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The Affordable Care Act (ACA) has clouded the future of ophthalmology, said William L. Rich, MD.

	“The whole future is uncertain and we don’t have a role in it,” said Dr. Rich, medical director of health policy for the American Academy of Ophthalmology.

	Though Dr. Rich said he supports the ACA, he blamed politics for causing the health-care overhaul to have several major problems, many of which affect ophthalmologists.

	He cited the implementation delay, website design flaws, as well as low penalties for non-participation by young and healthy people as causes for the overhaul’s complications and confusion.

	Furthermore, these problems have not just caused comprehension confusion-they will also result in fewer patients seeking medical care, he said.

	Many of the health-care plans set by the ACA will have high deductibles, which will decrease patient utilization as well, he said.

	While Dr. Rich acknowledged high deductibles are good for the system, they are a problem for ophthalmologists because high deductibles mean fewer patients will seek care for chronic disease, thus increasing the long-term costs.

	“That is a huge problem for the division of care and physicians, no matter the practice,” Dr. Rich said.

	The ACA’s new payment models-combined with the lack of relief on documentation guidelines and regulations-cause major problems for ophthalmologists as well, he said.

	“How can they really control costs if patients can see anyone,” Dr. Rich asked. “All these create big problems.”

	The ACA was supposed to increase patient care and utilization in 2014, Dr. Rich said.

	Instead, he said, “you’re going to see more patients, (but) fewer than we anticipated.”

	Unfortunately, Dr. Rich said, the outlook for 2014 is just not what many had hoped it would be.

	“There’s still some time for them (the government) to get the Act together, because most of the problems come from political decisions not the value of the Act, the intent of the Act,” Dr. Rich said.

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Articles

Obamacare confusion bad for ophthalmology

-Children born extremely prematurely have up to a 19-times greater risk of retinal detachment later in life than those born at term, according to a Swedish study published this month in 

, the journal of the American Academy of Ophthalmology.

	In the large population-based, long-term investigation, the research determined that birth before 32 weeks is associated with increased risks of retinal detachment in childhood, adolescence, and young adult life.

	The researchers used Swedish nationwide population registries of more than 3 million births from 1973 to 2008 to identify subjects born prematurely. The patients were then separated into two groups: those born between 1973 and 1986-at which point a national retinopathy of prematurity screening program was established-and those born between 1987 and 2008.

	For patients born extremely prematurely (less than 28 weeks of gestation) between 1973 and 1986, the researchers found the risk of retinal detachment was 19 times higher than those born at term. Patients born extremely prematurely between 1987 and 2008 were found to have a 9-fold increase in risk after adjustment for potential cofounders.

	Those born very prematurely (28 to 31 weeks of gestation) between 1973 and 1986 were found to have a 4-fold increased risk and those born very prematurely between 1987 and 2008 had a 9-fold increase in risk after adjustment for potential cofounders.

	“We may just be seeing the tip of the iceberg of late ophthalmic complications after preterm birth,” said Anna-Karin Edstedt Bonamy, MD, PhD, pediatrician at Karolinska Institutet in Stockholm, and the study’s lead researcher. “Not only does the risk of retinal detachment increase with age, but there also has been an increase in survival among people born prematurely since the 1970s. This provides opportunities for future research to address if the increased risk persists among those born prematurely as they age.”

	To receive weekly clinical news and updates in ophthalmology, 

Children born extremely prematurely have up to a 19-times greater risk of retinal detachment later in life than those born at term, according to a Swedish study published this month in Ophthalmology, the journal of the American Academy of Ophthalmology.

Study links premature birth, retinal detachment

OD-OS has announced that its Navilas laser has been selected for a new study to evaluate the efficacy and stability of laser plus anti-vascular endothelial growth factor for the treatment of patients with diabetic macular edema (DME).

	The investigator-sponsored trial will compare the ranibizumab treat and extend regimen with and without navigated retinal photocoagulation.

	It was conducted by David Boyer, MD, Retina-Vitreous Associates Medical Group, Beverly Hills, CA; David Brown, MD, Retina Consultants of Houston; Lloyd Clark, MD; and John Payne, MD, Palmetto Retina Center, West Columbia, SC.

	The goal of the study is to evaluate two treat and extend strategies, and to demonstrate a reduction of treatment burden without compromising visual outcome in patients with DME.

	“If the laser does what we’re hoping it will do, it will improve our compliance tremendously because we’re going to reduce the number of injections,” Dr. Boyer said. “Patients don’t mind coming in every 2, 2 ½, or even 3 months, but when you have to come monthly for 1 or 2 years, they become disenchanted with continuing the treatment.”

	Dr. Payne, the study’s lead investigator, will coordinate the randomly assigned multicenter trial for which enrollment has already begun. It will compare 60 patients treated with the regimen plus adjunctive navigated laser treatment to 60 patients under only the regimen, and 30 patients with monthly ranibizumab injections.

	“We are anxious to see if we can improve treat and extend therapy with a navigated laser while reducing burden,” Dr. Brown said. “The precision of an image-guided laser enables us to perform more complete and accurate treatments that were simply not possible with conventional or pattern lasers.”

Navilas laser chosen for DME study

An innovative-yet-simple holder created by an ophthalmologist serves to answer the conundrum for where patients can store their eyewear during an eye exam.

It was nearly 2 years ago when William Neusidl, MD, began to notice his once clutter-free exam room had been taken over by cords, hardware, and wiring due to his clinic’s recent adoption of 

Empty tables where patients had stored their glasses during an exam were no more, causing frustration and confusion. Not knowing what to do with their glasses, patients would end up holding them, which would get in the way of exams, Dr. Neusidl explained.

“There was really no work space for (patients) to put their glasses,” said Dr. Neusidl, an ophthalmologist at Coventry Eye Associates, Phillipsburg, NJ. “They were fumbling around.”

A few days later, Dr. Neusidl had a late-night epiphany.

“I got out of bed and cut up cardboard at 1 a.m.,” he said. “I made a cardboard cutout (of an eyeglasses holder) and put a hinge on it. I thought, that’s how I can attach it to the slit lamp.

“When the patients take off their glasses, (I) move the machine toward them, (and) they naturally put their hand on top of the holder and put their glasses in it,” Dr. Neusidl said.

NEXT: Turning an idea into a product + Photo

What came next was a year’s worth of tweaking the holder, contouring it so that most eyewear would fit into it, and figuring out how to make sure it did not detach from the table.

The spectacle holder attaches to a slit lamp table so patients can have a place to store their eyewear during their exams. (Images courtesy of William Neusidl, MD)

Several prototypes later, Dr. Neusidl said he began attempting to secure a provisional patent for his invention called Spec-Deck.  The name combines the words “spectacles” and “deck” to emphasis the easy-to-use quality of the invention, Dr. Neusidl said.

A flexible hinge with a range of motion of 90° to 180° allows a secure attachment to various structures, such as a slit lamp table.

3M dual-lock tape serves as a clear, low-profile, re-closable fastener that attaches securely to most surfaces, such as glass, plastic, steel, fiberglass, wood, and painted surfaces. The fasteners are reusable up to 100 times and can withstand a large variation in temperatures (–20° F to >158° F).

A clear, protective, non-slip pad is placed inside the holder to prevent glasses from moving, as well as from being scratched or damaged. The pad is washable with soap and water. This element is important, Dr. Neusidl said, because it maintains sterility.

The most important aspect that makes the holder so valuable, Dr. Neusidl said, is that his invention is a “necessity” for all physicians’ offices. The product not only saves time during exams because patients are no longer fidgeting with their glasses, but it also can be sterilized and is cost-effective ($19 for the holder, fasteners, and pads).

After receiving a trademark for the invention, as well as securing Gulden Ophthalmics as a distributor, Dr. Neusidl said he hopes to take the holder beyond the physician’s office.

“Right now, it is for ophthalmology, but I hope to get it everywhere (eventually),” he explained.

Since he started advertising the product, Dr. Neusidl said he has been approached by colleagues and friends for more uses where people would need a place to keep their eyewear, such as golf carts, cars, motorboats, and lockers.

It is the hope of Dr. Neusidl that his invention will be utilized in every ophthalmologist’s office within the next 5 years.

William Neusidl, MD, invents eyewear holder that attaches to slit lamp table, gives patients safe place for glasses

Eyewear holder gives patients place to store glasses during eye exam

Alcon Laboratories Inc. has launched ocriplasmin, its treatment of symptomatic vitreomacular adhesion (VMA), in Canada.

	Canada is the first market where ocriplasmin (Jetrea) has been launched outside the United States and Europe.

	Health Canada approved the treatment in August following priority review.

	Alcon, a division of Novartis, acquired the rights to commercialize the treatment outside the United States in March 2012. It launched the drug in the United Kingdom-its first European market-in April, and was then followed by launches in Germany, Denmark, Findlay, Norway, and Sweden.

	ThromboGenics NV is commercializing the drug in the United States, having launched it in January.

	“The launch of (ocriplasmin) in Canada . . . is another important step in the global roll out of this innovative new drug for the treatment of symptomatic VMA,” said Patrik De Haes, MD, chief executive officer of ThromboGenics. “We are looking forward to working with Alcon as it continues to roll out (the treatment).”

Jetrea launches in Canada

The Vision Care Institute, an affiliate of Johnson & Johnson Vision Care Inc., has announced that 100,000 eye care professionals attended courses throughout its network of 14 sites worldwide.

	Launched in 2004, the Vision Care Institute has evolved from one institute in the United States to sites across four continents. To date, there have been more than 4,000 courses taught by 256 faculty members in 30 languages to accommodate attendees from 56 countries.

	“Having 100,000 eye care professionals come through our doors is an incredible milestone that shows the importance placed on continuous learning,” said Ian Davies, head of global professional education for Johnson & Johnson Vision Care. “We have challenged ourselves to understand the diverse issues and concerns of practicing eye care professionals in both developing and developed markets so we can foster more confident and current vision care that will ultimately benefit patients.”