A weekly e-journal by Art Epstein, OD, FAAO


Volume 18, Number 45

Monday, November 5, 2018


Inside this issue: (click heading to view article)
######### Off the Cuff: Customer Service vs. Disservice: A Tale of Diametric Opposites
######### Myopia Growth Chart Based on a Population-based Survey
######### The Underestimated Role of Refractive Error and Strabismus in Children With ADHD
######### Anterior Segment Scheimpflug Imaging for Detecting Primary-angle Closure Disease
######### News & Notes

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Off the Cuff: Customer Service vs. Disservice: A Tale of Diametric Opposites

Many of you followed our journey to South Africa this past summer. During one of the most amazing and inspirational travel experiences of our lives, Shannon and I made friends, connected with colleagues and saw nature and the world differently than ever before. We also learned how powerful both good and bad customer service can be in shaping an overall experience.

While the trip itself was memorable and incredible, getting to South Africa now tops my list of painful and unpleasant travel. Past experience with British Airways invokes images of travel misery, but beyond the usual lost bags, absurd and senseless delays, and dealing with the pedantic uncaring asses who work there, this time BA fell far below even their own already miserable standards.

Because our trip sponsor’s budget was limited, we agreed to fly in premium economy instead of business class. I usually book international trips using American Express Travel for a number of reasons. My first credit card after graduating from optometry school was an American Express card and I've carried one ever since. For travel, American Express has been incredibly helpful, both for booking and when issues arise. They truly add an extra layer of comfort.

After a good deal of thought and discussion about the 24-hour plus travel time, Shannon and I decided to upgrade to business class for a not insignificant additional $6,000. Given the length of the trip, we decided it was worth it. So we called American Express who attempted to book the upgrade, only to be told by British Airways that our slightly discounted fare was not upgradable. Essentially, they didn't want our $6,000 or apparently to sell us their empty, overpriced seats. It took three days for this to play out, and after multiple failed attempts by American Express to fix the issue, we were supposedly placed back into our original itinerary. Supposedly.

A week before our journey began, as I usually do for complicated trips, I double-checked our flights and travel details. Amazingly, I discovered that BA had screwed up rebooking our reservations, leaving us stuck in London for an extra day. You would think such an obvious error would be easily and cheerfully corrected. Considering it was British Airways, you would be wrong. Thankfully, we had American Express on our side.

As soon as I discovered the error, I called Amex travel. I was connected to Lauren, a pleasant and efficient young lady who shared that she loved her job and would be happy to help straighten out BA’s error. She placed me on hold and cautioned it might take a while. It did. Forty-five minutes later, a clearly flustered, but still pleasant, Lauren apologized for the delay. She had spoken to five different BA agents, and only the very last one was willing to help fix what was their mistake in the first place. The problem was she would have to rebook our entire return. She assured me that she would take care of it first thing in the morning and wished me a pleasant Saturday night.

Two hours later we were in the office seeing an emergency patient when my cell rang. At first, I didn't recognize Lauren's voice, it was little more than a raspy squeak. She explained that she decided to resolve the issue that night and ended up staying at her desk an extra hour (on a Saturday night no less), spending two miserable hours on the phone with the dolts at BA. Thankfully, Lauren did have good news. She was able to rebook our flights. After hours of dealing with BA intransigence and nastiness, losing her voice in the process, you'd think she would have been quite frustrated and annoyed. Not so. Lauren couldn't apologize enough for BA’s issues and was clearly excited that she was able to help us.

I thanked her profusely and asked to speak to her supervisor to share how incredible this young woman was. As I finished singing her praises, her supervisor asked me to hold the line. Lauren wanted to confirm and finalize our flights. When she returned to the line, she also had an incredible and completely unexpected surprise for us. Because of all the problems and apparently because I was so nice about it, she somehow managed to get our return flights upgraded to first class. At first I thought she was joking, but she wasn't. She took what was an incredibly miserable experience with British Airways and turned it into what was the best customer service experience in more than five million miles of travel. I don't know how she and American Express managed it, but Lauren took miserable and made it remarkable.

While American Express is known for exceptional customer service, this was so far above the norm, I recognized it as a true learning moment, one that I've shared with my staff many times since. No extreme is too great to make things right or to take good care of a patient. I can tell you that attitude has made a difference in our practice.

A sincere thank-you to American Express and especially to Lauren for making things right and reminding me how important it is to go above and beyond. As for British Airways, next time, I'll walk.
Arthur B. Epstein, OD, FAAO
Chief Medical Editor


Want to share your perspective? Write to Dr. Epstein at artepstein@optometricphysician.com.

The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Medical Information LLC (JMI), or any other entities or individuals.


Myopia Growth Chart Based on a Population-based Survey
This study included 7,695 Korean participants, ages 5 to 20 years, from a population-based health survey (Korean National Health and Nutrition Examination Survey IV-V) to introduce a novel myopia growth chart, based on a population-based survey for the prediction of myopic progression. The authors collected spherical equivalent (SE) data converted from non-cycloplegic refraction data. To create a myopia growth chart, data were arranged in the order of SE from hyperopia to myopia to acquire specific percentiles of the SE by age. Myopia progression rates were calculated between two specific ages in each percentile.

The mean age of the participants was 11.8 years, and the mean SE was -1.82D. The SE of the 10th percentile was +0.72D for participants age 5, and -0.25D for those age 20, resulting in a total change in refraction of -0.97D. In contrast, the SE of the 90th percentile was -0.75D for participants age 5, and -6.73 D for those age 20, showing myopia progression of -5.98D. The myopia progression rate from 5 to 20 years of age was estimated as -0.06D, -0.15D and -0.40D/year in the 10th, 50th and 90th percentile groups, respectively.

Researchers suggested that the myopia growth chart might be used to diagnose the severity or estimate the progression of myopia. A patient in a higher percentile of myopia for his or her age might have myopia progressing at a faster rate and, thus, require close observation.

SOURCE: Kim DH, Lim HT. Myopia growth chart based on a population-based survey (KNHANES IV-V): a novel prediction model of myopic progression in childhood. J Pediatr Ophthalmol Strabismus. 2018; Oct 26. [Epub ahead of print].

The Underestimated Role of Refractive Error and Strabismus in Children With ADHD
This study examined the association of refractive error (myopia, hyperopia, astigmatism) and strabismus with ADHD. Based on data from the large, representative, epidemiological sample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study (n=13,488), the associations of myopia, hyperopia, astigmatism and strabismus with ADHD were examined, with and without consideration of other common ADHD risk factors.

In single logistic regression models, all examined forms of refractive error and strabismus showed an association with ADHD. After controlling for confounding variables, results remained stable and showed an increased risk for ADHD in children with hyperopia, astigmatism and strabismus compared with the control group. Only the association between myopia and ADHD in children was not significant.

Investigators wrote that hyperopia, astigmatism and strabismus seemed to be independently associated with ADHD. They added that health care professionals in different medical fields should consider this association to adequately diagnose and treat affected children.

SOURCE: Reimelt C, Wolff N, Hölling H, et al. The underestimated role of refractive error (hyperopia, myopia, and astigmatism) and strabismus in children with ADHD. J Atten Disord 2018; Oct 29. [Epub ahead of print].




Anterior Segment Scheimpflug Imaging for Detecting Primary-angle Closure Disease
This study evaluated the capability of anterior segment Scheimpflug imaging for detecting primary angle closure disease (PACD): primary angle closure suspect, primary angle closure and primary angle closure glaucoma, using cutoff points derived from reference databases of healthy subjects. Eighty-seven patients with PACD and 49 age-matched control subjects were included. Researchers evaluated the sensitivity and specificity of anterior chamber depth (ACD), anterior chamber volume (ACV) and anterior chamber angle (ACA) to differentiate patients with PACD from controls. Additionally, the study's raw data was analyzed via receiver operating characteristic curves for comparison.

One standard deviation from the normative data's mean values was used as the cutoff point and yielded a sensitivity and specificity of 96.2% and 92.6% for ACD, 97.1% and 75.9% for ACV, and 93.3% and 72.2% for ACA, respectively. Receiver operating characteristic analysis of the raw data showed the area under the curve to be 0.984, 0.975 and 0.931 for ACD, ACV and ACA, respectively.

Researchers found that the study demonstrated that the parameters of anterior segment Scheimpflug imaging, particularly ACD, accurately discriminated PACD. This was the first study to validate the device's normative data in a separate population. Researchers wrote that anterior segment Scheimpflug imaging was a potentially powerful screening tool for PACD, with its high reproducibility, ease of use, non-invasiveness and speed.

SOURCE: Winegarner A, Miki A, Kumoi M, et al. Anterior segment Scheimpflug imaging for detecting primary angle closure disease. Graefes Arch Clin Exp Ophthalmol. 2018; Oct 30. [Epub ahead of print].

2018 West Coast Optometric Glaucoma Symposium

News & Notes

Johnson & Johnson Vision to Showcase New Data and Interactive Experiences at 2018 American Academy of Optometry Annual Meeting
Johnson & Johnson Vision will highlight new data at the 2018 American Academy of Optometry annual meeting in San Antonio (Nov. 7-10). Two paper presentations highlighting visual performance of photochromic contact lenses were designated among the most newsworthy at the meeting by the Academy. Johnson & Johnson Vision will also sponsor and host a variety of interactive experiences throughout the meeting, focused on enhancing care and improving patient outcomes. Read more about Johnson & Johnson Vision at Academy 2018.


STAIRWAY Study Shows Potential for Extended Durability With Faricimab in Wet AMD
Genentech announced positive results from the Phase II STAIRWAY study, which explored the extended durability of faricimab (RG7716) in the treatment of wet age-related macular degeneration. At 52 weeks, faricimab subjects dosed either every 16 weeks or every 12 weeks demonstrated sustained vision outcomes comparable with ranibizumab dosed every four weeks. Results of the study were presented as an oral presentation during the American Academy of Ophthalmology’s annual meeting in Chicago. Read more.

2018 West Coast Optometric Glaucoma Symposium

2018 Ophthalmology Update

Optometric Physician™ Editorial Board

Chief Medical Editor
Arthur B. Epstein, OD, FAAO

Journal Reviews
Shannon Steinhäuser, OD, FAAO

Contributing Editors
• Katherine M. Mastrota, MS, OD, FAAO
• Barry A. Weissman, OD, PhD, FAAO (Dip CL)

Editorial Board
• William Jones, OD, FAAO
• Alan G. Kabat, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO



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