EyeCare Professional Magazine January 2011 Issue

January 2011 • Volume 5, Issue 37 • www.ECPmag.com

FABULOUS SUNWEAR / PAGE 6 CONTINUING EDUCATION “TYPES” / PAGE 20

VISIT US at www.OPTOGENICS.com1-800-optical (678-4225)

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FABULOUS SUNWEARImpress your patients in the new year with the latest and greatest in stunning sunwear.by ECP Staff

DEFINING HIGH INDEXLess weight, better aesthetics and UV protection are just some of high index’s advantages.by Carrie Wilson, BS, LDO, ABOM, NCLE-AC

CE ATTENDEESThere are generally three types of people who attend ContinuingEducation classes.by Anthony Record, RDO

CORE MARKETING CONCEPTSProduct, Price, Place and Promotion are the four keys to opticalmarketing success.by Warren G. McDonald, PhD

VETERANS AND VISION PROBLEMSA growing number of wounded soldiers are suffering from undetected vision problems.by Elmer Friedman, OD

GAS PERMEABLE CONTACTSThere is still a small, but significant market for Gas Permeable contact lenses.by Jason Smith, OD, MS

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On The Cover:OPTOGENICS800-678-4225www.optogenics.com EDITOR/VIEW .....................................................................................................4

MOVERS AND SHAKERS.................................................................................26

DISPENSING OPTICIAN .................................................................................28

MOBILE OPTICIAN .........................................................................................30

OPTICAL PHILANTHROPY............................................................................32

ADVERTISER INDEX .......................................................................................46

INDUSTRY QUICK ACCESS ............................................................................47

LAST LOOK .......................................................................................................50COVER: Varilux is a registered trademark of EssilorInternational, SA. Element, Autograph, and Attitude are registered trademarks of Shamir Insight, Inc.

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Publisher/Editor . . . . . . . . . . . . . . . . . . . . . . . Jeff Smith

Production/Graphics Manager. . . . . . . . . . . Bruce S. Drob

Director, Advertising Sales . . . . . . . . . . . . Lynnette Grande

Contributing Writers . . . . . . . . . . . . . . . . . . . Judy Canty,

Dee Carew, Harry Chilinguerian, Timothy Coronis,

Amy Endo, Elmer Friedman, Lindsey Getz, Ginny Johnson,

Jim Magay, Warren McDonald, Anthony Record,

Jason Smith, Carrie Wilson

Technical Editor . . . . . . . . Brian A. Thomas, P.h.D, ABOM

Internet Coordinator . . . . . . . . . . . . . . . . . . . . Terry Adler

Opinions expressed in editorial submissions contributed to EyeCareProfessional Magazine, ECP™ are those of the individual writers exclusively and do not necessarily reflect the opinions of EyeCareProfessional Magazine, ECP™ its staff, its advertisers, or its reader-ship. EyeCare Professional Magazine, ECP™ assume no responsibilitytoward independently contributed editorial submissions or any typographical errors, mistakes, misprints, or missing informationwithin advertising copy.

ADVERTISING & SALES(215) 355-6444 • (800) [email protected]

EDITORIAL OFFICES111 E. Pennsylvania Blvd.Feasterville, PA 19053 (215) 355-6444 • Fax (215) [email protected]

EyeCare Professional Magazine, ECP™ is published monthly by OptiCourier, Ltd.Delivered by Third Class Mail Volume 5 Number 37TrademarkSM 1994 by OptiCourier, Ltd.All Rights Reserved.

No part of this magazine may be used or reproduced in anyform or by any means without prior written permission of thepublisher.

OptiCourier, Ltd. makes no warranty of any kind, eitherexpressed, or implied, with regard to the material contained herein.

OptiCourier, Ltd. is not responsible for any errors and omissions,typographical, clerical and otherwise. The possibility of errorsdoes exist with respect to anything printed herein.

It shall not be construed that OptiCourier, Ltd. endorses, pro-motes, subsidizes, advocates or is an agent or representative forany of the products, services or individuals in this publication.

Purpose: EyeCare Professional Magazine, ECP™ is a publication dedicated to providing information and resources affecting thefinancial well-being of the Optical Professional both professional-ly and personally. It is committed to introducing a wide array ofproduct and service vendors, national and regional, and the myriad cost savings and benefits they offer.

For Back Issues and Reprints contact Jeff Smith, Publisher at800-914-4322 or by Email: [email protected]

Copyright © 2011 by OptiCourier Ltd. All Rights Reserved

MagazineEditor / viewby Jeff Smith

T he optical industry is experiencing an explosion of new technology. Ofcourse, that’s nothing new ... remember when all glasses had glass lenses?Or, to bring it in more recent perspective, when letters were typed on a

typewriter? For some of us, trying to understand how a computer works can bejust slightly easier than transcribing Sanskrit. Remember how frustrating it waswhen you tried to make sense of what the computer salesman was telling you:Byte? ROM? OS? Well, it has come full circle.

Technological advances in lens design, coatings, or frame design and materials canbe exciting to us, but just as frustrating to the patient if presented incorrectly.Remember, what patients really want is simply the best vision possible. While it has become easier to accept the technical jargon associated with computers, theaverage optical patient hears about PAL, AR, and poly maybe once every two years.The guiding principle when presenting the latest in optical technology is KIS(Keep It Simple).

The first step in presenting technology is to know as much about it as you can.The more you know, the easier it is to explain in simple terms. While it may not beimportant to know all the physics involved in, say, wave-front laser guidance, youshould know the benefits to the patient of a wave-front lens and why. Know whennew technology is beneficial to the patient, and when it may not be appropriate,and what the limitations might be. Many of the newer lens designs are engineeredto help patients with relatively high corrections, high cylinders, or other specialneeds. A patient with -0.50D sphere correction will probably not benefit muchfrom wave-front, 7.00 index lenses. However, when appropriate, never hesitate torecommend advanced designs.

When explaining new designs or materials, emphasize the benefits to the patient.Think of it as starting at the bottom of a pyramid, beginning with broad, generalterms and only advancing to more restrictive, technical language when necessary.Of course, there will always be those patients who want a more detailed explana-tion, either out of curiosity or to test you. In that case, go ahead and get moretechnical, but beware of your limits. If you’re not sure, admit it, don’t try to bluffyour way through. If your not sure (or even if you are), grab a brochure andquickly go over it with the patient. This will not only guide you through, but givescredence to what you’re saying.

If the new technology provides real benefits, and is presented in an understandablefashion, then the benefits will out-weigh the costs, and the patient will make a financial decision based on value. Get excited by the new technology, and get yourpatient excited with the amazing benefits made possible by it; after all, you’re offering the best solutions for their vision needs.

EEYECAREPROFESSIONAL

4 | EEYECAREPROFESSIONAL | JANUARY 2011

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2. SafiloThe Maison Valentino presents a new eyewear collection of sophisticated, one-of-a-kind modelswith an avant-garde and contemporary look. Thesenew “glam-rock” style sunglasses feature an acetateframe which flaunts small metal studs on the temples(VAL 5746/S). Colors include shades of dark Havana,red black and ivory. www.safilousa.com

3. MYKITAMYKITA and uslu airlinesfirst came together back in2006 to co-design a limitededition of aviator sunglass-es: EVE for the ladies andBOB for the men. The JetSet is a new edition of thesecult aviators in three newstriking color coatings withmatching nail polish, pack-aged together in a smallsuitcase. www.mykita.com3

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1. Villa EyewearThe 2011 X-IDE Sunglass collection was developed withsensations that touch the five senses. We were captivatedby emotions derived from the world of textiles; where wediscovered patterns, yarns and prints in a thousand shadesof nature, rich in tradition. www.villaeyewear.com

SUNWEARFabulousFabulous

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6. Jee ViceThe sleek silhouette “Evil” is asignature frame from Jee Vicethat’s quickly taking over theworld. The aviator style makesstaying incognito easy. Madewith TR90 frame technology,these larger frames are the perfect cover. The look comes

in seven different color ways.www.jeevice.com

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4. REM EyewearLucky Brand reveals its latest designs for Spring: 8impeccably designed sunglasses that are handcraftedfrom high quality metal, or smooth-to-the-touchacetate. All are fitted with optical quality CR-39 lensesthat filter 100% of ultra violet rays. The classic and colorful shapes capture the aesthetic of American chic,and have Lucky’s signature clover on the left temple tip.www.remeyewear.com

5. Alain MikliThe MATT sunglass collection covers the eyes withaudacious restraint and dresses them with chivalrouscamouflage. The AL1071 is a large sunglass for women,in a Jackie O style, and is 7 mm thick and facetted toplay with light. Finery for eyes, elegance and style, thisframe features classic shapes to fit any face shape.www.mikli.com

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Charmant

The Tru Trussardi eyewear collection offers an impressiverange of signature shapes that expresses the brand’s Italianlegacy and showcase unexpected uses of leather and tailoringtreatments. Pictured is style TR12800 in metal with leatherdetails at the temple and bridge and an attention-drivingslight gap between lens and upper metal frame.www.charmant-usa.com

R & R Eyewear

The Bellagio Sunglass collection consists of masculine, femi-nine and unisex designs. Quality materials, excellent crafts-manship and clean, timeless designs highlight this new sun-wear collection. The Bellagio 3032 shown here has a uniquetortoise marble color that is sure to turn heads.www.rreyewear.com

Revolution EyewearThe new Couture Line from TrueReligion keeps aim at the bohemian-chic-flare, with a vintage-feel-vibe, thattheir jeans emit. There are 15 styles,seven women’s and eight men’s. Colorsavailable include Rose Gold, ShinyGold, Blonde Tortoise, Black, SatinGold, Havana White.www.revolutioneyewear.com

Clariti Eyewear

The AirMag collection is comprised of polarized magneticclip-ons that are coupled with frames made of a special material that does not require two sets of magnets like theircompetitors. With these innovative frames, the clip-ons attachwith ease on multiple design options and make the AirMagcollection the strongest and lightest clip-ons in the markettoday. www.claritieyewear.com

Luxottica

Dolce&Gabbana’s Animal Print Collection features the hottestnew styles to hit the market. Style DG4101 (shown) is for theglamorous individual looking to make a statement. The flattering shape and comfortable fit are also great for everydaywear. This style features clear, thick acetate cuts to accent thehinge and temple. www.luxottica.com


Exquisitely Hand Crafted Italian Eyewear by TreviColiseum®

Distributed exclusively in North America by National Lens. Tel: 866.923.5600www.national-lens.com

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götti

Katya frames are part of götti’s revolutionary “Spin & Stow”collection that will be available in March 2011. With just asimple twist of the patented earpieces, the sunglasses easilyslip into a pocket and lay virtually flat. The “spin temple”is made with durable epoxy material and features a fully integrated hinge that can spin. www.gotti.ch

ClearVision

BCBG Drama is an oversized acetate frame with drop templedesign and CR 39 UV 400 gradient lenses. Drama is availablein Plum Laminate and Black Laminate. www.cvoptical.com

Morel EyewearIvy Sun: repeats the sleek look of theprescription version, with a wide stainless steel temple. Six stainless steelstrands are interlaced and joined at theendpiece to form an ornamental anddiscreet temple. The interlaced patternof the temple continues seamlesslyonto a glamour-look acetate front inblack, white and tortoiseshell.www.morel-france.com

L’Amy

Chloe’s Erine is inspired by the Chloé ready to wear universethanks to the two metal pieces on front which mimic the scal-lop design in Chloe’s ready-to-wear. Chloe’s Erine is availablein two feminine and trendy shapes and comes in three Chloécolors such as beige, old pink or green.www.lamyamerica.com

Rudy Project

Sleek wraparound design and glamorous detailing, togetherwith technological performance make GOZEN eyewear fit forany occasion. Cutting-edge “Flip Change Technology”, a sys-tem patented by Rudy Project that makes replacement a sim-ple operation. Available in photochromatic polarizedImpactX, and Laser - Multilaser, perfect for mountain biking.www.rudyprojectusa.com


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Real Kids Shades

Versatility and style come together in the high-tech RxableXtreme Convertibles. Quick-lock tabs allow a youngster toconvert from temples to sports band in just seconds, making iteasy to go from the playing field to the picnic. This is seriousgear for active kids. www.realkidshades.com

Creations in Optics

The White Facade Art collection consists of vintage inspiredlooks enhanced with a mix of today’s colors and trends.The model Spike combines a timeless retro eye shape with amodern edge. The use of leather and spikes on the templesgives this sunglass a new look in whimsical chic.www.creationsinoptics.com

Gerber Scientific announced that it has entered into an agreement to sell its ophthalmic lens processing business, Gerber Coburn, to Coburn Technologies, Inc.for $21.0 million. Coburn Technologies is a newlyformed company controlled by Edward Jepsen, a formerGerber Scientific board member, along with Alex Incera,president of Gerber Coburn and Wayne Labrecque, vicepresident of sales. Under the new ownership structure,Jepsen will serve as chief executive officer of CoburnTechnologies. Incera and Labrecque will have an owner-ship interest through the acquisition and will remain intheir current positions with the company.

Commenting on the pending acquisition, GerberScientific CEO Marc Giles said, “As we’ve stated, a keyelement of our strategy is to review our portfolio of businesses against a set of strict strategic criteria. After anextensive review, we concluded that we were not in aposition to maximize the potential of the ophthalmic lensprocessing business. This sale will allow us to furtherreduce our debt and better positions us to invest in ourcore Apparel and Industrial segment where we are amarket leader, with solid margins and strong positions inhigh growth market segments. As we have discussed pre-viously, this segment is one where we will actively pur-sue growth, both organically and through acquisitions.”

Jepsen said, “I am very pleased with the acquisition.Our new strategic ownership structure as an independ-ent, privately held company will ensure our teamremains focused on our core markets and it will helpfacilitate growth and the development of new businessopportunities through invigorated research and develop-ment efforts, and outstanding customer service and technical support,” said Jepsen.

Incera added, “We are excited about the acquisitionand the opportunity to build upon Gerber Coburn’s successful record of innovation in lens processing tech-nology and reputation for unmatched customer service. We have a great management team and organization andwe intend to capitalize on the many opportunities forgrowth within the industry through new product development, strategic partnerships and complementaryacquisitions, as well as growing in the expanding inter-national markets.”

Gerber Scientific said it expects to use the net proceedsof approximately $19 million, after fees and expenses, toreduce its outstanding debt and for general corporate pur-poses. The company also announced that based on theresults of the sales process and interim goodwill impair-ment tests, it anticipates recording a non-cash goodwillimpairment charge of approximately $16.9 million in itsfiscal 2011 second quarter ended Oct. 31, 2010.

Gerber Coburn’s Management Team to Acquire Company

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The American Board of Opticianry and the NationalContact Lens Examiners (ABO/NCLE) have establishednew management and financial procedures and controlsfollowing the embezzlement of $1.5 million from theorganizations.

Amidst concerns of inappropriate management practices, the ABO and NCLE boards launched an investigation of their office administration and manage-ment in early 2010. The investigation found suspectedfinancial impropriety involving ABO/NCLE ExecutiveDirector Michael Robey. Robey was immediately sus-pended and terminated from his position in March 2010.He pleaded guilty to four counts of embezzlement inNovember 2010 and is awaiting sentencing.

The investigation later found alleged financial impro-priety involving ABO/NCLE Chief Financial OfficerCarletta Carter-Stewart, who was terminated in August

2010. Carter-Stewart was arrested on December 9, 2010and charged with seven counts of embezzlement.

Based on results of a complete management and financial audit, ABO/NCLE has upgraded its managementprocedures, implemented additional internal controls,established a lockbox for receivables, and hired a newaccounting firm.

“Despite this incident, ABO and NCLE remain financially strong organizations capable of serving thecertification needs of the optical community,” saidABO/NCLE Executive Director Jim Gandorf. “We areimplementing every measure possible to assure that nofurther problems of this type will be repeated.”

For more information about ABO/NCLE, visitwww.abo-ncle.org.

ABO-NCLE Establishes New Management

and Financial Procedures Following

Termination of Two Employees

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Super Systems Optical Technologies has introduced anew version of the Fast Grind System that is easier tooperate and offers faster production time. The FastGrind for Dummies was engineered for the small inde-pendent optical shops to enable them to produce digitalquality progressive lenses and other bifocal designswithout having the knowledge or skill of surfacing.Anyone can learn to make quality prescription lenseson the Fast Grind system within one hour. Along withan edger Fast Grind provides one hour service for over80% of prescriptions. All the latest lenses are availableincluding photochromics, polarized and progressives inregular, short and ultra short corridors, all made fromdigital produced molds. www.superoptical.com

The new BPI® Digital4 & 5 Stroke Gradient™

Systems conform to thenew BPI® standard fordigital design. Theyprovide new level ofprecision in gradienttinting. The 5 strokesystem also allows precision timing ofsolid tints, the digitaltimer control can be setfor times from 1 secondto 99 minutes. It has aneasy to see digital dis-play, and a single pressof a button repeats thetiming cycle.www.callbpi.com

Kowa Optimed, Inc. offers its latest evolution of theirtechnologically inventive series of fundus cameras. TheKowa nonmyd αα-DIII is a compact digital camera thatcontinues the Kowa tradition of new and innovativeelectronic imaging technology. Kowa offers speed, reli-ability, and high resolution photographs in a strikingcompact design. The all-in-one compact, lightweightdigital fundus camera employs advanced technology. Itsuser friendly control panels are all accessible at the tipof your finger. The nonmyd α-DIII utilizes an internal 8mega pixel digital camera, and the connection throughUSB offers simple set-up and high volume operationsplug-and-play functionality. This innovative cameraalso features 9 point internal fixation targets andinfrared LEDs for maintenance free operation. www.kowa-usa.com

The ES-curve is the latest addition to Satisloh’sindustrial finishing product line. Utilizing provenNational Optronics’ 5-axis finishing technology, thearticulating bevel, groove, and drilling process providethe best fit for even the most challenging shapes andwraps. The ES-curve is equippedwith seven on-board tools formulti-task edging – additionaltools for complete edging capa-bilities can be programmed.Its lateral drilling featureexpands capabilities toinclude lens edge drilling. The ES-curve easily handles ARedging because of its uniqueroughing process that reduceslens stress and torque – makingit the ideal edger for finishingdelicate and slippage-prone lenscoatings. www.satisloh.com

MODERNIZE YOUR PRACTICE

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Through the LensCarrie Wilson, BS, LDO, ABOM, NCLE-AC

Defining High IndexDefining High IndexEvery direction the eye care professional turns, he or she isbombarded with information about the benefits of high index.But, is it thinner, lighter, better? But what is high index? How isit actually defined? What are the drawbacks to high index andhow can they be minimized? To help understand the nature ofhigh index materials, the eye care professional must understandthe factors that determine how a lens material is defined. Thesefactors are refractive index, specific gravity, ABBE value andimpact resistance.

Refractive Index

The technical definition of high index, within the United Sates,is any lens material that is over 1.530. However, for all practicaland marketing purposes, high index is actually any lens with anindex above conventional glass or CR-39. Some manufacturershave started to use the term mid-index for lenses in the 1.54 to1.60 range. However, this term is ill defined and not universallyutilized. In plastic lenses, the higher index materials are oftenderived from polyurethane mixed with sulfur to enable the lensmaterial to bend light to a greater degree than a conventionalplastic such as CR-39. In high index glass, metal oxides, such as flint or titanium, are added to crown glass to effect the substrate’s light bending ability.

To help determine what the index of refraction for a lens mate-rial is, a lens manufacturer measures the rate of speed that lightpasses through the substance. This enables the manufacturer tocalculate the refractive power of the lens as well as part of thedispersive power of the prisms within certain lens materials.Most manufacturers’ use the yellow wavelength of light (Nd)for this calculation. Yellow is used because human beings see thecolor of yellow first and foremost. Some manufacturers use thegreen wavelength of light for this calculation and it can lead tomisconceptions about the true index of a lens. The equation forthis is

N= Speed of light in airSpeed of light in material

So, a lens material that has light traveling through it at 110,000miles per second will have an index of refraction of 1.69.

Since higher index materials refract light so effectively, they canutilize a thinner prism base to create the same effect as a lower

index material. For example, a minus lens with an index of 1.50would have to be made with a thicker prism base (lens edge)than a minus lens with a 1.69 index. In addition, the lens can becreated with a shallower base curve creating a flatter surface. Inother words, a -4.00 lens created out of a lens substrate of 1.69will be approximately 25% thinner than a lens created out of amaterial with an index of 1.53.

Specific Gravity

Specific gravity, or density, is a measurement of the weight ofthe lens material. Density is generally measured in grams percubic centimeter and it is determined by the ratio of the massof the lens substrate to the mass of an equal volume of water at4 degrees Celsius. The lower the density the lighter the lens andthe more comfortable the glasses are for the patient. Commondensities for lens materials are:

Lens Material Index DensityCR-39 1.499 1.32Crown Glass 1.523 2.54Polycarbonate 1.586 1.201.60 high index MR-6 1.597 1.341.66 high index MR-7 1.66 1.351.60 high index glass 1.60 2.621.70 high index glass 1.70 2.931.80 high index glass 1.80 3.37

In general, when discussing plastic lenses, there is no direct cor-relation between the index and its density. This is not the casehowever with high index glass lenses. High index glass have amuch higher density than crown glass, especially in mild tomoderate powers, therefore the weight reduction in these lens-es is insignificant. In fact, some high index glass lenses can beheavier than the thicker crown glass. The use of lead oxide insome high index glass causes the weight increase.

ABBE Value

ABBE value is simply a measure or scale of how much light isdispersed when it enters a specific lens material. Every materialhas its own ABBE value. Contrary to a popular myth, there isabsolutely no correlation between a lens refractive index and itsABBE value. To illustrate this point, look at the original index of


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crown glass versus Trivex®. Both have the identical index of1.530 yet significantly different ABBE values. Since white light iscomposed of multiple colors, each color within the spectrum isbent at a different angle than the other during refraction.Therefore, each component of light has its own refractive index.Blue light has a higher refractive index than red light and istherefore bent more than red when it passes through a lens. Theresult is chromatic aberration or dispersion. This dispersionresults in chromatic aberration that can, at times, be observedby the patient. However, most frequently the complaint is thatoff axis viewing is more blurred than central viewing due to thecolor images overlapping one another.

The degree to which a lens disperses light is commonly referredto as ABBE value or constringence. Lenses with a high ABBEvalue have less chromatic aberration than those with a lowerABBE value. Generally, mid-index and higher index materialshave lower ABBE values than the conventional lens materials ofCR-39 or crown glass.

Lens Material Index ABBECR-39 1.499 57Crown Glass 1.523 59Polycarbonate 1.586 301.60 high index MR-6 1.597 361.66 high index MR-7 1.66 321.60 high index glass 1.60 401.70 high index glass 1.70 311.80 high index glass 1.80 25

Please note that ABBE values are approximate and the samematerial may have a slight variation from manufacturer tomanufacture depending on the manufacturing process that thelens goes through.

Minimizing Problems

Taking Measurements and ensuring fit

Although there are several factors that help to ensure patientsatisfaction when fitting a high index lens, the main factor is

taking accurate measurements. It is important that the eye careprofessional take monocular PDs and determine the opticalcenter placement both vertically and horizontally. The frame:

• should fit well.• have a minimal decentration.• have a pantoscopic tilt is between 10 and 15 degrees in

most instances.• exhibit an effective diameter (ED) within 2mm of the

frames A dimension.

Determining thickness

Once these measurements are taken, it is best to determine thelens thickness to ascertain if it meets the needs of the patient.This can be done by utilizing the sag approximation formulaand adding the result to the predetermined center thickness orby applying optical calculators such as those found onOptiCampus.com. For reference, the sag approximation formula is:

Sag = ((d/2)2 X D) / 2000(n-1)

where d is diameter in mmD is powern is index

Utilize Anti-Reflective Coating

Do not sell a high index lens without anti-reflective (AR) coat-ing. This may seem extreme, but an uncoated CR-39 lensreflects 8% of light, whereas an uncoated high index lens willreflect up to 50% more than CR-39. A rule of thumb is thehigher the index, the greater the amount of light reflected. Thiscan lead to increased difficulty with night driving as well as eyefatigue due to decreased light transmittance. With an AR coat-ed lens however, the light transmittance can increase to 99.5%.As a result, reflections and chromatic aberrations are reduced,the patient has a clearer view of his or her surroundings, and theglasses have a better cosmetic appearance. By applying AR, therate of non-adapt to the visual differences in high index mate-rial over lower index materials will decrease. Fortunately, ARcoatings have really improved over the last few years and are anessential enhancement to high index with the new scratch, dirt,and oil resistant formulas available.

JANUARY 2011 | EEYECAREPROFESSIONAL|17

Continued on page 18

Progressivelenses.com


Know your patient

Does the patient have a high prescription? Work with the public? Want a high fashion or minimalist look? Is he or she achild or very active? All of these questions help determine howwell a high index lens will fit with a patient’s lifestyle.

The thinness of high index makes it an ideal lens material forindividuals with a higher prescription. A general guideline is torecommend high index materials for any patient with a prescription of +/-3.00 D or more – depending on the frameparameters. With minimal decentration and a reasonable size,high index may not be required at this prescription level.Anything less than this prescription and the weight and thinness benefits are usually minimal.

High index, especially the index of 1.67 and 1.70, is an excellentchoice for individuals who want the minimalist look of drilledrimless eyeglasses. Due to the thinness of the material’s edge, thelens does not look out of place or heavy when placed in a drilledrimless. In addition, high index materials do not crack as easilywhen drilled and the hole maintains its size and shape more read-ily than lower index materials such as CR-39.

It is also essential for the newer, larger frame designs that aremaking a comeback. With the increasing popularity of largerframes, edge thickness problems due to decentration are going tobecome more prevalent. High index can eliminate some of thisbut remember that it is very important to consider the lens pre-scription when fitting a larger frame.

High index lenses are not ideal for everyone. One such instance ischildren or individuals who have severely decreased vision in oneeye. In these cases, the safety and impact resistance ofpolycarbonate is necessary to protect the patient’s vision. Also,the flatter base curves of high index lenses prevent the lensesfrom fitting into the wrap designs that are popular in some framedesigns and are therefore not recommended. Another frequentlyforgotten aspect of polycarbonate is the thinness of the center.Frequently a polycarbonate lens with a 1.0 mm center will beequal to or thinner than some high index lens materials withmore substantial center thickness – and safer as well.

Conclusion

High index is the most advanced lens material available today.When utilized properly it provides a thin profile, lighter weightand advanced optics to the patient. By taking all factors into con-sideration, the eye care professional can utilize high index lensesto provide a superior product to the patient as long as the ECPremembers to utilize good optical principles along with the lensselection. We cannot expect the lens to overcome poor framedecisions, so be sure to cover the basics prior to recommendingthe high index lens material. Putting solid optical practice togeth-er with a high index lens material can provide the patient withthe ultimate eye care experience. �

With contributions from Brian A. Thomas, P.h.D, ABOM

Impressions colored contacts blend naturally with your patientseyes to create a beautiful look. Available in 9 dazzling opaquecolors of which Grey, Green, Honey, Pure Hazel & True Sapphireare available in RX Pl to -6.00. Impressions are fun, hip, fashionable and very competitively priced to help your bottomline. POP materials and posters are available upon request.

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The CHC150 Ultra Tough is now included in both the Natural Vision and Kodak CleARTM

Anti-Reflective Coating at no extra charge. The CHC150 coating is index matched with the A/R and applied to both sides of the lens before the A/R coating. The result: a more durable and longer lasting product.

FREE SAMPLES AVAILABLESee for yourself the scratch resistance of the CHC150 Ultra Tough Hard Coat. Upon request, we will send you a regular plastic lens with the CHC150 coating and a piece of steel wool.

Kodak and the Kodak trade dress are trademarks of Kodak, used under license by Signet Armorlite, Inc. CleAR is a trademark of Signet Armorlite, Inc.

DEC2010_FEA.qxd 12/3/10 3:57 PM Page 1


Managing OpticianAnthony Record, ABO/NCLE, RDO

WHILE IT IS usually not a goodidea to stereotype or paint withbroad brushstrokes, I have

observed that attendees generally belongto one of three groups, which might accurately be described as 93, 5, or 2.

In my opinion and experience, ninety-three percent of the people who attendCE classes attend for one reason, and onereason only: They must obtain a minimum number of CE hours in orderto renew their license to practice. This isrequired by the state and/or theABO/NCLE. While that requirementexists for the other two groups as well, forthese 93ers, this is the only reason theyattend. It’s a safe bet that if there were noCE requirements for license renewal theywould not be there. Don’t get me wrong, these are good, kindpeople. They are usually attentive, and if pushed, will partici-pate in class discussions and activities.

The second group – the five percent – are also there becausethey have to be, but they resent it. They arrive late, take as manyextra breaks as they can, and pester the members of both othergroups. They slink to the back row. They sometimes carry onprivate conversations with one another, showing utter disrespect for me and the other attendees. Some of them sleep.Some of them sleep and snore. A few have arrived obviouslyunder the influence of...something. Other attendees complainabout them, and sometimes complain to them.

A few years ago, an optician literally stoodup in the middle of one of the classes,turned around, and shouted, “Would youplease shut up!” at one of the 5ers.These people lack any semblance ofprofessionalism. Not surprisingly, theseare also mostly the people who go fromjob to job, never making it past the firstrung of any corporate ladder. They complain that they have been overlookedfor promotions, and in their view the havebeen wronged by nearly every employerthey’ve ever had.

Which leaves the last group: the few, theproud – the elite two-percent. They arriveearly so they can get a seat up front. Theyare friendly, well-dressed, and exude professionalism. They ask questions and

proactively participate in all class activities. They take notes!They stay after the session to share insights or ask more questions. They take pride in their careers and their profession.They are well-paid and highly valued employees, though manyof them are not employees at all. They are independent practitioners, somehow magically thriving in this fierce,competitive, recession-laden economy. You think there mightbe a connection there?

The quintessential example of their behavior can be summedup with a young woman named Maria. A few years ago I wasteaching a class toward the end of the biennium in Florida.I noticed Maria was in attendance. (We instructors tend toremember people who fit in either of the extreme groups.) I was

Are you 93%, 5% or 2%?For the last fifteen years or so I have been honored to provide continuing education (CE) classes for eye care professionals

from around the world.

JAN2011.qxd 12/17/10 3:51 PM Page 20

surprised she was there because I had remembered her being ata few seminars earlier that year and the year before. In otherwords I thought she had already fulfilled her 20-hours of CErequirement. When I asked her about that, she replied that yes,she indeed had already taken enough hours. When I asked herwhy she was there, she simply and without hesitation said sheheard I was to be the instructor and that the titles of a couple ofthe classes I was teaching sounded interesting. She said, “I’ll tellyou what Anthony, I don’t care if I get credit or not...just giveme one or two things I can take back to work with me...I’ll behappy,” Wow! If only we had more Marias in our profession.

Regardless to which group you belong, I have a few suggestionsthat might make the whole process of continuing education alittle more bearable for both you, and the instructors.

First, don’t just go through the motions. Don’t be an automa-ton. Too often we get comfortable with our habits. For example, in my home state of Florida there are some ECPs whowill only attend seminars sponsored by the POF (ProfessionalOpticians of Florida), CEDO (Continuing Education for

Dispensing Opticians), or the NAO (National Academy ofOpticianry), and be damned if they’ll switch it up and try oneof the other organizations. While loyalty is admirable, you risklosing fresh insight and information by always going to thesame classes. Take a chance!

Second, consider “participating” in some of the CE modulesthat appear in this magazine and some of the other industrypublications. While some of those modules will not be accept-ed for CE credit by your state (check with your Board to besure), most are eligible for ABO credit. Regardless of whetheryou need ABO credit or not, why not read them and answer theassessment at the end? Here’s a novel idea: Maybe you’ll learnsomething new! Not a month goes by, that I do just that. Walkthe talk I always say. And don’t just do it because I suggest it...I bet Maria does the same thing!

Finally, ask your employer for access to all of the CBL (computer-based learning) modules they have available. Again,some may be eligible for CE credit, and many will have somevaluable information.

There are three great advantages when it comes to home-studyclasses and CBLs. One, you can do them at your leisure. Two,you can go back and do them again. And three...you don’t haveto put up with any of the 5-percent-ers! ■

Are you 93%, 5% or 2%?

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The 21st Century OpticianWarren G. McDonald, PhD

Professor of Health AdministrationReeves School of Business / Methodist University

FOR THE COMING YEAR, my articles will be focusedupon more day-to-day operational approaches for theindependent eye care professional, and one of the

primary issues is the message we send to the consumer. For thenext few months we will revisit marketing, and attempt to provide some useful information to assist you in getting yourmessage out to your target market, without breaking the bank.Many think marketing is only advertising, but that is far fromcorrect. Let’s first re-cap our definitions of marketing.

Marketing Defined

The term marketing conjures up images of media advertising,which is a component of any successful marketing plan, but itis so much more. According to the American MarketingAssociation (2007), marketing is, “an organizational functionand a set of processes for creating, communicating, and delivering value to customers and for managing customer relationships in ways that benefit the organization and its stake-holders.” Kotler and Bloom (1984) define marketing as,“The analysis, planning, implementation, and control ofcarefully formulated programs designed to bring about voluntary exchanges of value with target markets for achievingthe organization’s goals. It relies heavily on the meeting the target markets needs and desires through the use of effectivepricing, communication and distribution to inform motivateand service the markets”.

Each of these definitions describes far more than just advertis-ing. Since in previous articles we looked closely at advertising,let’s evaluate other components of the marketing mix that canbe of importance to your practice.

The 4 Ps

For us to approach marketing from an intelligent perspective,we need to have a clear grasp on the concept of the “marketingmix” (Longet and Darr, 2008). This excellent frameworkdescribes the significant components of marketing, the 4 Ps:Product, Place, Price and Promotion.

Product

There are numerous products and services we have available tous on a daily basis. How do we choose the correct frame mix, orthe right number of sunglasses? We must be certain we providefor our patients those products and services they value. Someyears back, a friend opened a discount optical shop in a veryhigh-fashion shopping center. He was certain this high trafficwould make him successful. Unfortunately the target marketwas more attuned to higher-end merchandise and he floppedmiserably. Another friend did as many are trying to dotoday...go high end! Surely we see it in the magazines all thetime, and it will be the savior of us all. NOT! He attempted tosell high-priced frames to folks who were not in the higherincome ranges, and also failed.

Core Conceptsin MarketingSome months back, we delved into marketingbriefly, and described its importance to the successof the contemporary eye care professional.

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What one must learn is to provide the right mix of productsand services to meet the needs and demands of the target market. That can be accomplished by looking carefully at his-torical sales data. We will easily be able to ascertain the numberof RXs dispensed in a given price range to a particular genderor other specified category. If we want to see if a new service issomething our practice can support, do a focus group withlong-time patients and let them tell you. Surveys and othertypes of feedback help us determine the right mix of productsand services.

Place

For years we have all heard that the most important thing inany business venture is location, location, location. Selecting aplace for your operations is still extremely important. Makingsure it is easily accessed by the patients you wish to attract isextremely important. If you are to be a high-end optical boutique, then a shopping mall with high levels of traffic mayjust be the ticket. If your focus is on price, then it may not bethe place for you. Low-cost leaders need a place that is highlyvisible, but it also must say to those who come in the door thatyou have what they are seeking.

One issue today that is on the mind of all of us in the eye careindustry, and in particular the optical side of the house is onlineretailing. The issue of place becomes somewhat skewed whenwe think about the online environment. One major concern isthat we have typically provided some services for little to nocost to get patients in our doors. Adjustments quickly come tomind, but there are many more. The consumer has now, unfor-tunately, placed those in the “free” category, and often come tosee us for free adjustments on spectacles purchased online.That really is a conundrum, and we have done it to ourselves.

There will be some pain felt in getting out of this mess, but Iencourage you to develop a pricing structure for purchasesmade elsewhere and stick to it. If patients only come to you forthe free stuff, you really don’t need them. If they value whatyour offer, they will return. Make yourself convenient, and eventhink about doing your own website to offer online conven-ience in a fashion that is palatable to you. You do not have tobecome a mass merchandiser, but can devise an online presencethat will help compete in that arena, and still keep patientscoming in the door.

Price

We have already discussed price a bit, but think about it thisway. A recent graduate student works at a golf course pro shop.

His pro got a great deal on some golf shirts at their very exclu-sive country club. He placed a low price on this recent purchase,thinking his customers would appreciate a “deal.” When youwalk in this club, it literally tells you through its appearance thatit is expensive. You know the place. The members do not wanta deal, but value exclusive merchandise. After meeting with us,they did a small experiment as this student’s final MBA project.He doubled the price on the same exact merchandise, and soldout quickly. It was re-packaged and in a different location,but was still the same shirt. What does that have to do with eyeglasses or contact lenses? It lets us to know that our patientsexpect a certain level of merchandise and to provide it for them.Just like my friend in the high-end shopping mall with the discount operation that failed, if you do not provide what yourtarget market wants, you will as well. Price appropriately, andyou will have a better chance of success.

Promotion

In earlier articles, we have addressed advertising, and I hopeyou will go back and review those articles to gain a broaderinsight on how to effectively advertise, but promotion is morethan just advertising. Do you serve on community boards?

Do you volunteer at the church? Do you make yourself visibleout there in the public domain so folks will want to come to seeyou? This is a part of promotion and costs nothing. When youbuy your stationary and business cards do they say to the folkswho receive them you are the kind of practice they want tocome to for their eye exam? I always recommend not to buy thecheapest card you can find, or worse, print them at home, butto have something designed that is reminiscent of the qualityorganization you want to portray. Promotion does not meanspend your last dime on a super bowl ad, but to appropriatelyget the message out to your target market, making them awareof your products and services, and asking them for their business.

Conclusion

The 4 Ps is an important concept. They are a frameworkaround which all of our marketing efforts can be developed,and will allow for higher levels of success. Next month we continue along this path, and talk about target markets. Whoare our patients/customers, and how can we effectively reachthem. I look forward to it. ■

“The significant components of marketing, the 4 Ps: Product, Place, Price and Promotion.”

JAN2011.qxd 12/17/10 4:01 PM Page 24

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26 | EEYECAREPROFESSIONAL |JANUARY 2011

Movers AND ShakersEssilor International

Essilor International has announced that itschief executive officer, Hubert Sagnieres, hasappointed two chief operating officers fromwithin its executive committee. Paul du Saillantwill be in charge of research and developmentas well as quality. In addition, du Saillant will

take on responsibility for global operations starting in the firsthalf of 2011. Du Saillant worked at Air Liquide for nearly 20years before joining Lhoist as Chief Operating Officer andmoving on to Essilor in 2008.

Laurent Vacherot will oversee corporate finance and will alsohead Essilor’s information systems & technology and investorrelations departments. Vacherot will also supervise the LatinAmerica region and will assume responsibility for Essilor’sequipment and instrument divisions.

RodenstockGerman lens manufacturer Rodenstock hasnamed two experienced global brand man-agers, Oliver Kastalio and Peter Körfer-Schünto top management positions. Kastalio,who was appointed chief executive officer, hasheld executive positions with Procter & Gamble

for 19 years in the areas of product development, brand management, marketing, M&A, finance and sales. Mostrecently, he was general manager and vice president of theGlobal Prestige Products division

Körfer-Schün, who was appointed toRodenstock’s supervisory board, served as CEOof Grohe AG until 2004. Under his leadership,the medium-size bathroom fittings manufac-turer from Hemer in Sauerland developed intoa complete provider of sanitary products and

systems and a global brand for bathroom fittings.

Eye Care Centers of AmericaGeorge Gebhardt, executive vice president andchief merchandising officer of Eye Care Centersof America (ECCA), retired last month.Gebhardt, a long-time optical industry retail executive, had been active in the buying,marketing and merchandising arena for many

years. He joined ECCA as executive vice president of mer-chandising in September 1996, when ECCA acquired his for-mer employer, Visionworks.

VSP GlobalVSP Global has named Yasmin R. Seyal as vicepresident, global treasurer. Seyal will overseethe company’s various treasury functions, anddirect global tax strategy and compliance,reporting to VSP Global CFO Donald J. Ball.

Most recently, Seyal served as senior vice president and CFOfor GenCorp Inc., a Northern California-based technologymanufacturing company that specializes in aerospace anddefense, as well as real estate. Prior to GenCorp Inc., Seyal heldnumerous positions with PricewaterhouseCoopers.

Bausch + LombBausch + Lomb has named Charl van Zyl ascorporate vice president and commercialleader, Europe, Middle East and Africa(EMEA). Mr. van Zyl will lead the company’scross-functional, multi-market EMEA opera-

tions team. He will also have direct commercial responsibilityfor B+L’s emerging markets in the region. Mr. van Zyl joinedBausch + Lomb in 2009, serving as vice president, EMEA, forthe company’s Pharmaceuticals business.

HOYA Vision CareHOYA Vision Care of North America hasannounced the promotion of Brad Main,FNAO to the positions of Director of Trainingand Technical Resources. Brad joined Hoya in2001 as a Territory Sales Manager in Virginia

and Washington, DC. He has also held the positions ofNortheast Region Training Manager and has been NationalTraining Manager at Hoya since 2007.

Davis VisionDavis Vision, Inc. has named James Knox to itsnational business development team as senioraccount executive of strategic sales-north. Hewill focus on sales and third-party accounts inthe northern part of the country. Prior to join-

ing Davis Vision, Knox worked with Citizen Security Life andHumana. Knox has over 30 years of experience in the grouphealth insurance industry including senior sales positions withmajor U.S group benefits companies and sales management oflarge and small group markets.

Eye DesignsEye Designs has named Patricia Bobilin as Managing Director,Southern Region. She will be responsible for managing

Paul du Saillant Yasmin R. Seyal

Charl van Zyl

Brad Main

James Knox

Oliver Kastalio

Peter Körfer-Schün

George Gebhardt

JAN2011.qxd 12/21/10 11:35 AM Page 26

accounts in the states of North Carolina,South Carolina, Georgia, Alabama,Mississippi, Arkansas, Louisiana, Oklahoma,and Texas. Patricia brings 21 of years of expe-rience in the eyewear industry having previ-ously served as District Manager, Key Account

Consultant, and Brand Specialist for Marchon Eyewear.

Eye Designs has also named Harry Stone asManaging Director, Northern California andPacific Northwest. He will be responsible formanaging accounts in the states of NorthernCalifornia, Northern Nevada, Washington,

Oregon, and Idaho. Harry brings 21 of yearsof experience in the eyewear industry havingpreviously served as District Manager forMarchon Eyewear.

Macular DegenerationAssociationThe Macular DegenerationAssociation announced thatDiana Schechtman, OD, hasjoined the organization’s

Medical Advisory Board. An associate pro-fessor of optometry at Nova SoutheasternUniversity College of Optometry,Schechtman also serves as an attendingoptometric physician at the Eye Instituteand Diabetic/Macula Clinic. She is a mem-ber of the American Optometric Associationand a fellow of the American Academy ofOptometry and the Optometric RetinalSociety.

Moscot OpticalMoscot Optical has promoted WendySimmons to the position of executive vicepresident. Simmons, who previouly servedas vice president of marketing for Moscot,has overseen public relations for the compa-ny since 2005. Simmons’ promotion is thesecond top management change Moscot hasmade since the death of its president, KennyMoscot, last month. Moscot’s brother, Dr.Harvey Moscot, OD, who had been vicepresident of Moscot Eyecare, has expandedhis role to president.

Transitions Optical Transitions Optical has announced the three finalists for its2010 U.S. Lab of the Year Award: Central Optical, ToledoOptical Laboratory, Inc. and Walman Optical. The winnerwill be announced on January 25. For the first time,Transitions Optical will also recognize a National andRegional Retailer of the Year, and a Vision Benefits Broker ofthe Year. Finalists for the National Retailer of the Year awardinclude Eye Care Centers of America & Empire Vision andNational Vision, Inc. Finalists for the Regional Retailer of theYear award include Eyear Optical, Henry Ford OptimEyesand SVS Vision Optical Centers. The Vision Benefits Brokerof the Year finalists will be announced mid-December.

Patricia Bobilin

Harry Stone

Diana Schechtman

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Show ‘EmSome Love!The lights and tinsel have been packed away. The tree has beenshredded into mulch for the garden. Gift cards spent and ThankYou notes written. The holidays are over for another year.

It’s time to transition from the Season of Light to the Season of Love. Believe me; what the world needs now is LOVE andsome fun.

What can you do to show your patients a little love?

♥ Wear Red Day is Friday February 4th.Thank every patientwho wears red with a red cleaning cloth or case. Visitwww.goredcorazon.org and www.nhibl.nih.gov for ideason recognizing the importance of good heart health andhow you can reach out to the local community.

♥ Send Valentines’ Day cards to your patients. They don’thave to be expensive, like so many things, it’s just thethought that counts. You could make your ownValentine postcards for very little expense and thepostage for a postcard is just over half the cost of a firstclass stamp.

♥ Valentines’ Day is Monday February 14th. Buy a coupledozen roses or carnations (depending on your budget)and give one to each patient who is in on Valentines’ Dayand keep that dish of candy kisses or hearts full all day.

♥ Put together a February frame and lens special for $214.Call it “Love Your Eyes.”Ask your reps about any specialsthey may be running or for help with special short-termpricing.

♥ Offer a special discount, perhaps 14%, on any red orpink products, from cleaning cloths to cases to frames.

It’s a great opportunity to group your red and pinkproducts together in an over-the-top display!

♥ Presidents’ Day is Monday February 21st. Offer a specialdiscount for every George, Washington, Abraham andLincoln who comes in.

That’s a lotta love for your patients, but after all is said anddone; they’re the lifeblood of your business. And if yourpatients are the lifeblood then your staff is its heart. Withoutthem, you’re not going to survive for very long.

Here are a few ideas to show some love to your staff.

♥ Have everyone wear red on Wear Red Day and take apicture for the office wall. Negotiate with a local pho-tographer to do the work in return for advertising inyour office. The photographer can do the same thing.It’s called cross-marketing and it works! I know a prac-tice that has a local photographer shoot pictures ofsome patients in their new eyewear to display in theoffice. It’s much more attention-getting than some ofthe POP supplied by vendors and an excuse for patientsto bring friends into the office. Once they’re in the door,they’re yours to keep!

♥ Bring in a Valentines’ Day breakfast for the staff. It’s aMonday after all and a great way to kick off the week.

♥ Present the staff with small corsages or boutonnieres.Everyone loves flowers and flowers at work are extraspecial. An added bonus is that your patients can seehow much you value your staff and that leaves a verypositive and memorable impression.

♥ Have a month long sales contest. Target an area you really need to improve and go for it. It can be any one ofa number of them:

Multiple pairsAnti-reflective (non-glare) treatmentsPolarized sunwearVariable tints (Transitions®, SunSensors®, LifeRx®, etc)

Dispensing OpticianJudy Canty, ABO/NCLE

JAN2011.qxd 12/17/10 4:09 PM Page 28

avoid too much internal competition. Contests should befun, not cutthroat.

Now, what about the office itself? Is it in need of a facelift?Nothing major, but enough to make it feel new again?According to several sources, including www.lifehacker.com,January is a good month for some investments in the office.

♥ Is it time for new carpet or some updated furniture?January seems to be the best month for making thesepurchases. Take a good look at the traffic wear patternson your flooring and if it needs replacing, do it. Nowlook at the waiting area furniture. Is it scratched, dirtyor just worn out and dated? If the frames are in goodshape perhaps just some paint and new upholstery willdo the trick. How’s the artwork on the walls? Gettingtired of the dogs playing poker or the frame manufac-turers’ calendar yet? Ask the staff, they have to live withit every day.

♥ Speaking of walls, how’s the paint looking?Fingerprinted, chipped, faded or stained? Paint is theleast expensive thing you can do to update the office.

♥ January is also a good month for purchasing appliances.Consider upgrading the refrigerator or microwave inthe breakroom. Perhaps the entire office would enjoyone of those single serve coffee makers. It sure beats los-ing a staff member to a coffee run in the afternoon.

Last but not least, show yourself some love. You own this busi-ness and you’ve survived the holidays and a sluggish economy.Give yourself a break!

♥ Learn to or force yourself to delegate. You have the best staff you could hire; now let them take some

responsibility off your shoulders. They’ll probably NOTsurprise you by doing a great job. If you have store managers in place, let them manage.

♥ Thank someone everyday. You’ll be surprised by howgood it feels and how motivating it can be for your staff,your family, your letter carrier or the delivery person.

♥ Take an hour every day to read a book or listen to musicor work in the garden. Whatever your passion is, don’tkeep it on the back burner. If you must be in the office,lock your office door, turn off the phone and take apower nap or play Solitaire on your computer or callyour Mom or Dad and just talk.

♥ Visit the Humor Project at www.humorproject.com.Click on their catalogue and order a Smile on a Stick foreveryone. February is the shortest month of the year yetsomehow feels like the longest. It’s still cold outside andevenings come early. Everyone’s gonna need a goodlaugh. According to the Mayo Clinic using laughter as astress reliever is no joke:

A good laugh has great short-term effects. When you start tolaugh, it doesn’t just lighten your load mentally, it actually inducesphysical changes in your body. Laughter can ‘enhance your intakeof oxygen-rich air, stimulate your heart, lungs and muscles, andincrease the endorphins that are released by your brain.’ Laughtercan improve your immune system by releasing neuropeptides thathelp fight stress and potentially more serious illnesses.

So, show ‘em some love and have a few laughs to start this NewYear. Your patients will appreciate it, your staff will appreciate itand you just may jump start the best year you’ve enjoyed in along time! ■

JAN2011.qxd 12/17/10 4:21 PM Page 29


If you have become shortsighted about your hired help then it’stime to put on those staffing goggles.

Why? Because staff is your biggest asset. One more time, staffis your biggest asset.

For those of you who see staff as your biggest liability thenhopefully this will be an eye opener.

Hiring adequate staff seems to be a mystery that doctors areconstantly trying to solve. What’s the motive behind these?

“We aren’t busy enough to hire anyone else.”

“I plan on hiring someone when things pick up.”

“There’s a 15 minute window between each patient and thatshould be plenty of time to get everything done, so why wouldI hire someone else?”

“I should have never hired Jack Slack but I feel so sorry for himso I have to keep him.”

“Patients will just have to wait because we can’t afford morehelp.”

“If we get busy I’ll just call my cousin who fixes kites to comeand help us.”

“There have only been a few days recently when we couldn’tkeep up or get to everyone that came in.”

“Don’t you have any friends that would want to work here everyonce in a while?”

“My wife said she might stop by today and help us.”

What’s busy enough? How do you know when things havepicked up to the hiring point? Is the 15 minute window closingin on you? What do you mean by couldn’t keep up?

The Mobile OpticianGinny Johnson, LDO, ABOC

Doctor my eyes have seen the years

And the slow parade of tears

Without frying (burnout)

Now I want to understand

I have done all that I could

To see our patients and sell goods

Without staffing

You must help me if you can

Doctor my eyes....

Doctor My Eyes...

JAN2011.qxd 12/20/10 9:51 AM Page 30

JANUARY 2011 | EEYECAREPROFESSIONAL| 31

Overloading staff with work to the point of obvious loss cancome back to haunt you. I’m referring to staff that works dili-gently to stay on top of everything. You might honestly thinkyou are making a wise business decision by running a skeletoncrew to save money. Does the amount you are saving on laboroutweigh inadequate staffing? Like rushing or neglectingpatients, lost sales, RX errors, lost third party reimbursementsdue to human errors, the phone ringing off the hook, work pil-ing up, staff turnover?

An understaffed medical practice may actually be your biggestliability.

Avoid focusing on staff using daily debt vision. What good doesit do to compare what you collect from one insurance patientto what you pay your staff on a case by case basis?

Example: “We only made $15 on that patient and I have to payyou more than that so I lost money.”

Is this what you call a profit and loss statement? Way to go, welost money because the patient didn’t buy anything and youwork here so I have to pay you. Save the daily comparisons forvent & bash staff meetings where everyone gets a turn. Yourstaff will be much more loyal to you if they are appreciated notdepreciated. And remember you should never underestimatethe value of any patient. You have no idea who that patientknows and that patient knows and on down the line. So thinkoutside the singular patient box.

Working with staff that has gotten too big for their britches (Idon’t mean obesity) can be a huge challenge. They are so over-ly knowledgeable to the point of knowing more about the prac-tice than the owner. If it weren’t for them the place would fallapart or not exist, right? If you have staff that throws theirweight around then tighten up that belt and start wearing thepants in your practice. It’s your livelihood, your future, yourdream, your investment; you should know every area of yourbusiness. Not that you want to micro or even macro managethe business but you don’t ever want to get caught with yourpants down. Staff will respect you more if they know you meanbusiness and are giving it your all.

Be careful if you like to remind your staff constantly that theyare lucky to have a job. How about this? They are not lucky tohave a job, you are lucky that they chose a great profession andyou as their boss. If that’s not the case then better luck next hire.

Speaking of new hire, maybe my list will help solve somestaffing issues before interviewing.

I’m Just Saying List

Full Time – 30-40 hrs/week (may vary).

Part Time – Less than 30 hrs/week.

Big Time – The money that hourly staff gets for their extra hardwork over and above their 40 hour workweek that sometimescomes with an explanation to the doctor.

Salaried – Staff ’s pay that is calculated annually not hourly.How many hours will you require your salaried staff to work?

ASAP Help – Look for mobile optical staffing in your area thatcan help out on short notice. Book them in advance for anyupcoming gaps in staffing that you may know of.

PTO – The well deserved time that the staff gets paid to beoutta there.

Bonuses – Who? What? When? Where? Why? How?

And So On or Etc. Time – The time that hourly staff spends offthe clock but on behalf of the practice (bank runs after hours,errands on the way to work, post office runs, internet workfrom home) Do you expect it from them? Do you consider it afavor you will repay? Have you even given it a second thought?

Vacation Time – How does your staff accrue vacation time?Can everyone qualify? How far in advance do vacation timesneed to be requested?

Health Insurance – No way, yes way, how much do you pay?

Vision Benefits – Free or discounted exam and products forstaff after so many days of employment? Will their familymembers be offered discounts?

Staycations – When staff is out of the office but offers to bereached at home. How do you compensate them for numerousphone calls or texts if you need their help?

Holidays – Which ones do you observe? Who is paid and whois not? Do birthdays count?

Lunch time – Do you stay open or close? Does lunch time lastfor 30, 60 or 90 minutes?

Sick days – The days that anybody who is contagious shouldstay away from the practice. For staff without paid sick daysthat need the money do you give in and let them stay at worksick? Do you require a doctor’s excuse after 3 days of absence?

Break time – Are breaks scheduled? How long are they? Willyou allow staff to work without taking breaks in exchange forleaving early?

Doctor – biggest resource

Staff – biggest asset

With all due respect, I’m just saying... ■

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Optical PhilanthropyLindsey Getz

A California-based ophthalmologist finds a way to do more for patients in need.

Kimberly Cockerham, M.D., F.A.C.S., was getting frustrated asshe watched more and more patients struggling with thehealthcare system, and not finding the help or answers theyneeded. Many were simply falling through the cracks. Thesepatients were in desperate need of care, but were unable toreceive it because of financial burdens and insurance issues.While they were turning to Cockerham for guidance, and shespent countless hours trying to find ways to help them, she toobegan to witness the confusion and lack of resources herpatients were experiencing. She was already involved in EyeCareAmerica, the Foundation of the American Academy ofOphthalmology’s program which allows ophthalmologists tovolunteer their services and provide eyecare for the medically

underserved. But her hands felt tied at doing more for thosewho had needs beyond vision care. After witnessing one toomany patients go without the help they needed, she decided tolaunch her own non-profit foundation to provide grants andother services. Cockerham has been helping patients ever since.

“The idea came out of spending more and more time adminis-tratively with my patients and trying to help them navigate thehealthcare system,” says Cockerham. “My patients were beingdenied funding for services or medications they really needed.When I tried to reach out to drug companies for help, I was toldI needed a foundation so that I could apply for grants—sothat’s what I did.”

Growing Concerns

Over the last five years in particular, Cockerham says she’s seenthe recession and changes in healthcare put her patients insome very difficult situations. She’s witnessed patients strug-gling to pay huge deductibles, patients who have had surgerydenied after the fact, and still more struggling with theMedicare “Donut Hole.” Cockerham has also watched manynewly unemployed patients on COBRA insurance unable to getthe full care they really needed. “Many of these are executiveswho may have once been at the top of their game—hardwork-ing, achieving businessmen and women that are now laid offand on COBRA insurance,” says Cockerham. “All of the suddenthey can barely afford medical care and their plans don’t covermuch.”

In addition, Cockerham says she was finding that patients wereconfused and overwhelmed by all the information they foundon the web—often information that was incorrect. “TheInternet is a huge resource when used correctly,” she says. But

HELPHELPA way to

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Cockerham says when used incorrectly, it can be dangerous.There’s a lot of false information out there, she adds.“Many people just want to find links to get information aboutprocedures and conditions but may end up getting incorrectinformation.”

But perhaps what discouraged her most was the decline in thephysician/patient relationship over the years. What is reallymeant to be a “helping profession,” and the reason so many gointo medicine is to do just that—help others—has changedgreatly as doctors’ hands are often tied as to what they can actually do for their patients. “I’ve been an MD since 1987 andduring the last two decades I’ve seen the physician/patient relationship suffer greatly due to managed care pressures thatlimit interactions and require ever-increasing staff time tomaneuver,” she adds.

As a solution, Cockerham founded, and is now executive direc-tor of, Let’s Face It Together, a non-profit that strives to put the“care back into healthcare.” The foundation helps patients whoneed help navigating the healthcare system through credibleeducational resources and seminars. It also offers grants topatients with a demonstrated medical and financial need and isworking to facilitate further research and medical advances onsome of the most common diseases and disorders.

Let’s Face It Together also provides what Cockerham calls a“consumer think tank”—a combination of blogs and chatrooms that can help consumers talk about how healthcare canget back on track. She is hopeful that with a collaborative effort,some long-term solutions may be discovered.

The Inspiration

While Cockerham says she has been inspired by many patientswho have turned to her for help over the years, one in particu-lar sticks out in her mind. In fact, Teresa Castenada—known byher friends as “Gina,” has been an inspiration to many. “Raisedin poverty, abuse, and violence, Gina overcame the odds tobecome the first in her family to graduate from high school,”says Cockerham. “She is now a deputy probation officer inSanta Cruz, counseling the kids in Salinas gangs to lead productive, non-violent lives.”

Though Gina had done so much to help others, when she need-ed help, she struggled to get it. This had a real impact onCockerham. “I met Gina months after a DUI driver slammedinto her car, severely injuring her face and inflicting otherinjuries,” she recalls. “While insurance covered restoring thetear drainage system to prevent infection, embedded glass waspresent in her forehead, nose, cheeks, and lips. That was tenderand disfiguring for Gina.”

Gina’s need for help was a major inspiration for Let’s Face ItTogether, says Cockerham. “She was able to be provided withcare when our current medical system couldn’t give it to her,”she says.“Over the past year, the painful glass has been removedand the scars have been resurfaced with an advanced resurfac-ing laser. All of this with no cost to Gina, who has a modestincome.”

Cockerham says her background in the Army was also an inspiration. “I was in the Army for 15years and in the military, communityis so important. You take care of yourown,” she says. “Then I went into private practice and academics andbegan to see a decline in community.Everybody is pointing their fingers atwho should provide care, but nobodyis providing it. I wanted to do some-thing—go back to the Army motto ofhelping each other. So I started brainstorming what would be mosteffective to the most number of peo-

ple. I obviously can’t solve everyone’s problems, but I wanted tostart solving what I could on a local basis. Then, if other doctorswant to join forces with the Foundation, they can help too.”

For more information, or to join forces with Cockerham, visit:www.lfitfoundation.org ■

Dr. Cockerham helped restore Gina’s tear drainage system.

Dr. Kimberly Cockerham

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VETERANSwith hidden

VISIONPROBLEMS

The picture of a wounded soldier with eye damage is usuallyseen as a person with bandages wrapped around their head andeyes. But those who have suffered from traumatic brain injuries(TBI) may still score high with Snellen letter testing, but mayexperience diplopia or movement of words on a page as well asother related symptoms.

These problems are often very difficult to discover and treat andmay have severe effects on a patient’s life. Due to the efforts ofinterested parties such as Dr. William Padula, legislation is in

place to help these soldiers who return with vision problems.Dr. Padula heads the Padula Institute of Vision in Guilford,Conn., and has spent most of his professional career researching the links between traumatic brain injuries andvision problems. The incidence of TBI has been one of the mostserious injuries sustained by returning vets from Iraq andAfghanistan. When roadside bombs or mortars strike, the shockwaves emanating from the explosion source may cause neurological problems in spite of the fact that no outward signsof damage are noticed. Dr. Padula states,“Even though there areeye injuries coming back from Iraq and Afghanistan, the majority of the soldiers also endure traumatic brain injuriesthat are causing brain processing problems in the visual cortex.This causes the visual process to become dysfunctional. It mayalso affect their speech, movement and behavior.”

Since the start of the war, 13 percent of the 9,000 seriouslywounded casualties who were evacuated from Iraq andAfghanistan suffered physical injuries to their eyes, according toThe Blinded Veterans Association. Dr. R. Cameron Vanroekel,an optometrist at Walter Reed Army Medical Center inWashington, D.C. reported that almost one third of all the soldiers treated at the hospital had TBI. He felt that 75 percentof that group had demonstrated problems with vision, hearing,reading, lack of peripheral vision, color blindness, poor concentration and total blindness. It is felt that the numbers aredrastically higher now than they were three years ago.

Dr. William Padula and two other doctors at Walter Reedapplied for a grant through the Blinded Veterans Associationadvocacy group as well as the office of Sen. John F. Kerry of Mass. Consequently, Sen. Kerry sponsored the Neuro-Optometric Center of Excellence bill. This would make $5 mil-lion available for the Dept. of Defense to create a model ofprevention, diagnosis, mitigation, treatment and rehabilitationof military eye injuries via a registry that tracks the handling ofcombat eye injuries and would set up research at Walter Reedregarding the screening and diagnosis of “visual dysfunctionrelated to traumatic brain injury.” Observers conclude that blastvictims who are protected by body armor can survive but maysustain severe injuries to the extremities and face. The soldier’suse of protective eyewear has limited effect since the explosionsare so powerful that they can reduce vehicles to scraps.One cannot expect high expectations from protective goggles.

Second GlanceElmer Friedman, OD


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Proudly mobilizing resources on behalf of the Global Optical Community for sustainable vision care projects.

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USD 328,000 for Vision Care Project (ICEE). 2001 – 2011.

Project aims: To establish new vision centers offering eye examinations and affordable spectacles to previously underserved communities.

Zambia

USD100,000 for Giving Sight to School Children in Zambia (SSI). 2008 - 2009.

Project Aims: To train teachers to screen primary school children and refer those with vision care needs to mobile optometric teams.

Mozambique

CAD50,000 for Regional School of Optometry, Mozambique (Dublin Institute of Technology, ICEE, WOF). 2010 – Future.

Project aims: Establish Mozambique’s first Optometry School in Lúrio University, Nampula.

Malawi

USD230,000 for Regional School of Optometry, Malawi (ICEE, SSI, WOF). 2008-Present.

Project Aims: To train Optometrists and Optometric Technicians as part of a multi entry / exit program and ensure that people using the public health system are the beneficiaries.

South Africa

USD875,000 for Giving Sight in South Africa Project (ICEE). 2006-2009.

Project Aims: To develop and implement a comprehensive child eye health programe and build the capacity of District Health systems to provide better access to vision care services.

East Africa

USD198,000 for Giving Sight to Blind Children in Africa Project (SSI, ICEE, CBMI). 2005-2006.

Project Aims: To provide vision careservices for vision impaired childrenbeing educated in blind schools inKenya, Uganda, Tanzania andMalawi.

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USD475,000 for Development ofOptometry in Eritrea (ICEE).2010 – 2011.

Project aims: Train eye care professionals and provide affordable, sustainable eye care services through establishing community based vision centers.

JAN2011_PSA-Africa.qxd 12/14/10 1:58 PM Page 1


Col. Francis McVeigh, OD is chief of the optometry service atWalter Reed and states that doctors at the Department ofVeterans Affairs identified some of the TBI related problemsthat included blurry vision and a “perceived shift in the visualmidline.” Like post traumatic stress disorder, many visionimpaired soldiers are not quickly diagnosed because the eyeinjuries are not easily apparent. Some physicians don’t knowwhat to look for. If they are only looking for physical injury tothe eye itself they may miss the brain injury as the causative fac-tor for the symptoms.

McVeigh adds that there are about 2 million TBI nationallyevery year because of car accidents and falls. Before the warhardly any attention was given to these cases. Dr. Padula revealsthat he has identified and researched two syndromes related toTBI, post traumatic vision syndrome and visual midline shiftsyndrome. Treatment involves prescribing special lenses andprisms that will lead to correcting the problem. It is pointed outthat many may be rehabilitated but a cure is not yet guaranteed.The therapy requires a multidisciplinary team. This mayinclude physical therapists, occupational therapists, orthope-dists, psychologists and optometrists. In addition to the hopesfor passing bills to supply these needed services for our menand women in the armed forces it will also raise the awarenessof millions of people who are victims of TBI and encouragethem to seek the help that they need.

A few days after experiencing a mortar explosion in Iraq whichalmost threw him off his heavy duty recon vehicle, GlenMinney reported to sick call with a headache and itchy eyes.He was treated for pink eye. A month later he woke up blind inhis right eye. He was evacuated to Germany where surgery wasperformed on both eyes. He was returned to the states to recuperate. The second day he was home he lost his vision completely. He was told that the surgeries were successful, butthe optic nerve was damaged beyond repair as a result of TBI.Minney had brain damage in the vision center of the occipitallobe as a result of the blast, which is not uncommon when theconcussion shock from an explosion whips the head back. Theimpact can stretch or tear actual brain tissue. The brain cellscan begin to necrose and produce the vision damage associatedwith these cases.

Army Staff Sergeant Brian Pearce lost his sight when shrapnelcut into his right occipital lobe in Iraq. The day after the injury,his wife Angela learned that her husband had gone blind. Hishead injury was so severe that he was in a comatose state for 47days. The doctors decided that his vision problems were notcared for due to the severity of his primary problem. AngelaPearce regrets that her husband was not referred to a TBI cen-ter since his visual acuity was 20/20 and his eyes were healthy.The problem concerned his inability to interpret the signalssent to the brain. He wonders how much better his vision

would be if his TBI problems were addressed earlier. Somecases may take as long as 15 to 20 years to diagnose.

Four years ago, Staff Sgt. Jay Wilkerson’s Humvee took a hitfrom a powerful roadside bomb near Baghdad. He was in acoma for 12 days. He lost two fingers and the left side of his facewas in shreds. He couldn’t walk for months. Wilkerson and hisdoctors failed to see what else was wrong. It concerned hisvision. He had Hemianopsia. It is a brain malfunction whicheliminates the effectiveness of his visual field. In his case,objects to the left of midline were invisible. Dr. GlennCockerham, chief of ophthalmology at the Palo Alto V.A., tookto calling them “occult” injuries since they seemed to escapedetection. He says,“If you ask these soldiers how they are doing,they’ll say they are doing fine. But when the examiner asks specific questions whose answers can be compared to othercases, they’ll then demonstrate that they are not doing as well aspreviously imagined.” Many of the veterans would bump intothings.

Dr. Gregory Goodrich, V.A. Research Psychologist joins Dr. Cockerham as a leader in the forefront of research anddevelopment of TBI investigations. He states, “Visual problemsgo hand in hand with cognitive or physical problems as well aspsychological problems such as depression. The patient mayisolate himself because he doesn’t want to be put in the worldbumping into people or losing his way. He may have a fear ofcrowds or feel embarrassed because he can’t visualize theexpressions on his friends’ faces. This social isolation can bedevastating and can lead to depression, anxiety and even substance abuse.” In an interview by Victoria T. McDonough,writing for Brainline, Dr. Goodrich reveals that it is difficult toconduct a conclusive study since TBI cases are so diverse andvaried and funding is very limited.

Dr. Goodrich revealed that they are considering three treatments that may be effective:

1. A technique to teach scanning wherein a person istaught to use an alternate area of the retina for best vision.

2. A device to take advantage of brain plasticity toincrease the needy vision field. Stimuli are adminis-tered to the vision field left intact and the area bordering it to allow a wider interpretation of thecombined fields of vision as they are meshed.

3. A device from Australia that uses a light board withrows of colored lights. A behavioral technique isemployed that uses head motions to scan into the lostvisual area. The motion somewhat resembles anobserver of a tennis match as the ball goes back and forth.


JAN2011.qxd 12/20/10 12:12 PM Page 38

More than 90 percent of decisions and reactions madebehind the wheel depend on good vision. While manybelieve a bright, sunny day is optimal for driving, thereality is that blinding glare from sun, snow and vehiclesis a significant contributing factor to fatal auto accidents.Additionally, a recent survey commissioned by Essilor ofAmerica, Inc., the world leader in eyeglass lenses,revealed a disturbing fact that 20 percent of eyeglasswearers sometimes drive without their prescription glass-es and instead wear non-prescription sunglasses,quicklymaking day-driving unnecessarily treacherous.

For blinding glare when driving, simple solutionsabound in the form of polarized, prescription sunglasses.In fact, a clinical study conducted by Essilor as a precur-sor to the survey found that driver reaction timesimprove by one-third of a second for drivers who wearpolarized lenses. For a car traveling 50 miles per hour,one-third of a second allows a driver to stop 23 feetsooner, or the length of an intersection. In glare-intense

situations, polarized lenses improve vision clarity by 75 percent, as opposed to ordinary sun lenses, allowingwearers to enjoy better clarity of vision.

“Only one-third of eyeglass wearers have prescriptionsunglasses with polarized lenses,” said Kim Schuy, SeniorGlobal Director of Marketing, Essilor. “As our roadwaysheat up this winter and glare from the sun and snowincreases, it’s critical that consumers discuss with theireyecare professional the life-saving benefits of prescrip-tion, polarized lenses.”

Trouble seeing while driving on sunny and/or snowydays is very common among glasses wearers. However,those with prescription sunglasses, particularly those with polarized lenses, experience less trouble.Specifically, over 60 percent of eyeglass wearers sur-veyed agree that when driving during the day, glare fromsun and snow makes it difficult to see while driving,notes Essilor’s survey.

Essilor Survey Finds One in Five Eyeglass

Wearers Drives without Prescription Glasses

Drivers Wearing Polarized, Prescription Sunglasses Are Less Likely to Report Problems Seeing During Winter and Day-Driving

JAN2011.qxd 12/21/10 4:43 PM Page 39

Dr. Goodrich advises that any victim of a TBI should be tested forvisual acuity, vision fields, contrast sensitivity and binocular vision. A conclusion must be reached to define eachparticular case as either a simple need for spectacles or is it related to something else? Further information is available viaVisionAWARE.org. It is a free, not for profit online resource center which can help veterans who are blind or have low visionproblems and their families to continue to lead satisfying,enriched lives by providing helpful resources and practical everyday hints. Details are also available on how to readjust lifeskills, train for a new job and utilize an adapted computer andother devices for better daily living tasks. Direct links are provided to the sites of the U.S. Dept of Veterans Affairs, BlindedVeterans Assoc., Disabled American Veterans and National Assoc.of Blind Veterans. A viewer will learn how to schedule a lowvision exam to determine whether certain appliances may be helpful.

Other online venues instruct how better lighting or other typesof training can help a person to use available vision more effectively. The sites mention Vision Rehabilitation Service suchas Orientation and Mobility and Vision Rehabilitation Therapy.This therapy can restore everyday functioning after vision lossand is similar to physical therapy utilized to help stroke victims.There are self help vision loss support groups and self-studyoptions that can help veterans and their families cope with theemotional impact of vision impairment. ■

Transitions Optical, Inc. recently supported the efforts ofTransitions Heritage Lab Ambassador Club member, ThreeRivers Optical, to raise $10,000 for Children’s Hospital ofPittsburgh of UPMC and the third annual DVE Rocks forChildren’s Radiothon. Representatives from Three RiversOptical, Transitions Optical, and WDVE 102.5 FM presented the check to Greg Barrett, president of theChildren’s Hospital of Pittsburgh Foundation (far right), on Nov. 5.

Transitions provided Three Rivers Optical with strategicbusiness support and customized marketing materials thatencouraged patients to take their kids in for an eye exam.For every Transitions® lenses sold during the month ofOctober, Three Rivers Optical donated $5 to the Hospital.

Three Rivers Optical and Transitions

Optical Help Local Children’s Hospital

JAN2011.qxd 12/22/10 11:28 AM Page 40

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IHAVE BEEN WEARING GAS PERMEABLE contact lenses(GP’s) for many years. Initially, I started wearing hard polymethylmethacrylate (PMMA) lenses and then switchedto GP’s. As a wearer, I have found there to be many

admirable traits to gas permeable contact lenses. Even thoughthe gas permeable contact lens market is a small one, it is indeeda viable market for the astute practitioner. The following articlewill cover the history of GP’s, comparisons of GP’s vs. soft con-tact lenses, fitting considerations, practical considerations, andfinish with an intriguing case history of a keratoconus patient.

Even though soft contact lenses dominate the market, there isstill a small, but significant market in 2010 for GP’s comparedto soft contact lenses (SCL’s). In present-day optical, optomet-ric, and ophthalmology offices – safety, convenience, comfort,practicality, and efficiency all drive the contact lens markets. Inthis atmosphere the patient will frequently wonder whichmodality is more comfortable, especially in the absence of anypromotion of gas permeable lenses. Have you seen any market-ing or advertising for gas permeable contact lenses in the news,print, or TV media? Probably not. Yet millions of dollars arespent by CIBA, Bausch +Lomb, CooperVision, and Vistakon topromote current and new SCL’s.

GP History

Gas permeable contact lenses were introduced to the market-place in the late 1970’s. Most gas permeable contact lenses aremanufactured with silicone which makes them more flexibleand more oxygen permeable than the hard PMMA contactlenses that predated the GP’s. Because gas permeable contactlenses do not contain water, protein and lipid materials in thetear film do not adhere to gas permeable contact lenses as readily as they do for soft contact lenses. This leads to greatercomfort and durability for this modality in the long term.

Why GP’s?

So why should ECPs fit rigid gas permeable contact lenses whenthe market is being driven by soft contact lenses, soft toric

contact lenses, and soft bifocal contact lenses? There are manypatients that have been fit with gas permeable contact lensesand do not want to change their eye care routine. They do notwant their crisp vision being affected by a different type ofcontact lens. They may simply be totally happy with their gaspermeable contact lenses and wish to continue. The risk ofmicrobial keratitis and serious corneal infections is much lesswith gas permeable contact lenses compared to soft contactlenses. There are also those patients that will definitely benefitby using gas permeable contact lenses, including those patientswith steep corneas, patients suffering from keratoconus,patients with irregular astigmatism, and those patients thathave been unsuccessful with soft contact lenses. Gas permeablecontact lenses can provide UV protection and the Dk valuesrange from a low of 18 to a phenomenal high of 151.

GP Benefits

Various colors such as blue, green, grey, crystal blue, brown,ocean blue, forest green, aqua, ice blue, and electric blue areavailable for color enhancement properties. Many ECPs stillenjoy the in-office benefits of finishing or polishing gas permeable contact lenses. Prescription changes can be donewithin an office setting and edges can be polished for comfortwhile a patient has a minimum of waiting time. Gas permeablecontact lenses will provide good vision, are durable, and aremore deposit resistant than soft contact lenses. Some eye careprofessionals are using gas permeable contact lenses to reshapethe cornea and to reduce or eliminate nearsightedness, a processcalled orthokeratology. Orthokeratology is being positionedsuccessfully as an alternate – a reversible alternate – to LASIKprocedures.

The Fitting Process

Every contact lens evaluation must include a thorough eyeexamination with an emphasis on ocular health. Cornealintegrity and corneal health must be thoroughly evaluatedthrough a biomicroscopic examination. One must be sure thatthe cornea is free of scars, infections, and dryness. Any of these

OD PerspectiveJason Smith, OD, MS

Gas Permeable Contact Lenses:A Primer on their History and Fitting


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problems must be addressed before considering a contact lensprocedure. The positions of the eyelids and the eyelashes mustbe determined. Ptosis, blepharochalasis, trichiasis, ectropion,entropion, and blepharitis need to be evaluated. The bulbar andpalpebral conjunctiva must be evaluated for redness,dryness, pingueculas, pterygiums, and allergic or infectiousconjunctivitis.

A trial frame refraction, keratometry measurements, a visualfield test, biomicroscopy, intraocular pressures, and a dilatedfundus examination will provide good information on thepatient’s overall ocular health and provide clues as to how suc-cessful a patient will be with contact lenses.

Contact lens fittings can be done either as a part of the ocularexamination or can be scheduled for another time. The goal ofa contact lens fitting is to find the most appropriate contact lensthat can be worn for optimal comfort, vision, safety, conven-ience, practicality and efficiency. Because there are manyoptions to consider between the patients’s needs and with thecurrent contact lens market, care must be taken to insure thatthe most appropriate lens is chosen initially. If the practitioneris recommending a gas permeable lens then base curves must becalculated, and prescriptions, thicknesses, diameters, andperipheral curves must also be determined.

Ordering Gas Permeable Contact Lenses

When ordering gas permeable contact lenses from optical laboratories, it is necessary to provide as much information aspossible to ensure that the product ordered is specific to thepatient’s visual needs. Refraction results and keratometry measurements should be included unless the eye care profes-sional is calculating the base curve measurements and contactlens prescription themselves. The color of the contact lens mustbe included in the order. Base curves, powers, diameters, opticaldiameters, thickness, and peripheral curves can be calculated bythe ECP or they can be calculated by the optical laboratory. Itdepends upon what is most appropriate for the patient and howreliable the optical laboratory is at manufacturing a specificproduct with only a refraction and keratometry numbers. Manycompanies will provide the eye care professional with a manualor fitting guide for determining the fitting parameters for specific brands of lenses.

Specialty GP’s

Many contact lens companies have keratoconus gas permeablecontact lenses that can be made to order. The ABBA-Kone lensby ABBA Optical is a Paragon HDS lens with a Dk of 58 and isavailable in blue or green. Art Optical makes the AKS lens andis available in “various GP materials” according to Tyler’sQuarterly. The Dk values are available from 18-151, dependingupon the material. Blanchard Optical makes the Rose K lens

and is available in any Boston material. Conforma Labs makesthe Conforma-K available in Boston XO with a Dk of 100 orBoston ES material with a Dk of 18. These lenses are availablein the color blue. Quite often, gas permeable contact lenses willbe able to provide keratoconus patients with good vision andgood comfort, but they are always a fitting challenge.

A Keratoconus Case Study

This case study involves a challenging keratoconus patient whohas been a patient for many years. “Sandra” is a 50 YO WF andhad been a soft contact lens wearer for many years. Her visionbegan to change in 2009 and I became suspicious of kerato-conus in her left eye due to those changes. She was referred to anoted local corneal specialist in order to have her corneas eval-uated with a corneal topographer. Due to some issues withcorneal dryness, punctual plugs were placed in both eyes in thesuperior and inferior puncta.

In 2009, her refraction was:OD: -3.00-0.50 X 50 Va 20/20 ADD +2.00 OS: -4.75-2.25 X 100 Va 20/40 ADD +2.25

Keratometry measurements were:OD: 45.25/45.62 180/90 degrees, mires clear and regularOS: 49.87/47.25 20/110 degrees, mires irregular and oblong

She was using Refresh artificial tears, 1-2 gtts OU four times aday and was placed on HydroEyes nutritional supplements.HydroEyes has nutritional components that treat the mucin,aqueous, and oily layers of the pre-corneal tear film and can bea very effective adjunctive tool in treating dry eyes. At this time,she was using her CooperVision soft contact lenses infrequent-ly. She was using a Cooper Proclear lens OD: 8.6 -3.25 14.2 anda Frequency Toric OS: 8.7 -4.50-2.25 X 100 for distance use andusing a pair of +2.00 reading glasses.

In 2010, her vision in her left eye became worse and herrefraction was:OD: -2.75-0.75 X 70 Va 20/20OS: -4.50-6.00 X 100 Va 20/100

Her new keratometry measurements were:OD: 45.37/45.75 180/90 degrees, mires clear and regularOS: 51.37/46.00 20/110 mires irregular and oblong

With such a big change in corneal curvature, it was now time toconsider a gas permeable contact lens for keratoconus. Allinformation was discussed with the patient with the goal ofinvestigating if I could improve her vision in her left eye. A gaspermeable contact lens fitting was completed and instructionswere provided concerning removal, insertion, wearing times,solution use, and the need for follow-up care.



JAN2011.qxd 12/21/10 2:30 PM Page 44

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21st Century Optics 41 800-221-4170 www.21stcenturyoptics.com

ABS Smart Mirror 27 888-989-4227 www.smart-mirror.com/us

Balester Optical 11 800-233-8373 www.balester.com

Clark Eyewear 9 866-923-5600 www.national-lens.com

CNS Frame Displays 13 877-274-9300 www.framesdisplays.com

Drivewear 33 888-807-4950 www.drivewearlens.com

Eyevertise 5, 39 847-202-1411 www.EyeVertise.com

FEA Industries 19, 35 800-327-2002 www.feaind.com

Grimes Optical 48 800-749-8427 www.grimesoptical.com

i-see optical 17 800-257-7724 www.iseelabs.com

Jee Vice BACK COVER 949-542-4838 www.jeevice.com

Luzerne Optical 23 800-233-9637 www.luzerneoptical.com

My Vision Express 47 877-882-7456 www.myvisionexpress.com

National Lens 18, 43 866-923-5600 www.national-lens.com

Nellerk Contact Lens Cases 49 607-748-2166 —

Opticom 40 800-678-4266 www.opticom-inc.com

OptiSource 47 800-678-4768 www.1-800-optisource.com

Optogenics FRONT COVER 800-678-4225 www.optogenics.com

Optometry Giving Sight 37 888-OGS-GIVE www.givingsight.org

Pech Optical INSIDE FRONT COVER 800-831-2352 www.pechoptical.com

SECO 51 770-451-8206 www.seco2011.com

Super Systems 15 800-543-7376 www.superoptical.com

Tech-Optics 47 800-678-4277 www.techopticsinternational.com

Three Rivers Optical 45 800-756-2020 www.3riversoptical.com

US Optical 21 800-445-2773 www.usoptical.com

Vision Expo East 25 800-811-7151 www.visionexpoeast.com

Vision Systems Inc. 47 866-934-1030 www.Patternless.com

The parameters that I ordered were:Paragon HDS material with a Dk of 58 in a blue colorOD: Base curve 7.42 Diameter 9.1 mm Rx: -3.25 Optical Zone 7.7 Center Thickness 0.13 mm

OS: Base Curve 7.45 Diameter 9.3 mm Rx: -3.00-2.25 X 180 Optical Zone 7.7 Center Thickness 0.24 mm Peripheral Curve 1.25 Prism, Front toric special design lens

Upon evaluation, both lenses were centered well and movedwell. Visual acuities were OD: 20/20 and OS: 20/40

She continues to use the +2.00 for reading. After dispensingthese new lenses with a wearing schedule for 2 weeks, she wasprovided written and verbal instructions and solutions.She left my office happy that her vision in her left eye was at anacceptable level, for now. She returned for a follow-up visitwhich yielded the same results as the initial consultation. I gaveher further instructions concerning vision changes, sensitivityproblems, movement of the contact lenses, and the need for follow-ups annually or as needed if she experienced any discomfort or fluctuations in her visual acuity.

I discussed the options with her that if this was not a satisfacto-ry outcome, then a corneal transplant may be an option downthe road. Another contact lens option would be a keratoconusgas permeable lens. Other future options for this patient mayinclude; Intacs or corneal inserts which received FDA approvalfor treating keratoconus in 2004. Tiny plastic inserts are placedin the periphery of the cornea that can help reshape the corneafor clearer vision. Corneal cross-linking is a non-invasive procedure that strengthens cornea tissue in keratoconus patients. FDA clinical trials began in 2008. Theouter epithelial portion of the cornea is removed and riboflavinis then activated with UV light.

New technology, new plastics, and future research discoverieswill add to our improved options for keratoconus patients aswell as for those who simply want contact lenses in any form.The advances that have occurred over the past twenty years havebeen very helpful for those patients in need. It will be interestingto see what develops over the next 5-10 years. It is one of themany reasons that I love being an optometrist. Keeping up withthe latest technological advances as well as furthering one’s educational aptitude allows all of the eye careprofessions to be dynamic and wonderful professions.For those of us blessed to pursue these outstanding professions,we are truly fortunate. ■

With contributions from Brian A. Thomas, P.h,D ABOM


Insight Software, LLC has announced that My Vision Express version 10.0 is ONC-ATCB 2011/2012 compliant and is certified as a Complete EHR in accordance with the applicableeligible provider certification criteria adopted by the Secretary of Health and Human Services (HHS). The 2011/2012 criteriafinancial support the Stage 1 meaningful use measures requiredto qualify eligible providers to receive compensation under theAmerican Recovery and Reinvestment Act (ARRA).

Listing on the CHPL website confirms that the Complete EHRproduct has been certified to meet all of the General Criteria listed in Section 45 CFR 170.302 and the Ambulatory PracticeSetting specific criteria defined in 45 CFR Part 170.304 whichhas been approved by the Secretary of Health and HumanServices (HHS). ONC-ATCB 2011/2012 certification conferred by InfoGard does not represent an endorsement of the certifiedEHR technology by the U.S. Department of Health and HumanServices nor does it guarantee the receipt of incentive payments.

JAN2011.qxd 12/22/10 2:25 PM Page 46

JANUARY 2011| EEYECAREPROFESSIONAL | 47

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Framedisplays.comis the leading provider of opticalframe displays for ophthalmic

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BACK WHEN EVERYTHING ON THE NET was through dialup connections we bought a ham for Christmas from aSmithfield Virginia Ham purveyor. Everyone at our holidaygathering was floored that we could do something like that!(The ham was terrific).

Now I watch my nieces and nephews on their smartphones,iPads, Droids, etc. navigating their way through life orderingmovie tickets, checking restaurant reviews, getting directions,finding out who is going to the pub tonight, and a myriad ofother activities that would tax Dick Tracy’s wrist phone.

The connections on the Internet are truly impressive, but thereis a dark side to this lovely picture. Stalkers, child molesters,cyber bullies, identity thieves, and eyeglass frame vendors!

Wait, what?

Yes, the New York Times has done a major story about VitalyBorker, a Brooklyn resident who has a web store calledDecorMyEyes. Mr. Borker has discovered a unique way to clawhis way to the top of the Google rankings when folks are looking for an eyeglass frame online.

His technique flies in the face of everything most of us havelearned about customer service. This is a guy who threatens

customers, uses false names, has made up “enforcer”pseudonyms that would scare Tony Soprano, sends pictures oftheir houses to them with a not too veiled threat that “he knowswhere you live” and; quoting from the NYT article, “‘Listen,bitch, I know your address. I’m one bridge over — a reference,it turned out, to the company’s office in Brooklyn. Then, shesaid, he threatened to find her and commit an act of sexual violence too graphic to describe in a newspaper.’”

He dotes on terrible reviews, the more bad reviews the higherhe climbs on the Google rankings. From the NYT again:“Borker says that selling on the Internet attracts a new horde of potential customers every day. For the most part, they don’tknow anything about DecorMyEyes, and the ones who botherto research the company – well, he says he doesn’t want their money.”

If you read consumer reviews he would rather you shop elsewhere.

A website called Get Satisfaction attempted to mediate onbehalf of Borker’s unhappy customers. They wrote, “We’d liketo talk to you; we should take a proactive approach.” His replywas a photograph of himself raising his middle finger.

This rudeness is key to the story; Borker stumbled upon theupside to it by accident. When he lost patience with customersand started telling them off in blunt terms – his Google searchrank improved. The more online chatter about his appallingways, the better his search engine rank.

How does he get away with it? Easily apparently. The Internetand the companies we deal with on it are still feeling their wayalong in these dark and seamy corners. Some day an order willbe established but for the meantime caveat emptor!

At this point I must make a strong point that we should beemphasizing to our customers (patients, clients, whatever) how important it is for them to BUY LOCAL! ■

Jim “Keep it Local” Magay

Last LookJim Magay, RDO

Online DispensingThe Dark Side of

JAN2011.qxd 12/22/10 11:29 AM Page 50

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Documents

EyeCare Professional Magazine January 2011 Issue