EyeNet Magazine

Academy Notebook

What's Happening 

EyeSmart Promotes Protective Eyewear

It may not surprise you or your patients that, according to the 2008 Eye Injury Snapshot survey, the majority of eye injuries at home occurred in the yard (39.4 percent), garage (11.8 percent) and workshop (8.1 percent). What’s less obvious is that eye injuries also occurred at a high rate in other in-home locations, such as the kitchen, family room, bedroom and bathroom (34 percent combined).

The number of eye injuries in and around the home is why the Academy and the American Society of Ocular Trauma have kicked off the second phase of the EyeSmart campaign with a recommendation that all households have a pair of ANSI-approved protective eyewear. The key message is that wearing proper eye protection can help prevent up to 90 percent of eye injuries.

For more information and to sign up for free educational materials, visit www.aao.org/eyesmartcampaign. Information to help patients select the right protective eyewear is also available at www.geteyesmart.org, the Academy’s public education Web site.


EyeNet Earns High Scores in Media Rankings

EyeNet Magazine has earned high readership ratings again this year. In the 2008 Nielsen Focus survey, EyeNet ranked No. 1 for the fourth year in a row in both Cover-to-Cover readers (all ophthalmic publications) and Reader Frequency (non-peer-reviewed publications). EyeNet also maintained first place for Average Issue Ad Exposure (all ophthalmic publications).



International Scholar Award

The International Scholar Award offers international members who have already received the International Ophthalmologist Education Award the opportunity to further demonstrate their commitment to lifelong learning. Interested members need to pass a timed online self-assessment and achieve 60 continuing medical education (CME) credits within a two-year period after applying. Half the credits must be Academy-sponsored CME.

In recognition of this honor, participants will receive a certificate and will be listed on the Academy Web site, in the Annual Meeting Final Program and in EyeNet.

For more information, or to apply for the award, visit www.aao.org/international. To access the online CME transcript service, visit www.aao.org/cme.


New Member Benefit on the O.N.E. Network

The fifth edition of The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease is now available online as a member benefit. The full-color book covers disorders that might be encountered in the office, emergency room or hospital, and it includes symptoms, signs, workup, treatment and follow-up for each.

To access The Wills Eye Manual, visit www.aao.org/one and click “Library” and “Access Now.” For information on technical questions and system requirements for accessing the O.N.E. Network, visit www.aao.org/one and click “Start Explorer.”  


Efficiency Advice for Utilizing Technicians

Some practices maintain a highly efficient and productive workflow because they successfully leverage a combination of technicians and scribes. This frees the physician to do more complex tasks. For example, by staggering work shifts for its technicians and offering alternative work schedules, a practice can arrange for greater coverage on busy days. Cross-training technicians can allow all techs to perform diagnostics and exams. Having two autorefractors and lensometers in the office makes for fewer bottlenecks. These are some of the practical tips you will read about in the white paper Utilizing Ophthalmic Technicians to Increase Throughput: Experiences of a Model Practice by David A. Durfee, MD.

The paper provides both tips and strategies that allow practices to function more efficiently in anticipation of increased patient loads that are expected with the aging of the Baby Boom generation.

To view the full paper, visit www.aao.org/practice_mgmt/boomer.cfm.


Ask the Ethicist: Conflicts of Interest

Q: Is stock ownership in a medical device/equipment firm or a pharmaceutical company a conflict of interest for an ophthalmologist?

A: A conflict of interest may exist if a physician recommends treatments using devices or drugs manufactured by a company in which he or she has substantial stock ownership (especially if there are better or more appropriate choices in the marketplace).

Conflicts of interest or other serious ethical dilemmas may occur when a physician inappropriately interprets research results or reports or lectures to colleagues in order to increase demand and utilization for that device or drug. A conflict also may arise if the number of company shares awarded or the value of shares or options held may depend on the outcome of the research.

Unacceptable conflicts can occur if a physician recommends the utilization of certain devices or drugs to a hospital, insurance company or drug benefit plan, for example, and has substantial stock ownership in related industries. On a smaller scale, conflicts could arise when a physician recommends an equipment purchase for his or her practice or department.

The ownership of mutual funds that include stock in companies with which the physician is involved is generally not considered a conflict, except in the unlikely event that the physician is able to influence the selection of stocks for that mutual fund, pension plan or investment portfolio.

Potential conflicts of interest are all around us, and it is likely that any busy ophthalmologist occasionally will encounter them. Management of conflicts of interest begins with recognition and then disclosure to all parties who may have an interest, including patients, colleagues and the public. Beyond disclosure, we must be prepared to recuse ourselves from a decision or position of influence when appropriate.

For more information about conflicts of interest and other ethics-related topics, visit www.aao.org/about, click “Ethics” and “Advisory Opinions.” To submit a question for this column, contact the Ethics Committee staff at ethics@aao.org.


Annual Business Meeting

Notice is hereby given that the annual business meeting of the American Academy of Ophthalmology will be held on Sunday, Nov. 9, in Hall A-3 Session Room at the Georgia World Congress Center, Atlanta, from 10 to 10:30 a.m.
The order of business shall be:

Call to order
Report of the president
Report of the executive vice president
Election of fellows and members
New business
Announcements and notices

As stated in the bylaws of the Academy, the order of business of each annual business meeting may be amended by an affirmative vote of a majority of the voting fellows and members present and voting at the meeting.


Academy Store 

Preorder 2009 Coding Products

The Academy is now taking advance orders for next year’s coding products.

In addition to the full line updated for 2009, the Academy is offering three new products.  

  • The 2009 Frequently Asked Questions Coding Module (#012361) contains thousands of questions and answers identified by subspecialty.
  • The 2009 Code This Chart Module (#012359) features actual chart documentations and correct E&M code designations.
  • The 2009 ICD-9 Quick Reference Cards (#012329) includes frequently used ICD-9 codes.

Buy any four coding products together and receive a discount of 10 percent. Each module costs $39 for members and $53 for nonmembers. Each card set costs $25 for members and $33 for nonmembers.


New Patient Education DVDs Now Available

Two newly revised patient education DVDs are now available.

Understanding Age-Related Macular Degeneration (#050117) explains nonproliferative and proliferative diabetic retinopathy from both the physician’s and patient’s perspectives.

Understanding Diabetic Retinopathy (#050118) features real AMD patients discussing their experiences with the disease, and physicians discussing diagnosis and treatment options.

Both DVDs feature a Spanish-language option and contain high-quality images and animation to illustrate conditions and treatments. Each DVD costs $225 for members and $295 for nonmembers.


Gonioscopy Book Revised

The Color Atlas of Gonioscopy (#0212357) is a comprehensive introduction for clinicians wishing to be proficient in examining the anterior segment of the eye.

The second edition features: a reader-friendly format; updated text, references and review of disorders evaluated by gonioscopy; and new chapters on selective laser trabeculoplasty and anterior segment imaging. The book also includes a DVD-ROM of video clips demonstrating basic and advanced gonioscopic techniques.

The Color Atlas of Gonioscopy costs $69 for members and $89 for nonmembers. This product will be available for the first time at the Academy Store in the Academy Resource Center (Hall B-4, Booth #3532) during the Joint Meeting.


OTA: Anti-VEGF Pharmacotherapy for AMD

The Ophthalmic Technology Assessment of Anti-VEGF Pharmacotherapy for Age-Related Macular Degeneration (#112067), published in Ophthalmology this month, concludes that anti-VEGF pharmacotherapy is safe and effective treatment for neovascular AMD for up to two years.

This OTA costs $11 for members and $16 for nonmembers. OTAs can also be downloaded for free online. Visit www.aao.org/education and click “Ophthalmic Technology Assessments.”


Academy Store

To order products from the Academy Store, visit www.aao.org/store or phone the Academy Service Center at 866-561-8558 (toll free in the United States) or 415-561-8540.

You can also make purchases at the Academy Store in the Academy Resource Center (Hall B-4, Booth #3532) during the Joint Meeting in Atlanta.


Member At Large 

Advocacy in South Carolina

As part of their yearlong participation in the Academy’s Leadership Development Program (LDP), participants are required to develop a project of personal interest that also is beneficial for the state or subspecialty society responsible for their nomination.

Jennifer H. Merritt, MD, a member of the South Carolina Society of Ophthalmology (SCSO) and participant in LDP X, presented her project goals in January 2008 at a joint session of the Academy’s LDP and the Pan-American Association of Ophthalmology’s Curso de Liderazgo. During her presentation, Dr. Merritt noted, “I hope to develop a program for residents and young ophthalmologists that would allow for them to meet twice each year in the state capitol.”

Her ideas took shape on May 7 as she organized a Day at the State House in Columbia, S.C. Eighteen residents from both of South Carolina’s ophthalmology training programs were in attendance along with SCSO Executive Director Ronald C. Scott, JD, MBA, and SCSO members Kurt F. Heitman, MD, and Malcolm R. Edwards, MD. The day’s activities included a tour of the state house and a lunch program in which the participants discussed advocacy as well as the need to join their state society and the Academy. 

“Dr. Merritt’s efforts come at a critical time for the SCSO, as major scope of practice legislation is anticipated for the 2009 general assembly,” said Dr. Scott. “Her efforts will serve SCSO well in the future and also can serve as a national prototype, as it was very well received by legislators, residents and faculty.”



The Glaucoma Foundation has announced the creation of a new Award for Innovation and Excellence in Glaucoma to recognize the contributions of individuals who have played a unique role in promoting the medicine and science of glaucoma.

It will be presented to Robert Ritch, MD, on Dec. 3 at the Glaucoma Foundation’s annual gala. Dr. Ritch is the organization’s founder and holds the Shelley and Steven Einhorn Distinguished Chair in Ophthalmology and is surgeon director and chief of glaucoma services at the New York Eye & Ear Infirmary.


Candidates' Views 

Meet the Board of Trustees’ Nominees for 2008 Election

In June, the Academy’s Board of Trustees nominated an official slate of officers for its Board of Trustees. The following have given their consent to serve if elected and therefore constitute the official slate. If the Academy’s membership approves all candidates, their respective terms begin Jan. 1, 2009.

Academy members will be given the opportunity to vote online or by traditional paper ballot for officers and trustee-at-large positions of the Board of Trustees.


Randolph L. Johnston, MD 
Board of Trustees’ Nominee for President-Elect

I am honored to be nominated for the position of President-Elect of the American Academy of Ophthalmology for the year 2009.

Ophthalmology is facing the perfect storm. The environment in which we practice is unsettled as never before.

In the political arena, we face constant pressure on reimbursement, with a 5 percent cut in Medicare fees in 2002 and higher cuts threatened yearly. Even when Congress intervenes at the last minute with a freeze or a minimal update, our fees decrease as measured against inflation. Ophthalmologists are increasingly retiring early or refusing to see Medicare patients. Medical liability reform continues to be a pipe dream in most states.

On the state level, we face an increasing threat to quality patient care because of nonphysicians who broaden their scope of practice by legislative and regulatory means rather than education.

These pressures are compounded by the coming explosion in geriatric disease as the Baby Boomers enter their “golden years.”

All is not lost for the practice of ophthalmology. The Academy continues to make inroads in educating the public about the difference between physician and nonphysician. We know that patients, once educated, strongly prefer to have their surgery performed by a physician.

The Academy is working to help us become more efficient in order to care for the increase in patients. There are a number of models of efficient practice that have been or are being developed. The Academy does not claim to know which is best for your practice, but we can help you evaluate the options.

Lastly, our greatest strength is our education. The best patient care comes from the best educated practitioners. Education is what separates us from the nonphysician. Continuing medical education, which the Academy does better than anyone else, is what guarantees quality care for our patients. The Academy is developing newer and better methods of continuing education such as the O.N.E. Network.

You, the member, can help the Academy achieve these goals. In my time with the Academy (State Affairs, the Council, the OphthPAC Committee and the Board of Trustees), I have seen the major benefits of the Academy’s advocacy tools. OphthPAC played a significant role in the recent Medicare fee fix, helping our Eye M.D.s and our excellent lobbyists gain the ear of members of Congress. The Surgical Scope Fund has so far helped 26 states forestall optometric surgery and laser privileges. The Academy’s excellent staff makes all of this possible. We are handicapped, however. The idea that we use only 10 percent of our brains is an urban myth. That we use only 14 percent of our members is, unfortunately, true. Only 14 percent of our members contribute to OphthPAC and the Surgical Scope Fund. Imagine what we could do by using, say, 50 percent of our members.

If elected, I will work hard to maintain our excellence in education and improve our clout in advocacy. I am interested in everyone’s ideas for the Academy. I can be reached at rjohnston@cheyenneeye clinic.com.


Cynthia A. Bradford, MD 
Board of Trustees’ Nominee for Senior Secretary for Advocacy

Ophthalmology is a great profession that not only allows daily miracles for patients, but is personally and financially rewarding for physicians. Our educational programs have high standards and our research leads to incredible new treatments for patients. But without advocacy for our profession and patients, our foundation of education and research cannot survive. For years, reimbursement for our services has declined and more physicians are now aware that we must all participate in the solution to stop further decline. Slowly over the decades, optometry has expanded its scope of practice using the phrase, “this is all we want,” forgetting to add the disclaimer, “for now.”

Ophthalmologists must realize optometry is not going to stop unless we act together to stop the progression. As a young ophthalmologist in Oklahoma, I was witness to one of the early laser shots by optometry—a patient who came to me for a second opinion on a laser peripheral iridotomy performed by an optometrist. Her problem? An epiretinal membrane. The year? 1988. Until that time, I thought state government protected patients, but I learned that we must all be active in the political process to protect patients and our profession. As state ophthalmology society president after the 1998 optometric laser bill (you read right, 10 years after they started doing ocular lasers) and subsequent “scalpel law,” the political process was painfully obvious. As a regional representative, Associate Secretary and Secretary for State Affairs, I have had the opportunity to learn extensively about the state political process. I have also had the opportunity to meet comprehensive, subspecialist and academic ophthalmologists throughout the country and am awed and amazed at the hundreds of dedicated ophthalmologists who represent our profession actively in each of our state, subspecialty and specialized interest societies . . . Unsung heroes. Individuals who donate their time and money for the entirety of our profession.

On a federal level, we have equally talented ophthalmologists who are known both inside and outside our profession as experts in the complex system of Medicare. Without this expertise, ophthalmology’s reimbursement levels would be lower. Our Washington, D.C., lobby team is extraordinary and recognized as one of the best. I look forward to leading our state and national advocacy teams in promoting our profession as the leader of the eye care team. We are the only professionals trained to diagnose and treat ocular disease. Ophthalmologists should be paid reasonably for our work, and others without equal training should not be able to legislate the right to mimic our profession.


Laurie Gray Barber, MD 
Board of Trustees’ Nominee for Trustee-at-Large

I am honored to receive the Academy Board of Trustees’ nomination for the office of Trustee-at-Large. I hope to contribute a unique perspective, representing the interests and concerns of the general membership of the Academy.

My leadership perspective stems from six years on the Academy’s Council, five years as chairwoman of OphthPAC, five years on the Academy’s Advocacy Committee and experience as president of the Arkansas Ophthalmological Society and the University of Arkansas for Medical Sciences (UAMS) Women’s Faculty Development Caucus. I am currently chairwoman of the Surgical Scope Fund Committee and professor of ophthalmology at UAMS, Jones Eye Institute.

As an ophthalmologist, many of my patients have become like extended family. They have advanced my education in medicine and life in general. As a physician, I have the duty and honor to care for each patient as a whole. I am also duty-bound to protect them in the political arena, if I fear for their safety.

As an educator, I have taught and mentored a continuum of students, from high school to practicing physicians. Personal and political advocacy is a critical component of physicians’ and patients’ education. In addition, my research into medical students’ empathy drives my emphasis on positive role modeling of effective physician/patient relationships.

Clinical research is an important part of my career and the relationships that have been forged with pharmaceutical scientists and representatives have led to scientific improvements in patient care. Although it is critical to keep relations with pharmaceutical companies transparent, I do not believe it is in the best interest of our patients or future medical developments to completely divorce pharmaceutical research or relationships from expert physicians.

As a mother, wife and daughter, I am concerned with the health of the nation and the future of medical and ophthalmologic care. I believe that the Academy is and should remain at the vanguard of positive political change. In order to most effectively serve the general membership as Trustee-at-Large, I will maintain an open mind, high ethical standards and approachability. As a team, we can affect progress with medical education, physician/patient relations, medical advances and political activism.


George A. Williams, MD 
Board of Trustees’ Nominee for Trustee-at-Large

I am honored to accept the nomination as a Trustee-at-Large of the American Academy of Ophthalmology. Since my first meeting in 1979, the Academy has played a central role in my professional development through its Annual Meeting, journal, educational programs and leadership as the voice of ophthalmology. Like all Academy fellows, I continue to benefit from the educational and advocacy missions of the Academy, and I welcome the opportunity to serve this outstanding organization.

The future of ophthalmology has never been so promising or so challenging. The promise is evident in the continuing evolution of breakthrough therapies for blinding disease. These therapies are testimony to the innovation and dedication of our ophthalmic colleagues throughout the world. During my career, there has been an explosion of remarkable advances across all of ophthalmology. The recent advent of effective therapies for neovascular age-related macular degeneration is revolutionary. The despair and depression that characterized AMD has been replaced by hope and optimism for both patients and ophthalmologists. Driven by our improved understanding of the molecular and genetic mechanisms of visual loss, we now stand on the threshold of an era with the realistic expectation of therapies that can prevent or reverse blindness for millions of people. It is probable that within the next decade we will have genetic therapies, stem cell based therapies and even artificial vision. The implications of these new treatments for our profession and our patients are staggering.

Unfortunately, there are significant challenges to our nascent therapeutic wonderland. Not surprisingly, these challenges involve money and the very real question of whether we will have the financial resources necessary to bring these therapies to fruition. A perfect storm is rising in health care, in general, and ophthalmology, in particular, with a confluence of factors involving patient demographics, physician manpower shortages, new technologies, macroeconomics and, perhaps most ominous of all, politics. There is consensus that the growing proportion of gross domestic product consumed by health care is not sustainable. Therefore, significant change is coming to the practice of medicine. This change will involve how physicians are paid, what drugs they may prescribe, what procedures they may perform, which patients they may see and even how many hours they may work. Central to these changes will be the requirement that physicians demonstrate the value of their care. Treatments with high value, proven by evidence-based analysis, will be rewarded and treatments with low value will be discarded. As always, the devil is in the details, and exactly how and by whom value will be determined is uncertain.

Fortunately for ophthalmology, the Academy has already recognized the impending storm. As a member of the Health Policy Committee and as the Academy’s alternate delegate to the Relative-Value Update Committee, I have been impressed by the leadership and vision of the Academy as it addresses the future of ophthalmology in a changing health care system. With a strong focus on the value of ophthalmic care, I am confident that we can achieve our therapeutic


Academy Governance Overview

BOARD OF TRUSTEES. The policy-making body of the Academy. The charge of the Board of Trustees is to manage and direct the business affairs of the Academy in furtherance of its mission and strategic goals.

SECRETARIATS. Directly involved in the development and management of program activities and services. The Secretaries provide recommendations to the Board on the relative priority of major programs within the Academy.

COMMITTEES. Under the direction of the Secretariats, Committees develop and implement specific programs that address the long-range objectives of the Academy.

COUNCIL. The Council serves as the advisory body to the Board of Trustees and provides recommendations for Board action based on membership concerns.


Washington Report

2009 Fee Schedule Continues Quality Emphasis

Next month, CMS will publish the 2009 Physician Fee Schedule, including a controversial proposal to require physicians who provide office-based imaging to enroll as an independent diagnostic testing facility (IDTF).

CMS believes there are unequal requirements for imaging services because IDTFs must adhere to significant quality and performance standards not required of individual physicians and group practices. In June, CMS expressed concern in the 2009 Medicare Physician Fee Schedule Proposed Rule that such physician practices may be providing diagnostic testing with unqualified personnel or improperly maintained or calibrated equipment. The Academy opposes this CMS proposal.

The Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), which became law in July, separately requires that providers of advanced imaging services become accredited with a national, third party accreditation organization by 2011, ensuring the qualifications of nonphysician personnel and supervising physicians for the most costly imaging services. Congress acknowledged the uniqueness of ultrasound services when the Academy fought and won its exclusion from the mandatory accreditation provisions included in H.R. 6331.

Extending the IDTF requirements to ophthalmologists and ophthalmic imaging such as ultrasound and optic nerve imaging will threaten access to vital diagnostic services. Individual Carrier IDTF supervision rules often do not recognize that ultrasound services are provided by a wide variety of physicians. Ultrasound services are uniquely integrated into the clinical practice of physicians engaged in direct patient care, unlike other imaging.
For practices, enrolling as an IDTF requires:

  • Onsite pre-enrollment carrier inspections.
  • Completion of an extensive application process.
  • Licensing or certification of nonphysician personnel to perform diagnostic imaging services.
  • Designation of a supervising physician who must be proficient with each diagnostic test the IDTF performs. Enrolling as an IDTF also:
  • Limits a physician who provides general supervision to no more than three IDTF sites.
  • Prohibits sharing a practice location with; leasing or subleasing its practice location or its operations to; or sharing diagnostic testing equipment used in the initial diagnostic test with another Medicare-enrolled physician or practice.

A final decision won’t be known until the final rule is published in November. The requirements are set to begin Jan. 1 for new physicians and Sept. 30 for all others.

CMS will propose new imaging standards next month.


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