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In the News
In the News Health insurance premiums in the past year had the biggest annual increase—4.8 percent—in the last five years. That's more than double the U.S. inflation
rate of 2.1 percent, the Kaiser Family Foundation's 1999 Annual Employer Health Benefits Survey reports. The average worker's contribution has risen along with premiums. For single coverage, it rose to $35 a month this year from $8
about 10 years ago. The number of companies that offer coverage and the choices that employees have were the same. CIBA Vision has granted the marketing rights for the generic form of Ocupress (carteolol hydrochloride) to Akorn
Inc. The product's patent expires January 2, 2000. St. Louis-based Crown Optical has signed an agreement with Laser Vision Centers to begin offering laser vision correction beginning November 1. Once its remodeled
facility—including a portable excimer laser— is up and running, Crown expects to serve about 40 patients a month.
AMD Buzz: New Devices to Test Investigators are
cooking up a couple new devices to objectively measure levels of macular pigment. They're working on the theory that MP protects the central retina and prevents macular degeneration. Several elaborate research devices that measure
MP exist, but two new instruments may arrive in your office in a few years. At the University of Utah, ophthalmologist Paul S. Bernstein, M.D., Ph.D., has developed a device that uses a low-power
argon laser to measure macular pigment. The laser hits the fovea, from which the light scatters at a measurable wavelength. This wavelength measurement corresponds to the level of macular pigment to provide an accurate reading of
MP density. The device should be as easy to use as a "point-and-shoot" camera, as the laser allows a reading in one second. Dr. Bernstein is developing a newer, self-aligning model so that the patient's gaze allows the laser to
fixate directly on the fovea. The devices won't be commercially available for a couple years at least. In the meantime, advise your AMD patients to keep eating their spinach. PrimeSight Network Closes Up Shop "PrimeSight's projected earnings could not offset the substantial
amount of capital required to continue business operations," says PrimeSight Chairman Michael Redmond, M.D., in a statement released by the AAO. The ophthalmology-led network launched in 1996. From the start it fought an uphill
battle, says Howard Gottlieb, O.D., a practice management consultant to both optometrists and ophthalmologists. "I don't know if [PrimeSight] could have brought in the price points that would have pleased their members, because
surgeons have an average exam fee in the $75-125 range but managed vision care is in the $25-45 range," Dr. Gottlieb says. "Perhaps they were hoping that maybe people would pay a premium for an ophthalmologist." Vision care is
most efficient when the optometrist provides primary care and the ophthalmologist provides the medical and surgical portion, Dr. Gottlieb explains. "I think PrimeSight was a prime example of violating that very sound business
model," he says. LASIK Is Right on Time "An article like this, from our perspective, is very helpful," says J. James Thimons, O.D., executive director of TLC Connecticut in Fairfield, Conn. "A primary responsibility of facilities like ours is to educate
patients in understanding the process, the potential benefits, the possible risks, and all the elements that lead to a successful procedure." The article gives patients a head start on that learning process. Says Dr. Thimons: "I
like the fact that it says, these are the tough questions. Ask your doctor. Patients use the article as a springboard to create the questions." Following a review of how myopia and hyperopia develop, a layman's explanation of how
LASIK works, and a balanced survey of its track record to date, the article makes four recommendations:
The piece makes it clear that risks such as haloes, glare and diminished contrast sensitivity are real. It tells of a New Jersey man with postoperative diplopia and poor night vision that prevents him from driving. A sidebar by
a Time staffer who suffered severe dry eye for several months after surgery further explicates the potential risks. "I think articles like this one provide an appropriate tempering of the process," Dr. Thimons says. At the same
time the article makes it clear that serious complications are rare. That accords with a study involving 1,026 eyes that was published in the January 1999 issue of Ophthalmology, which found that 4.8 percent of patients lost two or
more lines of best-corrected vision following LASIK. By year's end, an estimated 900,000 Americans will have undergone LASIK in 1999, up from about 430,000 last year, according to industry analyst Rebecca Irwin of the Warburg
Dillon Read Global Health Care Research Group. Thanks to word-of-mouth testimonials from happy patients as well as high-profile media coverage, those figures are only likely to grow. What the 'Patients' Bill of Rights' Means to You Of course, whatever final shape the legislation takes is up to a House-Senate conference committee and, ultimately, President Clinton.
Both House and Senate bills could improve an independent doctor's status under managed care, says Cape Coral, Fla., optometrist Don Williamson, chair of the AOA Federal Relations Committee. The key provisions:
Of course, the spotlight has been on how the different bills handle a patient's right to sue his health plan. The House bill allows this, the Senate legislation doesn't. That could tie the Conference Committee in knots. Dr.
Williamson's take on the House bill: "It's a great victory for patients and optometry, and swings the pendulum back to patients and from health plans." That's the task lobbyists for doctors and patients now have before them:
getting that pendulum to at least stay put.
FDA Approves Refractive Surgery Bonanza • Summit cleared for myopia and hyperopia. The FDA OK'd Summit Technology's Apex Plus excimer for treatment of myopia with or without astigmatism. Treatment ranges up to -14.00D of
myopia, with astigmatism of -0.50D to -5.00D. The FDA based its approval on safety studies of 1,013 eyes. Of the eyes treated, 92 percent were corrected to 20/40 or better and 47 percent were corrected to 20/20 or better without
glasses or contact lenses. Side effects experienced by patients after treatment included under-correction (11.9 percent); over-correction (4.2 percent); severe halo (3.5 percent); loss of best-corrected vision with eyeglasses
(3.0 percent); severe visual fluctuations (2.6 percent); and severe glare (1.7 percent). Summit's laser also received approval for PRK for hyperopia from +1.50 to +4.00D, with less than 1.00D of astigmatism. • Nidek gets OK
for astigmatism and keratome. Surgeons now can use Nidek's EC-5000 laser for PRK on myopes with astigmatism. The approval allows correction of myopia ranging in severity from -1.00D to -8.00D, with refractive astigmatism from
-0.50D to -4.00D cylinder. The FDA also granted 510(k) clearance for the company's MK-2000 microkeratome. The instrument is for use in lamellar surgery for patients with refractive errors or corneal anomalies. • Staar phakic IOL
clears trial. Staar Surgical's phakic intraocular lens, the Implantable Contact Lens (ICL), completed its phase III clinical trial. The study included 278 patients with -3.00D to -20.00D of myopia without severe astigmatism,
cataract or a history of refractive surgery. From post-op data of at least one month on 311 eyes, about 82 percent of patients saw 20/40 or better without glasses or contacts. (For more on phakic IOLs, see In other refractive surgery
news, VisX celebrated its 1 millionth procedure using its VisX Star S2 laser. The procedure was performed in Chattanooga, Tenn., and was telecast over the Internet on Yahoo!. VisX is also about to push the envelope on refractive
acuity. The company has signed with 20/10 Perfect Vision, a German company that has "wavefront technology" which ideally will identify a patient's best achievable vision, according to information from the company. The complex
optics technology was originally derived for astronomical applications. VisX says it plans to make the technology commercially available in a stand-alone diagnostic device. Meanwhile, the Council for Refractive Surgery Quality
Assurance (CRSQA) has launched a campaign to alert the public that it certifies refractive surgeons. Check CRSQA's website at
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