Access Low Vision in Pennsylvania

I am so proud of what we at the POA have achieved this year. The POA has provided leadership development for over 40 members and established a new Diversity, Equity and Inclusion (DEI) Committee. Additionally, we have developed a new POPAC Proactive Optometry Initiative. After advocacy efforts this year, we've seen the successful passage of the Early Eye Drop legislation. We have even supported Salus University’s Ophthalmic Lasers Procedures for Anterior Segment certification course. You can register here. 

In addition to our established initiatives with the Pennsylvania Diabetic Eye Health Alliance (PDEHA)  and Children’s Vision Care Alliance (CVCA), the POA has now formed a Low Vision Awareness Committee. The overall purpose of the Low Vision Awareness Committee is to promote Low Vision awareness to Optometrists, Ophthalmologists, other health care providers, and the general public.

We are reminding our members that the standard of care for a patient with low vision is to refer to one of the many Optometrists in Pennsylvania who provide Low Vision rehabilitation.

So, what constitutes a referral for Low Vision services? No longer is the trigger for a referral to Low Vision a certain visual acuity, visual field or diagnosis. The standard of care now is to refer any patient who is struggling with at least one activity of daily living due to their vision loss. Examples could be: difficulty reading mail or pill bottles; trouble keeping up in school (at any age); concerns about driving; difficulty performing work-related tasks; difficulty traveling through unfamiliar environments; trouble reading books, magazines, or computers; inability to see favorites hobbies or past-times; difficulty seeing to provide self-care such as shaving; or difficulty seeing to perform housekeeping such as cooking and laundry. 

If you have provided the best optical correction, but your patient is still struggling, please refer to a Low Vision Optometrist. They can tackle the problem, not only by traditional glasses or contact lenses, but also by use of lighting, contrast, prisms, modified working distances, eccentric fixation, various forms of optical and electronic magnification, training with these devices and techniques, and referrals as needed to other supportive professionals. The earlier the Low Vision Optometrist can become involved, the more successful your patients are likely to be.

Of course, at no time should Low Vision care replace proper medical or surgical intervention. But do remember, Low Vision is an essential treatment modality to those with visual impairments. Also, please do not prejudge a patient’s ability to adapt to Low Vision care or pay for the services. Low Vision consultations are generally covered under a patient’s medical insurance. If not, other funding sources are available such as the Pennsylvania Bureau of Blindness and Visual Services. Get to know your local Low Vision Optometrists. They can guide you. Consider the Low Vision Optometrist a part of your team. They do the rehabilitation and you continue to be the patient’s primary eye care Optometrist.

If you are a POA member who provides Low Vision Rehabilitation, please make sure your AOA profile indicates you have a special emphasis in Low Vision Rehabilitation. Also, join the AOA Vision Rehabilitation Advocacy Network by signing up on the AOA website under practice > specialties > Vision Rehabilitation. By identifying yourself as a Low Vision Provider with your professional association, your colleagues and the general public will be able to find you on the AOA and POA “doctor finder” under Low Vision Emphasis. If you are not a Low Vision provider, search on the AOA or POA websites for a Low Vision Optometrist in your area.

I want to thank the POA for all its support. I ask members to stay involved, join PDEHA, join CVCA, and join or refer to POA Low Vision Optometrists. Become a keyperson. Join the Proactive Optometry Initiative. We all know that Optometry is the premier eye care profession in Pennsylvania. Let’s keep it that way. Great things are being planned for 2023, and I look forward to continued success for Optometry in Pennsylvania. 

Tracy Carpenter Sepich, O.D., M.S.

Doctor of Optometry

Masters of Science in Low Vision Rehabilitation

Unprecedented Times

I’ve got to be honest: when I figured out during the early years of my Board service that I would be president of the Pennsylvania Optometric Association in the year 2020, I thought “wow, how many ODs get to say that?” Both the POA and the AOA prepared for this unique year with big plans to promote our profession. None of us ever expected what we currently face both in our personal and professional lives. Like you, I am unsure of how long things will take to get back to normal and what the new normal will look like. The POA faces many of the same concerns and challenges as we wait to see what the future holds. However, as members of the POA, we are fortunate to have a strong professional organization that employs dedicated staff who truly care about us as individuals and as an organization. They are working from home to support and protect the POA in ways they never anticipated. As members of the POA, we are also fortunate to have a committee structure with volunteer ODs that are passionate about our profession.

Since the onset of COVID-19, the following optometry-centered events have been cancelled:

• Vision Expo East
• POA’s Lobby Day in Harrisburg
• POA/VSP eye exam clinic in Harrisburg
• POA’s Spring Congress in Gettysburg
• AOA’s Optometry’s meeting in Washington, D.C.
• POA’s CE in Italy trip

Keeping members updated during this time is the POA’s topmost priority. Here is an update on several of the committees and their current strategies:

THIRD PARTY COMMITTEE
This committee continues to work with the insurances we deal with every day. Their in-person meetings have been replaced with conference calls and Zoom events. They continue to advocate for us and work to resolve the ongoing issues between the insurance industry and optometrists as providers. Of utmost importance is their efforts to ensure that optometry is included in telehealth delivery of care to our patients.

LEGISLATIVE AFFAIRS COMMITTEE
The way the Pennsylvania Legislature functions during this pandemic has changed dramatically. There are no in-person meetings between our elected officials and constituents or lobbyists. Communication happens via email or phone calls. The LAC is working to update and modernize the optometric practice act as this pandemic has proven we are the primary eyecare profession and our diversity geographically increases patient access to urgent and emergency care.

Governor Tom Wolf has designated optometrists as life-sustaining providers. The Federal Government has recognized us similarly. We are on the frontline of urgent and emergency eye care statewide. The time is now to make your legislators aware of optometry’s expanded role during the pandemic and how we can continue to be a vital resource as we move out of this crisis.

CLINICAL EDUCATION COMMITTEE
The Clinical Education Committee has been working overtime to develop educational programs to assist members in renewing their licenses in 2020. The governor has allowed optometrists to obtain 100% of their credits for license renewal online for this renewal period only. The Committee sent out a survey to the membership and based on the responses have developed a series of webinars to include the core requirements for renewal and beyond. By now, you have hopefully participated in one or more of our web-based offerings. With the unexpected cancellation of our Spring Congress, the POA sustained a substantial loss of income. The Committee is doing what it can to give the membership what they need. Please support this endeavor when choosing the source of your online credits. Your financial support enables your professional organization to better support you!

As of now we are moving full steam ahead on our Fall Education Conference from October 23 to 24 at Seven Springs Mountain Resort. A few weeks ago, the POA emailed the membership a survey regarding continuing education this year and were encouraged by the number of members who still want to attend an in-person meeting this fall. Topics covering glaucoma, therapeutics, Act 31, and opioids for doctors still needing to meet the core requirements will be offered as well as additional educational topics.

I hope that you can appreciate all that the POA continues to do to support its membership. It is so very important to every Pennsylvania optometrist that the organization remains strong to support us in the coming weeks, months, and years. Your continued support of the POA and its programs is vital.

David Evans, O.D.

POA President

Contact lenses continue to evolve to meet patients’ needs

Contact lenses have become modernized over several decades including large strides that have changed the health and optics available. In the past two to three years, major manufacturers of contact lenses have continued to expand the population that can be potentially served by innovative technology and combining successful design models from the past.

Many patients come into optometrists’ offices having gone more than 10 years since trying a contact lens and are unaware of the available options. No longer are conditions of astigmatism or presbyopia restrictions from achieving excellent visual outcomes from contact lenses. The availability of trial contact lenses to every optometrist allows a wide variety of options to meet a patient's needs for those that work indoors or outdoors, as well as those with specific lighting sensitivities. 

Innovative eye care professionals are ready and able to work with patients to problem-solve the demanding vision environments and find a lens fit that is right for them. Sensitive, strained eyes may also suffer from dryness and can be helped by the benefits of contact lenses. Fortunately, dry eye conditions can be better managed to help promote the wear of contact lenses and return once disappointed patients into healthy contact lens wearers.

Daily wear contact lenses can provide full-time comfort or be used for patients who wear lenses for special occasions. These offer the lowest risk of infection of all of the current contact lens modalities and are available in thousands of customized parameters to meet the most stringent needs. In addition to daily wear contact lenses, monthly and two-week contact lenses still offer a cost effective and convenient way to treat vision and manage ocular surface health. Contact lens companies have utilized advancements in manufacturing techniques and materials to develop contact lenses that are healthier and more comfortable than traditional varieties of years past. The surface of the lens is more comfortable and more resistant to infection-causing bacteria than ever before, which also contributes to long-term health. Specialty contact lens manufacturers now offer healthier options from reputable vendors for theatrical and cosmetic contact lenses.

In the hands of an experienced eye care provider, manufacturers can offer significantly better quality-controlled lenses reducing the risk of complications. Less reputable contact lens providers that break down the doctor-patient relationship can cause short-term and long-term complications that can be addressed and sometimes reversed while under the care of an eye care professional. Considerations should also be made for specialty contact lenses that can be utilized for therapeutic purposes for the treatment of complex ocular diseases and dry eye disease.

Doctors of Optometry continue to learn and apply expertise to the implementation of individual plans to make contact lens wear more successful for their patients. The future of contact lenses is brighter than ever and is an excellent topic of discussion for yearly eye exams. 

A message from AOA President Andrea Thau, O.D.

Dear Colleague, 

As a practicing doctor myself, I know firsthand the challenges and frustrations that come with keeping up with ever-changing Medicare program requirements. As the Centers for Medicare & Medicaid Services (CMS) begins the new Quality Payment Program (QPP) this year, the AOA is working to support our doctors to protect future reimbursement and maximize incentives.

Just last month, CMS began sending out letters to all Medicare doctors to indicate whether the doctor has qualified for one of the exclusions under the Merit-Based Incentive Payment System (MIPS). CMS also developed an online NPI look up to check participation status. With this information, doctors can now best prepare themselves for MIPS participation. To equip doctors of optometry with the information needed to successfully participate in the program, we’ve developed a number of resources, including:

• A webinar that dives deeply into MIPS program requirements.
• A webinar that provides much-needed guidance on MIPS for those doctors who are not using EHRs in their practice.
• An overview of MIPS and how the AOA’s Measures and Outcomes Registry for Eyecare (AOA MORE) can help support program requirements. 
• QPP frequently asked questions
• MIPS group reporting frequently asked questions

While these are all great resources, we know that many of our doctors are still unsure of the path forward when it comes to these program changes. The AOA wants to do more to support you. Please join us on June 12 at 9 p.m. Eastern time for a webinar that will offer the opportunity to ask your specific MIPS questions. The webinar will be presented by Dr. Zachary McCarty, chair of the AOA’s Quality Improvement and Registries Committee, and Dr. Jeff Michaels, immediate past chair of the AOA’s Quality Improvement and Registries Committee. Register here. If you have a specific question you would like addressed on the webinar, please email Kara Webb, the AOA’s associate director of coding & regulatory policy, at kcwebb@aoa.org.

If there are additional MIPS tools and resources that would be useful to you in your practice, please email me at president@aoa.org.

Sincerely, 

Andrea P. Thau, O.D.

AOA President

An optometrist’s responsibility to aging patients behind the wheel

By Paul Freeman, O.D.

We have had the good fortune of the excellent representation of Dr. Robert Owens (POA) and Dr. Marshall Stafford (ophthalmology) on the Pennsylvania Department Motor Vehicle Advisory Board. Recently, after many years of capable representation, Dr. Owens has stepped down from that position. As the incoming optometric representative on the advisory board, I am posting the Vision Standards Related to the Licensing of Drivers in Pennsylvania on the POA website as they appear, with the addition of a place to specify the visual acuities and visual fields of a patient who might want to know if they are legally capable of driving or what their restrictions are. This can then be used as a handout for a patient or family member as they can appreciate that the information is a state code and not a cutoff designed by you as a health care provider.

Why is this necessary? As I’m sure you can appreciate, the population of Pennsylvania is aging, and it is not a secret that the aging process has some impact on driving safety. As I have noted in the past, there is a difference between legal and safe driving, but it is important, especially in a duty to inform state, that the legal requirement is both understood and met by the patient. After that, it is up to the individual practitioners to decide how best to handle safe issues of driving as they relate to one’s community and to the greater Commonwealth.

Please think about the responsibility to your patients, their families and the general welfare of the public of the Commonwealth as you discuss the privilege of driving. 
See the Department of Transportation’s Rules and Regulations for Title 67 -- Transportation here: pennsylvania.aoa.org/Documents/PA/POA-2015-DOT-Transportation-RR.pdf.

Declining Eye Health: An Increasing Concern for Adults

78 percent of aging Americans affected by vision loss; Pennsylvania Optometric Association gives advice to protect eyesight

It’s an unfortunate fact of life that vision can change over time, resulting in noticeable differences in how well adults see the world around them. In fact, 78 percent of adults age 55 or older report experiencing some vision loss according to the American Optometric Association’s (AOA) 2014 American Eye-Q^® consumer survey.

“The number of blind and visually impaired people is expected to double over the next 16 years,” said the AOA’s Vision Rehabilitation Section chair, Dr. Brenda Heinke Motecalvo. “This staggering statistic has implications for millions of aging Americans, but these changes don’t have to compromise a person’s lifestyle. Maintaining good health and seeing an eye doctor on a regular basis are important steps to help preserve vision.”

More common age-related vision problems include difficulty seeing things up close, far away or in low light, and sensitivity to light and glare. Some symptoms may seem like minor vision problems, but may actually be warning signs of serious eye diseases that could lead to permanent vision loss. Those diseases include:

• Age-related macular degeneration (AMD): An eye disease affecting the macula, the center of the light sensitive retina at the back of the eye. AMD can cause loss of central vision.
• Cataracts: A clouding of the lens of the eye that usually develops slowly over time and can interfere with vision. Cataracts can cause a decrease in visual contrast between objects and their background, a dulling of colors and an increased sensitivity to glare.
• Diabetic retinopathy: A condition occurring in people with diabetes, which causes progressive damage to the tiny blood vessels that nourish the retina. The longer a person has diabetes, the more likely they are to develop the condition, which can lead to blindness.
• Glaucoma: An eye disease leading to progressive damage to the optic nerve due to rising internal fluid pressure in the eye. Glaucoma is one of the leading causes of blindness.

Another common and often chronic condition that Americans can experience later in life is dry eye. This occurs when there are insufficient tears nourishing the eye. Tears maintain the health of the front surface of the eye and assist in clear, quality vision. Studies show that women are more likely to develop dry eye, especially during menopause.

By 2030, aging Americans will represent 19 percent of the population, which is an increase from 12 percent in 2000. Coping with age-related eye diseases and disorders and the resulting changes in health and lifestyles is a priority for this growing group of consumers. The AOA’s American Eye-Q^® survey revealed that 40 percent of consumers age 55 or older are concerned about losing their independence as a result of developing a serious vision problem. Many eye diseases lack early symptoms and may develop painlessly; therefore, adults may not notice vision changes until the condition is advanced. Creating a healthy lifestyle helps to ward off eye diseases and maintain existing eyesight.

“Eating a low-fat diet rich in green, leafy vegetables and fish, not smoking, monitoring blood pressure levels, exercising regularly and wearing proper sunglasses to protect eyes from UV rays can all play a role in preserving eyesight and eye health,” explained Dr. Montecalvo. “Early diagnosis and treatment of serious eye diseases and disorders is critical and can often prevent a total loss of vision, improve adults’ independence and quality of life.”

For those suffering from age-related eye conditions, the Pennsylvania Optometric Association (POA) recommends the following tips:

• Control glare: Purchase translucent lamp shades, install light-filtering window blinds or shades, use matte or flat finishes for walls and countertops and relocate the television to where it does not reflect glare.
• Use contrasting colors: Decorate with throw rugs, light switches and telephones that are different colors so they can be spotted quickly and easily.
• Give the eyes a boost: Install clocks, thermometers and timers with large block letters. Magnifying glasses can also be used for reading when larger print is not available.
• Change the settings on mobile devices: Increase the text size on the screen of smartphones and tablets and adjust the screen’s brightness or background color.
• Stay safe while driving: Wear quality sunglasses for daytime driving and use anti-reflective lenses to reduce headlight glare. Limit driving at dusk, dawn or at night if seeing under low light is difficult.

Yearly eye exams provide the best protection for preventing the onset of eye diseases and permits adults to continue living active and productive lifestyles as they age. To find a doctor of optometry, or for more information on age-related eye conditions, please visit www.poaeyes.org.

About the survey:

The ninth annual American Eye-Q® survey was created and commissioned in conjunction with Penn, Schoen & Berland Associates (PSB).  From March 20-25, 2014, PSB conducted 1,000 online interviews among Americans 18 years and older who embodied a nationally representative sample of the U.S. general population. (Margin of error is plus or minus 3.10 percentage points at a 95% confidence level)

About the Pennsylvania Optometric Association (POA):                  

The Pennsylvania Optometric Association is the professional organization for over 1,250 doctors of optometry in Pennsylvania. An affiliate of the American Optometric Association, POA promotes the highest quality eye and vision care by optometrists, represents optometry to state government, provides its members with post-graduate education and membership benefits, and conducts activities in the interest of the visual welfare of the public. For more information, visit www.poaeyes.org.

About the American Optometric Association (AOA):

The American Optometric Association, a federation of state, student and armed forces optometric associations, was founded in 1898. Today, the AOA is proud to represent the profession of optometry, America’s family eye doctors, who take a leading role in an individual’s overall eye and vision care, health and well-being. Doctors of optometry (ODs) are the independent primary health care professionals for the eye and have extensive, ongoing training to examine, diagnose, treat and manage disorders, diseases and injuries that affect the eye and visual system, providing two-thirds of primary eye care in the U.S. For information on a variety of eye health and vision topics, and to find an optometrist near you, visit

www.aoa.org.

Parents and children aren't seeing eye-to-eye

Identifying vision problems caused by digital devices

Rising technology use in both homes and classrooms is leaving parents underestimating the time their children actually spend on digital devices. The American Optometric Association (AOA) conducted a survey that discovered 83 percent of children between the ages of 10 and 17 use an electronic device for at least three hours a day. Only 40 percent of parents polled on a separate survey were aware that their children were using digital devices for that same amount of time. These statistics may indicate that parents are likely to overlook warning signs associated with vision problems caused by technology use.

Prolonged technology use can cause burning, itchy or tired eyes, headaches, fatigue, loss of focus and blurred vision. This temporary condition is called digital eye strain. To protect vision from digital eye strain, children should practice the 20-20-20 rule: every 20 minutes, take a 20 second break by staring at something 20 feet away. The following tips can also reduce this particular type of eye strain:

• Make sure computer screens are four to five inches below eye level and 20 to 28 inches away from the eyes. Hold digital devices, like phones and tablets, slightly below eye level.

• Turn your desk or computer away from windows or other light sources to prevent glare on the screen.

• Match the room lighting and the computer screen by using a lower-watt bulb in the overhead light.

• Make text bigger and easier to read.

• To minimize the chances of developing dry eye, blink frequently and fully.

Also concerning is the effect that high-energy, short-wavelength blue light emitted from electronic devices can have on the eyes. Early research on the topic shows that overexposure to blue light may be a contributing factor to eye strain and discomfort, and may lead to serious conditions such as age-related macular degeneration.

The Pennsylvania Optometric Association (POA) recommends that children have regular eye exams by an optometrist to keep their eyesight healthy and strong. POA also encourages parents to start their child's eye exams early. Every child should have an examination after 6 months of age and again before age 3. Now, under the Affordable Care Act, children through age 18 are covered for yearly comprehensive eye exams.

To learn more about eye and vision health, or to find a nearby doctor of optometry, please visit www.poaeyes.org.

About the Pennsylvania Optometric Association (POA):

The Pennsylvania Optometric Association is the professional organization for over 1,250 doctors of optometry in Pennsylvania. An affiliate of the American Optometric Association, POA promotes the highest quality eye and vision care by optometrists, represents optometry to state government, provides its members with post-graduate education and membership benefits, and conducts activities in the interest of the visual welfare of the public. For more information, visit www.poaeyes.org.

About the American Optometric Association (AOA):

The American Optometric Association represents approximately 36,000 doctors of optometry, optometry students and paraoptometric assistants and technicians. Optometrists serve patients in nearly 6,500 communities across the country, and in 3,500 of those communities are the only eye doctors. Doctors of optometry provide two-thirds of all primary eye care in the United States.

American Optometric Association doctors of optometry are highly qualified, trained doctors on the frontline of eye and vision care who examine, diagnose, treat and manage diseases and disorders of the eye. In addition to providing eye and vision care, optometrists play a major role in a patient's overall health and well-being by detecting systemic diseases such as diabetes and hypertension.

Prior to optometry school, optometrists typically complete four years of undergraduate study, culminating in a bachelor's degree. Required undergraduate coursework for pre-optometry students is extensive and covers a wide variety of advanced health, science and mathematics. Optometry school consists of four years of post-graduate, doctoral study concentrating on both the eye and systemic health. In addition to their formal training, doctors of optometry must undergo annual continuing education to stay current on the latest standards of care. For more information, visit www.aoa.org.

Window Tinting Requirements

In Pennsylvania, the level of sun screening (window tinting) acceptable under current regulations is a minimum of 70% light transmittance. This means that 70% of light contacting the window must pass through the window. The current regulations, adopted by PennDOT in 1996, also eliminate the requirement that sun screening be checked at the time of inspection; however vehicle owners who have sun screening materials that exceed the light transmittance requirements may be stopped and cited while operating the vehicle on the highway.