports board certification. "I am sick and tired of tests, I am sick and tired of jumping through hoops, but I'd jump through hoops of fire to better this
profession," he said. Dr. Kinetz will get his chance to jump through those hoops soon enough. Review of Optometry Wins Best Journal Award Other first-place awards, all in the Trade Journal category, went to: • Chairside columnist Montgomery Vickers, O.D., Best Guest Editorial for "A Farewell to Two Best
Friends," September 1998. • Senior Contributing Editor Judith Lee, Best Non-Technical Article, "How M.D.s' Best Practices Can Help You," July 1998. Review of Optometry authors receiving third-place awards are: •
Ron Melton, O.D., and Randall Thomas, O.D., for their guest editorial, "Point Counterpoint: What's the Best Medicine for This Glaucoma Patient?" March 1998. • Senior Editor Jeffrey S. Eisenberg, Best Non-Technical Article for his
article about optometric unions, "The Philadelphia Experiment: What it Means to You," January 1998. • Editor-in-Chief Rich Kirkner, Best Editorial, for "Lasers are OK in Oklahoma," March 1998. Stem Cell Transplants May Offer Hope When Conventional Grafts Don't The researchers performed 73 stem-cell
transplants on 42 patients (some eyes received multiple transplants). Study subjects suffered from chemical or thermal injuries, Stevens-Johnson syndrome or ocular pemphigoid. Almost all were legally blind. In follow-up
evaluations of 43 eyes, 51 percent (22 eyes) had corneal epithelialization. Fifteen of those 22 eyes had completely clear corneas. Also, visual acuity improved by two or more lines in 26 eyes. Stem cells, located in the periphery
of the cornea, are responsible for the growth of new, clear epithelial cells. However some severe ocular surface disorders destroy the limbal epithelium, including the stem cells. Even with corneal transplant, damaged cells move in
from the periphery, turning the new cornea opaque, or causing new vessels to grow into the cornea. As a result, the graft fails. "So, even if you get a 50 percent success rate [with stem cell transplants], you've taken a
group of patients that had virtually no other treatment, and you've given at least improved sight to half of them," says James Zieske, Ph.D., of the Schepens Eye Research Institute in Boston. Dr. Zieske also has researched stem
cell transplants. The study is significant because it included a significant number of patients with a long follow-up period, says C. Stephen Foster, M.D., of Harvard Medical School and Massachusetts Eye and Ear Infirmary. The
average follow-up period was a little over three years. Although promising, Dr. Foster says stem cell transplants are not a panacea. "The majority of patients who can benefit from this are some of ophthalmology's most
complicated patients," he says. These include patients who may have extreme tear deficiency, keratinization of the lid margins and incomplete lid closure. These problems can destroy the transplanted stem cells and must be corrected
before the surgery, a process that can take six months to a year. Also several study subjects developed complications after the stem cell transplants, including persistent epithelial defects (the eyes healed in all but two of
these patients), graft rejection and ocular hypertension. The researchers believe that better control of these complications may increase the efficacy of stem cell transplantation. N Engl J Med. 1999;340:1697-703. Intravenous Uveitis Treatment Holds Promise In a preliminary study, 10 patients with severe noninfectious uveitis were weaned off their steroid-based systemic drugs. Instead, they were given monthly infusions of humanized
anti-IL-2 receptor antibody therapy, dubbed Daclizumab. Over a 12-month period, the treatment controlled uveitis in eight of 10 patients as effectively as standard treatment, but with reduced complications and side effects.
Researchers say that larger, multicenter uveitis studies are expected, and that the antibody provides hope as a treatment for other autoimmune disorders. Proc Natl Acad Sci USA. 1999 Jun 22;96(13):7462-6. Mid-year Economic Report: A Healthy Year (So Far) About 16 percent of our 1,000-member National Panel, Doctors of Optometry responded to this year's
Mid-year Economic Report. More than eight in 10 say their practices have at least equaled last year's performance, and half of that group reports profits are up. Gross income rose for 66 percent of doctors this year vs. last year's
47 percent; 16 percent reported no change. And, 55 percent increased their net. The typical panelist is still conducting 10 exams per day, essentially unchanged from last year. On the other hand, panelists are fitting fewer new
contact lens patients: 6.43 new contact lens patients per week, down a bit from last year's average of 6.47, with a median of about five. Accordingly, only 41 percent of doctors report an increase in income from contact
lenses, down from 49 percent last year (39 percent maintained last year's level). One in five doctors incurred a drop in contact lens income. But panelists are making up the loss in other areas of the practice: 62 percent
increased their income from treatment (vs. 58 percent in 1998). Only 7 percent say that income from treatment fell off in the first six months of 1999. Over half (53 percent) of doctors earned more from eyeglass sales, and 30
percent report no change from last year; 16 percent saw a decrease in this area. Harry Landrum, O.D., of Philadelphia cites managed care's affect on his dispensary: "Most third-party plans are decreasing reimbursements and paying
me a small dispensary fee and using their own labs. They are also only paying wholesale costs for frames." Though business is good for most doctors, many are concerned about the future and question the financial viability of
their practices. Seventeen percent report they were less profitable this year than last; only 14 percent reported so in 1998. In fact, one in five doctors report that their practices' long-term prognosis is "so-so" or worse.
This pessimistic outlook stems from a number of sources, the top one being managed care's lower fees and restrictions. On average, half our panelists' patients pay discounted fees through third-party coverage. "Third-party
reimbursements controls fees and we have no recourse but to discontinue participation," says Stanley W. Hatch, O.D., of Plattsburgh, N.Y. We asked the panelists about the last time a third-party panel increased its reimbursement.
Some simply scoffed, while one doctor predicts such an event will occur "when hell freezes over." Murray Glusman, an optometrist in Mobile, Ala., says his practice stayed the same this year because of "HMOs and insurance
companies—like getting blood from a stone." Other sore points and sources of concern include: commercial optometrists, discount pricing, staffing and a saturation of corporate optical companies. Most panelists, however, have
faith in the country's economic outlook. Sixty-seven percent call the economic outlook for 2000 good; another 15 percent say it's excellent. Expectations for local economies follow a similar pattern. Just 12 percent label the
country's financial future "fair" or worse, but one in five forecasts that for their local economies. Panelists' concerns for the economy center on inflation, taxes, Social Security and, of course, Y2K issues.
By the time this survey rolls around again, that Y2K thing should be in the past.
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