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


Volume 18, Number 43

Monday, October 30, 2017


Inside this issue: (click heading to view article)
######### Off the Cuff: The Art of Selling
######### Scleral Contact Lenses for the Management of Complicated Ptosis
######### Anti-Vascular Endothelial Growth Factor Therapy for Myopic Choroidal Neovascularization
######### Alcohol Expectancies Longitudinally Predict Drinking and the Alcohol Myopia Effects of Relief, Self-Inflation and Excess
######### News & Notes

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Off the Cuff: The Art of Selling

While death and public speaking rank among the greatest fears for many, I suspect that fear of selling tops the list for most ODs. No matter if the recommendation is good for the patient, the idea of actually selling something has many ODs silently whimpering and avoiding eye contact with their patients.

Trust that selling isn’t my thing either, but as a center director for TLC back when I practiced on Long Island, I realized the need for “selling” what patients wanted and would benefit from. Look at daily disposable contact lenses. I am convinced the reason that they aren’t the only lens modality fitted today is our widespread inability to “sell” what is clearly in our patients’ best interests.

Oddly, we cheer when our optician sells $1,000 of Armani frames, but we can’t manage to sell a bottle of omega-3s that will dramatically improve our patient’s dry eye and overall health. I am guilty, too. While PRN’s Dry Eye Omega Benefits is a key part of my dry eye protocol, it took my staff yelling at me before I was able to “sell” it to my patients.

In truth, our discomfort with selling hurts us more than you think. As regular readers know, I am a huge believer in LipiFlow. We embraced the technology back when it cost three times as much as it does today, yet paid it off in less than six months. Not everyone had the same success. One of my friends bought a LipiFlow system soon after we did, but after an initial burst of procedures, his system sat mostly unused.

He recently told me about an epiphany that changed that, and I think it’s worth sharing. My friend ultimately realized that it wasn’t the procedure or its cost that he was avoiding, it was his aversion to selling it. Today he uses meibography to screen all of his patients and shares the images while discussing the results with his patients. Like many successful dentists do, he now has his staff present treatment recommendations and costs. Today my friend performs twice as many procedures as I do.

While the art of selling is often studied and frequently discussed, sometimes the true art of selling is letting someone else do it for you.

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.


Scleral Contact Lenses for the Management of Complicated Ptosis
Three patients (five eyes) with ptosis resulting from levator dehiscence due to long-term rigid gas permeable contact lens wear for keratoconus, phthisis bulbi and myopathy due to Kearns-Sayre syndrome were identified during a two-year period. They were fitted with scleral contact lenses to provide cosmesis and simultaneous vision correction where applicable, by lifting the upper eyelid with the bulk of the lens.

The scleral contact lenses provided comfortable wear and significantly improved cosmesis, as palpebral aperture and marginal reflex distance were increased. In addition, visual acuity subjectively and objectively improved. Two patients opted for the scleral contact lenses, whereas the parents of the third patient, a 10-year-old girl with Kearns-Sayre syndrome, chose to undergo ptosis surgery due to handling issues of the scleral contact lenses.

Researchers concluded that scleral contact lenses can be a useful addition to the treatment option for patients with complicated ptosis.

SOURCE: Katsoulos K, Rallatos GL, Mavrikakis I. Scleral contact lenses for the management of complicated ptosis. Orbit. 2017; Oct 20:1-7. [Epub ahead of print].

Anti-Vascular Endothelial Growth Factor Therapy for Myopic Choroidal Neovascularization

Myopic choroidal neovascularization (CNV) is one of the most vision-impairing complications in patients with pathologic myopia, authors wrote. It is also one of the most frequently encountered non-age-related macular degeneration causes of CNV and affects young patients in the working age group, they added. Fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) are generally indicated to confirm the diagnosis of active myopic CNV before initiation of treatment; without treatment, natural history studies have shown that the vision outcome can be very poor, authors wrote further.

More recently, a number of retrospective, prospective and Phase III, multicenter, randomized controlled trials have established the safety and efficacy of intravitreal anti-vascular endothelial growth factor (VEGF) agents for the treatment of myopic CNV. Long-term follow-up studies have found that some of the initial vision gained after intravitreal anti-VEGF therapy might not be maintained, owing to the presence and progression of chorioretinal atrophy (CRA) adjacent to the CNV, authors wrote.

They suggested that further research on clinical and imaging characteristics might elucidate the prognostic factors that are crucial to optimizing the treatment and prevention of visual impairment associated with myopic CNV.

SOURCE: Ng DSC, Lai TYY, Cheung CMG, et al. Anti-vascular endothelial growth factor therapy for myopic choroidal neovascularization. Asia Pac J Ophthalmol (Phila). 2017; Oct 20. [Epub ahead of print].




Alcohol Expectancies Longitudinally Predict Drinking and the Alcohol Myopia Effects of Relief, Self-Inflation and Excess
The alcohol myopia theory posits that alcohol consumption attenuates information processing capacity and that expectancy beliefs together with intake level are responsible for experiences in myopic effects (relief, self-inflation and excess). Adults (n=413) averaging 36.39 (SD=13.02) years of age completed the Comprehensive Effects of Alcohol questionnaire at baseline, followed by alcohol use measures (frequency and quantity) and the Alcohol Myopia Scale one month later. Three structural equation models based on differing construct manifestations of alcohol expectancies served to longitudinally forecast alcohol use and myopia.

In model 1, overall expectancy predicted greater alcohol use and higher levels of all three myopic effects. In model 2, specifying separate positive and negative expectancy factors—positive but not negative expectancy—predicted greater use. Furthermore, positive expectancy and use explained higher myopic relief and higher self-inflation, whereas positive expectancy, negative expectancy and use explained higher myopic excess. In model 3, the seven specific expectancy subscales (sociability, tension reduction, liquid courage, sexuality, cognitive and behavioral impairment, risk and aggression, and self-perception) were simultaneously specified as predictors. Tension reduction expectancy, sexuality expectancy and use contributed to higher myopic relief; sexuality expectancy and use explained higher myopic self-inflation; and risk and aggression expectancy and use accounted for higher myopic excess. Across all three predictive models, the total variance explained ranged from 12% to 19% for alcohol use, 50% to 51% for relief, 29% to 34% for self-inflation and 32% to 35% for excess.

Investigators wrote that the findings indicated that the type of alcohol myopia experienced was a concurrent function of self-fulfilling alcohol prophecies and drinking levels. The interpreted measurement manifestation of expectancy yielded different prevention implications.

SOURCE: Lac A, Brack N. Alcohol expectancies longitudinally predict drinking and the alcohol myopia effects of relief, self-inflation and excess. Addict Behav. 2017; Oct 12. [Epub ahead of print].

Review of Optometry's New Technologies and Treatments in Eye Care in Philadelphia, November 3-5, 2017 at Loews Hotel Philadelphia

News & Notes
AAOF Names 2017 VSP Global/FYi Doctors Scholarship Recipients
The American Academy of Optometry Foundation announced the 2017 Practice Excellence Scholarship recipients. Nearly $200,000 will be distributed among 44 top-performing, fourth-year optometry students in the United States, Puerto Rico and Canada. Two students from each college of optometry were selected as recipients from nominations submitted by their institutions. Since 2000, VSP has provided nearly $2 million in scholarship support to hundreds of optometry students. The scholarships are funded through VSP Global’s Eyes of Hope Global Charitable Fund in collaboration with FYi Doctors in Canada (for Canadian recipients) and administered through the AAOF. View the recipients.

Academy 2017 Attendance Exceeds Records, AAO Aids Puerto Rican Attendees
Academy 2017 Chicago was the largest meeting in the American Academy of Optometry’s history. The 96th annual meeting had a total of 7,692 registrants, including 4,799 optometrists and vision scientists and 1,206 students. In addition, the AAO secured funding to provide financial assistance to optometrists, students and others from Puerto Rico who attended Academy 2017 Chicago. The devastation in Puerto Rico caused by Hurricanes Irma and Maria led to the temporary closure of the Inter American University of Puerto Rico School of Optometry. Donations by CooperVision, National Vision and individuals are enabling $750 student travel fellowships to each student at the Inter American University of Puerto Rico School of Optometry who attended the meeting. As well, individuals residing in Puerto Rico who were registered for Academy 2017 Chicago received refunds on registration fees regardless of whether the individual was able to attend the meeting.

Study: Patients Using Rohto Dry-Aid Report All-day Relief of DED Ocular Signs & Symptoms
Over the course of a day, Rohto Dry-Aid, a new, over-the-counter lubricant eye drop, demonstrated superior relief of discomfort associated with visual tasking activities and showed longer duration of symptomatic relief vs. a widely used ocular lubricant, according to a study published in Clinical Ophthalmology. This prospective, single-center, parallel-group study compared in a real-life setting the effects of Rohto Dry-Aid with a leading artificial tear brand in the United States in patients 18 years of age or older (n=80) diagnosed with mild to moderate dry eye disease over approximately 30 days. Read more.


Katena Acquires Rhein Medical
Katena Products purchased Rhein Medical, a provider of ophthalmic surgical instruments and devices focused on the anterior segment surgical business, including cataract and refractive surgery, glaucoma and corneal procedures, and the ocular surface. Katena, an independently owned company, offers its products to more than 7,000 customers in the United States and around the world. Read more.



Review of Optometry's New Technologies and Treatments in Eye Care in Philadelphia, November 3-5, 2017 at Loews Hotel Philadelphia

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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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