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In the News
In the News On October 19 the National Eye Institute will introduce a Low Vision Public Education Program
offering information, education and resources to the public and the estimated 14 million Americans with low vision. For more information, visit Seven out of 10 Americans don't know about the leading cause of blindness for people over age 50: age-related macular degeneration
(AMD). So says the AMD Alliance International, a coalition of more than a dozen vision and seniors organizations. The alliance, headquartered in Duluth, Ga., aims to alert people worldwide about AMD and how to get treatment for it.
Approximately 25-30 million people worldwide are affected by AMD, and that number is expected to triple in 25 years. Visit Update your Rolodex: the International Association of Boards of Examiners in Optometry (IAB), based in
Bethesda, Md., has changed its name to the Association of Regulatory Boards of Optometry (ARBO). The name change seeks to forge a stronger identity and to raise awareness among optometrists, says ARBO. Kids Suffer Frequent Vision Problems; "If the child has normal visual acuity, the parents
may have a false sense that the child's vision is normal, and that if there are symptoms present that the symptoms are not related to a vision problem," write the authors, The Convergence Insufficiency and Reading Study Group. The
researchers also found a high percentage of these children had accommodative insufficiency. Optometric vision therapy, they recommend, may be the most effective treatment. (Rouse MR, et al. Frequency of convergence insufficiency
among fifth and sixth graders. Optom Vis Sci 1999;76:643-649.) On a related note, the National PTA has adopted a resolution, "Learning Related Vision Problems —Education and Evaluation." The resolution will petition educators and
the public about the need for more comprehensive vision screening programs performed by qualified personnel. For information on how you can get involved and how this resolution could impact your practice, contact the College of
Optometrists in Vision Development, 1-888-268-3770, ICO: Then and Now National Keratoconus Study The National Eye Institute first funded CLEK for a five-year term in 1994. Before that NEI provided a planning grant in 1990, and the study received additional funding from the AOA's Council on Research, Paragon Vision
Sciences, CIBA Vision and the Ohio Lions Eye Research Foundation. CLEK researchers are studying the progression of keratoconus, patients' quality of life and onset of corneal scarring over an eight-year period (the first year
involved setting up the study and recruiting patients, the 10th year analysis of the results). CLEK is not looking at treatment options; rather, the goal is to provide O.D.s with information to answer patients' questions about how
quickly the disease progresses, says study chairman Karla Zadnik, O.D., Ph.D., of Ohio State University College of Optometry. More than 1,200 patients in different stages of the disease are enrolled at 15 clinical centers
nationwide. Researchers follow these patients with annual visits, which include clinical assessment, slit lamp photography, quality of life assessment and corneal topography. "When we got this funding in 1994, this was not the
kind of research optometry was doing," Dr. Zadnik says. Since then, other studies have begun, and more optometric centers should be able to apply for federal funding in the future. "The nice side effect of having done that is that
we've gotten to train a whole bunch of people in optometry in how to do this work," she adds. Since the study began, CLEK researchers have characterized the sample, including patients with moderate to severe keratoconus, and
have allowed for differences in geographic area and ethnic background. Some findings to date:
• Three out of four patients with moderate to severe keratoconus wear RGP contact lenses comfortably. UH Professor Receives Grant for Photoreceptor Research David Sherry, Ph.D., will use time-lapse microscopy to study how retinal photoreceptors regenerate in the adult eye. This research is expected to help improve success
with photoreceptors transplanted into patients with retinitis pigmentosa and diabetic retinopathy. When photoreceptors are transplanted into patients with degenerative retinal diseases, the transplanted cells survive but fail to
integrate with the retinal cells of the host. When the transplanted cells don't integrate, the damaged retinas do not recover vision. Dr. Sherry has been interested in photoreceptor regeneration since he was an undergraduate. His
Ph.D. dissertation and post-doctoral work focused on how the cells and circuits of the retina are arranged and how chemical neurotransmitters mediate communication through these circuits. In the last few years, his work has taken
a particular interest in how photoreceptors reestablish circuits and choose their targets. Dr. Sherry notes that the Lions Eye Bank grant will fund his research for about a year, but he hopes to continue the research for much
longer: "This work progresses slowly because we're currently limited to recording one cell at a time on the microscope, and we're planning to record individual photoreceptors continuously for 10 days to two weeks. Even with the
system running full-tilt, the process is slow." "Time-lapse microscopy is pretty demanding in terms of instrumentation," Dr. Sherry explains. "Basically the system consists of an inverted light microscope fitted with a shutter, auto-focus, a
temperature-controlled stage and video camera. This assembly sits on an air table to isolate it from vibration. The microscope and its associated components are all connected to a computer which coordinates the components and
captures the sequence of images, which are then assembled into a time-lapse movie for analysis of survival and growth." Time-lapse microscopy has been used in research on a limited basis, Dr. Sherry says, due to the cost and
complexity of building a dedicated microscopy system. He believes, however, that his project may be on the cutting edge of an emerging technique: "Time-lapse methods appear to be poised for rapid development and application in a
variety of fields in which questions remain about how dynamic processes—like nerve regeneration—occur and are regulated." Photochromic Lens Titans Settle Antitrust Lawsuit Corning, the leader in
glass photochromic lenses, had charged that Transitions, the dominant force in plastic photochromics, violated antitrust laws. In documents submitted in U.S. District Court in Rochester, N.Y., Corning claimed Transitions
threatened to cut off supply of products to four major lens makers if they were to start carrying Corning's plastic photochromic lens. Neither Corning nor Transitions Optical disclosed the terms of the recent settlement.
Corning has started distributing its plastic photochromic under the name SunSensors in Puerto Rico. The company has been holding launch of the product in the United States pending resolution of the suit against Transitions. Medicare Q&A Answer: Medicare only pays for lenses when medically necessary for patients who have either had the eye's natural lens surgically removed, or a congenital absence of the lens. Covered diagnoses are limited to
pseudophakia (V43.1), aphakia (379.31) and congenital aphakia (743.35). Otherwise, these are non-covered services for which you may bill the patient. Have the patient sign a Medicare waiver of liability acknowledging that
Medicare may not cover these services, and that he or she will then be responsible for payment. Allentown, Pa., optometrist Joe Gackenbach, liaison to his state's Medicare carrier, suggests you also submit a claim to your Durable
Medical Equipment Regional Carrier (DMERC). Once the DMERC rejects the claim as non-covered, then bill the patient. With this patient, however, the contact lens is a non-covered routine service. "Since the routine charges are
always non-covered services, a claim would not have to be filed to DMERC," says Heather Loveland, consultant to the Tennessee Optometric Association. "If the patient has a secondary policy that may cover the charge, or if the
patient insists you file a claim, then send a claim to DMERC. Make sure you use the appropriate modifier on the charge to indicate you have the patient waiver of liability on file," she explains. Since you're seeing this patient
for a medical eye problem, you may bill Medicare for any office visits. Use either a 92000 exam code or 99000 evaluation and management code, and a diagnosis of corneal scarring (refer to your ICD-9-CM book for the most specific
diagnosis within the 371.xx series). The procedure code you choose depends on your level of documentation. Check your carrier's specific documentation guidelines. You may bill corneal topography as a separate procedure if the
patient's condition is on your carrier's list of acceptable diagnoses. Use code 92499 (unlisted ophthalmologic service or procedure) and specify that you performed corneal topography. —Jeffrey S. Eisenberg Send questions to Review of Optometry, 201 King of Prussia Road, Radnor, PA 19089; or e-mail them to reviewofoptometry@jobson.com.top
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