InfantSEE Success Story - Dr. Arnold Bierman

The following success story comes from Dr. Arnold Bierman.

A 10-month-old patient was brought to Dr. Bierman due to the child’s lateness in crawling, standing and walking. The patient’s mother told Dr. Bierman that there was a history of bad eyesight on the patient’s father’s side and she wanted to rule out visual problems that might be contributing to developmental delay.

Upon examination, Dr. Bierman discovered the patient was significantly farsighted in each eye, the right eye being +4.25 and the left eye +5.25 on objective near point retinoscopy. He informed the mother that glasses would be best for the child.

This is when obstacles presented themselves to Dr. Bierman and the patient. The child’s pediatrician requested a report of Dr. Bierman’s findings, and the child’s father did not want the baby to have glasses. While in contact with the pediatrician, Dr. Bierman found out that an appointment for the patient was already made to have him evaluated by a pediatric ophthalmologist despite his having been examined and diagnosed by Dr. Bierman.

Following that appointment, the chief pediatric ophthalmologist at Children’s Hospital of Philadelphia spoke with Dr. Bierman and told him that all his findings were valid and he agreed with Dr. Bierman’s desired course of action. The family followed through with Dr. Bierman’s original recommendations and ordered the glasses. Dr. Bierman contacted the patient’s mother to check in with the boy and the mother reported that “he’s like a different child” now.

Thanks for sharing your success story, Dr. Bierman! If you have an InfantSEE success story, send it to Kelsey@poaeyes.org to be included in a future issue!

Don't Lose Sight of Your Vision

The AOA recently teamed up with the FDA, Entertainment Industries Council and the industry-leading artists from the popular FX show, American Horror Story, to provide an interesting and informative look at decorative lenses and their proper use.

Purchasing Contacts without a Prescription is More Than Dangerous

Over half of Americans unknowingly buy decorative lenses illegally

A growing American trend in recent years is the use of decorative contact lenses to alter the appearance or color of the eyes. Mostly used as costume accessories around the Halloween holiday, these non-corrective, decorative lenses pose the same health issues as corrective contact lenses. Like all contacts, these should only be acquired through a prescription from a licensed optometrist.

The U.S. Food and Drug Administration (FDA) classifies contact lenses as medical devices requiring a valid prescription. The accessibility of these decorative contacts have eye doctors growing increasingly concerned about the risks for consumers who purchase them illegally on the Internet, at flea markets, off-the-shelf in retail or drug stores and even on the street. The American Optometric Association (AOA) has collaborated with the FDA and the Entertainment Industries Council (EIC) to help educate consumers about only acquiring lenses with a valid prescription from an optometrist.

Decorative contact lenses, without a prescription from an eye doctor, can cause serious eye and vision problems, just like any contact lenses. Many consumers mistakenly believe a prescription is unnecessary for decorative contacts because they do not provide vision correction. It’s important that consumers get an eye exam and only wear contact lenses that are properly fitted and prescribed by an optometrist, regardless if the lenses provide vision correction or not.

According to the AOA’s 2014 American Eye-Q^® consumer survey, 11 percent of consumers have worn decorative, non-corrective contacts, and of that 11 percent, 53 percent purchased them illegally and without a prescription. Wearing illegally purchased lenses can result in unhealthy consequences such as bacterial infections, allergic reactions or even significant damage to the eye’s ability to function, which can lead to irreversible sight loss.

When used properly, contact lenses are among the safest forms of vision correction. A medical eye and vision examination from your optometrist is a great way to determine if you are eligible for contact lenses. During the exam, the eye doctor will make sure the lenses fit properly and teach you how to safely care for them.

The Pennsylvania Optometric Association (POA) identifies six common mistakes made by patients when it comes to handling contact lenses:

• Not washing and drying hands. It is common sense to wash your hands, but the American Eye-Q^® survey found that 35 percent of contact lens wearers skip this important process. Drying your hands before applying contacts is also important because tap water can contain harmful microorganisms that easily transfer from your hands, to the lens and therefore onto your eye.

• Wearing lenses longer than recommended. Many contact lens wearers allow their contacts to overstay their welcome until irritation in the eye occurs. The American Eye-Q^® survey found that 57 percent of contact lens wearers admitted to wearing disposable lenses longer than directed. Optometrists recommend a changing schedule for contact lenses to help prevent eye irritation or permanent eye damage from bacterial infections.

• Not replacing contact lens cases regularly. Lens cases should be replaced at least every three months, with frequent cleaning and disinfecting in between replacements. Despite eye doctors recommending this, only 41 percent of contact lens wearers follow this rule.

• Sleeping in contacts overnight. The American Eye-Q^® survey revealed that 21 percent of lens wearers are guilty of this bad habit. Sleeping in contacts puts consumers at risk for eye infections unless the lenses are specifically designed for day and night use and monitored by your doctor.

• Reusing old contact lens solution. Use only fresh solution to clean and store contact lenses. Products recommended by your optometrist to clean and disinfect lenses are the best bet. Remember that saline solution and rewetting drops do not disinfect lenses.

• Wearing contact lenses while swimming or in a hot tub. More than a quarter of contact lens wearers report swimming in their contact lenses. This act can lead to serious sight-threatening eye infections and irritation. According to the FDA and POA, contact lenses should not be exposed to any kind of water, including tap water or water found in swimming pools, oceans, lakes, hot tubs and showers.

To educate yourself on the risks associated with decorative contact lenses, visit www.contactlensart.org. For additional resources about contact lens hygiene and safety, please visit www.contactlenssafety.org or http://pennsylvania.aoa.org/x5230.xml.

About the American Eye-Q® 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.

POA Forum: Food, Facts and Fun!

Each year, POA sponsors an event at Pennsylvania College of Optometry (PCO) that allows the Board of Directors and PCO students to discuss the benefit of joining the association. This year's event, titled "Food, Facts and Fun," took place Friday, September 12th in the Hafter Student Community Center.

E-health information exchange assures better patient care

In order for patients to receive better and safer care, all players in the healthcare system, like hospitals, doctors and pharmacies, must be able to quickly find, evaluate and understand a patient’s medical information. The process of securely sharing this information prevents a patient from receiving medications that interfere with those previously prescribed. The gap in communication between a patient’s physician and a doctor in the emergency room can have serious health-altering consequences.

To close this gap, electronic health information exchange, soon enabled by the Pennsylvania Patient and Provider Network (P3N), is here to help. For this to work correctly, local healthcare providers need to connect to a regional health information organization (HIO). The HIO connects to the P3N hub and patient’s information flows to other HIOs and participating healthcare providers. 

P3N, a service from the Pennsylvania eHealth Partnership Authority, is currently under development, but pilot programs will launch later this year in the Lehigh Valley and southwestern Pennsylvania. 

Electronic health information exchange is important for patients and providers alike. The information exchange benefits everyone by cutting down on redundant testing and medications. It will help to reduce unnecessary costs; in Washington state, a similar data-sharing initiative saved $33 million in Medicaid ER costs in the first year of the program alone.

For this program to be successful, maximum participation from doctors, hospitals, pharmacies and others in the healthcare system is a must. The more patient information provided, the better. 

For additional information, please see: www.pennlive.com/opinion/2014/07/in_emergencies_minutes_matter.html.

InfantSEE Success Story - Dr. Daniel Schott

The following InfantSEE success story came from Dr. Daniel Schott.

Schott Associates Eye Care in Potter and McKean counties have found a way to better its InfantSEE screenings by coordinating the appointment with the patient’s pediatrician. The Coudersport location owes its success, in part, to the office’s ideal location in Cole Memorial Hospital, but the other locations have also found this coordination tactic successful despite the pediatrician’s office being in another building.

At the child’s nine-month check-up, the infant comes to the office for a screening first. After the screening, the InfantSEE report is sent with the parent to be delivered to the pediatrician at the child’s visit. This way, the pediatrician is reviewing the report with the parent at the appointment and can stress the importance of early intervention in visual development.

Schott Associates Eye Care has found the nine-month visit to be the best time for this screening because infant cooperation is typically better at this age. Cooperation leads to more accurate data. Also there are usually no immunizations at a nine-month well-child visit, so if the patient must come in after visiting the pediatrician’s office, they are usually not cranky from receiving shots.

This has been a very successful way to market not only the practice, but also the importance of early childhood eye exams. In addition, the interaction with pediatricians in this manner has lead to other cases being referred to the practice. This is a win-win for all parties involved. 

Well done, Dr. Schott! Send your own InfantSEE success stories to Kelsey@poaeyes.org to be included in a future issue of the Keystoner and featured here on our blog.

AOA’s House of Delegates meeting

Richard Christoph, O.D.
POA President-Elect

During Optometry’s Meeting this year, my duty as POA’s president-elect was to attend AOA’s annual business meeting, the House of Delegates, as a POA representative along with POA president Dr. Marianne Boltz. Just as it is for POA, the House of Delegates sets policy for AOA. It is made up of representatives from each affiliated organization of AOA, which includes the 50 state associations, plus Washington D.C., the American Optometric Student Association and the Armed Forces Optometric Society.

As is protocol, the House of Delegates opened with a flag ceremony, the Pledge of Allegiance, an invocation and the Optometric Oath. During the meeting, there were reports and introductions from the member volunteers in the Sergeant At Arms, Credentials, Resolutions and Nominating Committees. There were also votes to approve the handbook and procedures, adopt the agenda and approve the actions of the Board since the last House meeting.

This year, three resolutions were brought forward for vote. One was related to optometric care of brain injury, including concussions. It recommends an optometric evaluation following brain injury to diagnose and treat ocular disorders or vision changes. The Vision Rehabilitation Section of AOA was involved in crafting this resolution. They have assembled an excellent resource, the Brain Injury Electronic Resource Manual, available online at aoa.uberflip.com/i/225867. The other two resolutions were modifications of existing resolutions regarding paraoptometrics. Because the paraoptometric section was dissolved and reformed as the paraoptometric resource center last year, some changes in wording were necessary to reflect the current status of paraoptometrics within AOA.

AOA’s secretary-treasurer, Dr. Andrea Thau, informed the House that AOA’s financial standing was strong. The new dues accounting procedures and restructuring of membership classes has resulted in more consistent cash flow for the organization, without a significant loss of membership. In fact, both total membership and dues revenues have increased.
The AOA-PAC chair, Dr. Ron Benner, reported on the status of AOA-PAC. Donations were down in every measurable way: total dollars, number of donors, average donation and percentage of donors all decreased for 2013 compared to the last few years. AOA has been relying heavily on a small number of larger donors who are approaching the end of their careers. If you are not already an AOA-PAC donor, please make it a priority to donate this year. In addition, please also donate to POPAC. Optometry has to be active at both the state and national levels to ensure our inclusion in healthcare reform. 

Next, there was a presentation regarding the Think About Your Eyes Campaign. AOA members who participate in this campaign may receive discounts. The purpose of its media campaign is to increase the number of eye exams performed. For more information, please see www.thinkaboutyoureyes.com. 

Dr. Teri Geist reported on AOA’s public relations efforts as of mid-June, stating that AOA had over 1 billion positive media impressions so far in 2014. 

The advocacy team also reported on their activities for the past year. Between state government relations, third party, federal relations and the clinical resource group, the activities are far too numerous to list here. Some of the newer legislative initiatives are as follows: to advance scope at the state level; to address issues with insurance and vision plans, such as discount on non-covered services, credentialing and restrictive material ordering; telemedicine issues like online exam and kiosks; and Medicaid issues, specifically inclusion and reimbursement. 

The Clinical Resources Group is involved with the creation of an optometric registry, an important tool for optometrists to fully participate with PQRS, meaningful use and other incentive programs. The statistics gathered through this registry will provide individual doctors with valuable information about their own practice, and benchmark data to compare themselves with others. It will also provide state associations and AOA with aggregate data that can be used in negotiations with government entities and insurance plans. Most importantly, it will enable optometrists to improve the quality of care provided to patients. AOA expects this to roll out in early 2015. Doctors will need to be using electronic records to participate.

And lastly, elections were held for 2015 and the following slate of officers was elected: Dr. Steven Loomis (president-elect), Dr. Andrea Thau (vice president), Dr. Christopher Quinn (secretary-treasurer), Drs. Barbara Horn and Samuel Pierce (trustees; three-year term), and Dr. James DeVleming (trustee; one-year term). Dr. David Cockrell assumes the office of president and Dr. Mitch Munson assumes the office of past-president. Drs. Greg Caldwell, Robert Layman, and William Reynolds continue their three-year terms as trustees.

Latest VOSH PA Mission

Paul Halpern, O.D.

A new Volunteer Optometric Services to Humanity of Pennsylvania (VOSH PA) mission site was opened in Pont Sondé, Haiti about sixty miles northwest of Port-au-Prince and just inland from the sea. The mission was sponsored by Sové Lavi, which is liberally interpreted to mean "save lives." Founded by one-time Haitian presidential candidate and American food industry capitalist Dumas Simeus, Sové Lavi is a community-based group that concentrates on uplifting health care in Haiti.

This mission was unique; we stayed in a small hotel located adjacent to the Sové Lavi sponsored community health clinic. This very clean, but small two-story building was a hodge-podge of little examination rooms connected by narrow hallways and located on the main street of the town. Because the building lacked a large standing area, the patients were forced to line up along the heavily traveled street prior to registration causing some episodic breakdown of behavior. As is usually the case, once registered and in line for care, the most outspoken of the patients became sweet and tame.

Our volunteers saw about 1,125 patients and referred 35 for cataract surgery to the ophthalmology residency program at the University of Haiti Medical School in Port-au-Prince. Unfortunately they are not equipped to provide tertiary care for glaucoma patients so we could only provide them with a year's supply of glaucoma medication and our good wishes. We successfully treated several trachoma cases, most notably a seven-year-old who returned for a follow-up the next day and was essentially clear. As is VOSH policy, we instructed the family on the necessity of good personal hygiene as the best way to combat this condition.

We did one remote village clinic on our last day in Noé, a very poor community with few resources. The living conditions were the worst that I personally encountered in all my ten trips to Haiti. Our team made the best of it and did great work despite the circumstances.

On this mission, we were fortunate to have a Surgical Eye Expedition (SEE) physician from Harvard University, Paul Cotran. Dr. Cotran is a fellowship trained glaucoma specialist and educator. He stayed with the group for two clinic days and then moved on to the hospital at the university to tend to the cataract patients we had referred. It is important to note that I saw some of the worst glaucoma sufferers that I have ever come across. At least six patients were totally cupped out and stone cold blind. As Dr. Cotran and I began to see these people and others with emerging glaucoma, we became increasingly frustrated with our inability to provide proper care for them.

We came to the conclusion that Haitian eye surgeons and ophthalmology residents needed to be trained to do more complex and lasting procedures to treat glaucoma. We need to make this care geographically available to the people, perhaps at yet-to-be created Centers of Excellence located in north, central, and southern Haiti. Spaced about 100 miles apart these centers could bring glaucoma care closer to the people. The discussion broadened by taking it online and to various national and international glaucoma experts for extra input and suggestions. A plan began to evolve that centered on ways to best treat for long-term wellness and to also train local ophthalmologists to provide the care needed. It is most important that we stay at the forefront of this exciting new effort.

Finally, we are indebted to the wonderful group of volunteers that made this trip. They were spectacular under difficult conditions. They never faltered; they only asked what else they could do. I don't understand how we are so fortunate to be blessed by this quality volunteerism but we, as an organization, must recognize, treasure, and when possible, reward them.

For more information about VOSH PA, visit www.vosh-pa.com.

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.

John McAllister, the father of optometry

Well, if you weren’t in Philadelphia for AOA’s Optometry’s Meeting, you missed at least three great reunions: on a personal level, a reunion with your friends; on an academic level, a probable reunion with your alma mater (Pennsylvania College of Optometry); and on a historic level, two old (very old) friends named Ben and John (Franklin and McAllister, that is.)

Indeed it only seemed appropriate – what with our national meeting taking place in Philadelphia – to have Ben’s old friend, John McAllister, the true father of eye care in America, stop by the POA reception.

John McAllister, born in 1753, immigrated to New York from Scotland in 1775. In becoming a newfound Patriot, he was taken prisoner by the British a few weeks after the colonists declared their independence in 1776. Upon his release, he headed to Philadelphia in 1781 and started a whip and cane business on Second and Market Street. He expanded his wares by purchasing the stock of a hardware merchant, within which he discovered a bushel basket of ready-to-wear eyeglasses. His business prospered as customers sampled what seemed to best suit their needs.

The British naval blockade provided John his revenge because no longer would eyeglasses be coming from Europe; his challenge, though, was to develop techniques for making lenses and frames. He was the first to accomplish this in America. His friend, Benjamin Franklin encouraged him to pursue an even greater pursuit; vision care, which is now known as Optometry. In those days, quackery was common and often resulted in blindness. In 1796, he moved his business to 48 Chestnut Street where he not only provided glasses but also sight testing. Additionally, he made scientific instruments. His knowledge of optics continued to increase and he applied this knowledge towards eye care.

His son, John Jr. was born in 1786 to the former widow Frances Wardale (a cousin of the famed navigator Captain Cook). Since Philadelphia was still the capital of the United States, John, Jr. grew up attending the Congressional debates and knew George Washington and John Adams. He graduated from the University of Pennsylvania in 1803 with honors and joined his father’s work in 1811. Between them, they served the ophthalmic needs of George Washington, Thomas Jefferson, Chief Justice Tilghman, Count Joseph Bonoparte, Henry Clay, Andrew Jackson, et al.

John, Sr. died in 1830. John, Jr. continued to advance eye care and was the first to diagnose and correct astigmatism. He also provided eye examinations and glasses at Wills Eye Hospital. He served as the manager of Wills Eye Hospital from 1848 to 1859. Civically, he devised a system for numbering the houses according to street layout and was a lifelong member of the Pennsylvania Historical Society, which still houses his collection. He died in 1877 at the age of 91.

John, Jr.’s sons William Young, John and Thomas continued the family’s legacy in eye care. Thomas Hamilton McAllister established the first optometric practice in New York City where it flourished until his death in 1899. Like his father, William was also associated with the Wills Eye Hospital and served on the Philadelphia City Council. He was the first to teach physicians in the country the practice of optometry. He retired in 1882 and his sons (John, Sr.’s great grandsons) continued his practice well into the first third of the twentieth century. One of his sons Frank W. McAllister settled in Baltimore in 1879 and was one of the founders of the AOA. His son, John McAllister’s great-great-great grandson, was Dr. John Warden McAllister who (at the time of this reference’s publication [1968]) was practicing on Franklin Street in Baltimore. Five generations of ophthalmic care, birthed in the City of Brotherly Love.

This historic account was gleaned from a pamphlet published in conjunction with an optometric exhibit at the William Penn Memorial Museum in Harrisburg. The exhibit was the result of a grant from the POA and the Vision Conservation Institute

Respectfully shared,

Robert Owens, O.D., F.A.A.O.

Diplomate, ABO

A Reflection on Campaigning

Anthony S. Diecidue, O.D., M.S.
POA Past President

The time was right. I had just sold my practice, my oldest child had already graduated college and my youngest was a sophomore. I was entertaining thoughts of retirement when redistricting created a new legislative district in my home town. So, knowing full-well how optometry is a legislated profession, and how advantageous it would be to have an OD in the legislature, I thought that this was the right time for me to run for the State House of Representatives here in Pennsylvania.

Unfortunately, my run was not successful. But I, and those involved, learned some valuable lessons that I would like to pass on so that any other OD that decides to step up and take a shot at a House or even a Senate seat can be more efficacious.

Know the playing field before you get in – Knowing when to run is critical. The ducks may be in a row for you personally, but check out your competition and assess your chances of winning prior to getting in the race. Gauge your competition’s strengths. Do they know the issues and have solutions? Do they have a connection to the people? Are they influential? Do they have support and a good team behind them? You may find that this is not the best time to run and delaying your campaign for another election year with less competition or better conditions may be a better way to go.

Volunteers – There are two types of people in the world: those that DO and those that DON’T. To run an effective campaign, you will need help and lots of it. In any political party there are going to be those individuals who do the work and those who sit idly by. If you have competition in a primary election, you will be running against someone from your own party and will have to compete for the “doers” in the party. Too many people in the same party running for the same seat will simply dilute the pool of helpers and make it more difficult for everyone.

These folks are going to be the ones that help you make phone calls, knock on doors, put out yard signs, get your printed materials, manage your schedule, plan your strategy and spread the good word about your campaign. They’re also going to be the ones having meet-n-greets and fundraisers for you, so your helpers should have lots of friends and influence in the community.

It’s expensive – Although the cost of running for an office is highly variable, you can count on it costing some money, and on the local level, the expenses can be pretty reasonable. Undertaking a run for the state or federal level ups the ante considerably.

State Representative campaigns can cost anywhere from $20,000 to $80,000, or even up to $100,000. A Senate seat can be anywhere between $200,000 to $800,000 and more! Having a plan on how to get that money before you throw your hat in the ring is one of the most important things you can do. Be prepared to spend some of your own money, too. A percentage of your total budget, 10-25%, will come out of your personal funds.

In the beginning of any campaign the expenses will be light because you will be concentrating on building your war chest for what is to come. This will involve getting out to see people by going to spaghetti dinners and pancake breakfasts, asking for contributions and having fundraisers.
At the end of the campaign, the expenses will mount up exponentially with increased advertising, mailers, TV, radio, newspaper and whatever other media you deem appropriate to get the populace to vote for you in the election.

Time – You’ll need plenty of this. As a matter of fact, when running for a state-level office, plan to take a lot of time away from your practice. Timing is important here. When you announce your candidacy and start your campaign is critical, and the earlier you announce the more volunteers you will be able to get. That also means that you will start campaigning earlier, too. So, the dinners, breakfasts, civic meetings and more will begin early also.

Getting volunteers to help with your campaign is crucial but, in the end, the voters want to hear from you. That means you will need to make phone calls, go door-to-door and ask for contributions. More and more of your time will be in demand as the campaign continues.

Campaign manager vs. campaign advisor – Nothing is more important than having a good, experienced, well-connected campaign manager (CM). Dr. Doug Clark, an OD from Alabama, is running for his State House and has managed to procure the former Alabama Speaker of the House as his campaign manager. You can’t ask for a better CM than that!

One of the main jobs of the CM is to rally the troops for you. That person needs to coerce, cajole and otherwise twist the arms of every person he or she can to support you in one way or another. The CM will organize your meet-n-greets, fundraisers and House parties. They will also manage your schedule so that you attend the important civic meetings like school board meetings, town councils, debates, etcetera. He or she will also coordinate with your “team” to divvy up the jobs needed to promote your campaign and get as many volunteers as possible. Choose your CM wisely as he or she can make or break your run for office.

There are companies and organizations that will act as campaign advisors. For novice candidates, these organizations can be a valuable resource. They generally provide advice along with marketing suggestions. But beware, they can be expensive and can chew through your budget pretty quickly if you let them.

Connecting to the people – In the end it’s all about getting votes, and you get votes by connecting with the people in your community. That will mean going to plenty of affairs, but it also means calling folks and asking for their vote even though they probably don’t know you. It means knocking on strangers’ doors and introducing yourself as their candidate. At the same time, you’ll probably be asking them for money or support in some fashion and in return they’ll get a button or a pen.

Having an OD in the legislature would be a win for optometry and I hope I’m not the last person to make a run for the House or Senate. I also hope this information will be useful to the next person who gives it a try. I was extremely fortunate in having the support of the POA and its members to help fund my campaign and I can’t thank those who contributed and those who volunteered enough. There are too many to mention here, but you know who you are and I thank you from the bottom of my heart!

Accommodating patients with a hearing disability

What your obligations are and are not

Sooner or later, a practice will face a communication challenge when a patient with a hearing impairment schedules an appointment. The protocol on how to deal with this type of disability in an examination has led to some confusion in the past.

First and foremost, an optometric office, regardless of the title ‘private practice,’ is a public accommodation. As a public accommodation, steps to ensure the practice and services are accessible to individuals with disabilities should be taken. Individuals with disabilities, as defined by the September 2008 amended Americans with Disabilities Act (ADA), are those with a physical or mental impairment that substantially limits one of more major life activities of such individual; a record of such an impairment; or being regarded as having such impairment.

Patients with a hearing impairment may request a sign language interpreter, but an optometrist is not required to hire one unless both parties have agreed on it. Other means of communication are an option, like having a family member of the patient or a certified employee interpret, writing a conversation with the patient on a note pad, or using various tools like a computer or phone to communicate. Auxiliary aids or services should be agreed upon prior to the scheduled appointment.

An optometrist is permitted to deny the use of an interpreter if there is proof that the cost or service of the interpreter would be an undue burden. An undue burden is a significant difficulty or expense for the practice. Factors in deciding the inclusion of an interpreter are: cost against financial status of the practice, the need for enhanced communication and the availability of the service desired. If an interpreter is needed, the optometric office is responsible for covering the cost. The patient holds no obligation to incur the fee. Passing this cost along to the patient would be a violation of the ADA, as would refusing to see the patient based on the needs of their disability or referring the person to another physician solely because the patient wants an interpreter.

The person with disability is entitled to only reasonable accommodation and cannot demand an interpreter if other alternative services are available. If no satisfactory services can be found, the practitioner is required to provide an interpreter. The downside to this justification is that ‘satisfactory’ differs for each person, but this means an interpreter is not always necessary. If a reasonable alternative is found, and would otherwise be acceptable, the patient cannot refuse the accommodation.

If hiring an interpreter, the best way to find one would be through a licensed audiologist. Using one of these professionals can ensure premium service and occasionally a discount.

Under the ADA, an optometrist is responsible to accommodate every disabled patient wanting to use the practice’s services, but are not obligated to accommodate with only an interpreter. Exploring all options is beneficial to the practice and the patient, who may assume the only option is an interpreter. Discussing all available auxiliary aids and services with patients helps to reduce financial cost in the long run. A person may not be denied an appointment or referred away from the practice based on their disability or desire to have accommodations made.

Optometry's Meeting®

AOA and POA members surged to Philadelphia in full-force for AOA's annual Optometry's Meeting®. The Pennsylvania Optometric Association had the honor of hosting the meeting. Below are some photos highlighting POA's involvement in the event.

Dr. Boltz, president of POA, waits to proudly represent Pennsylvania in the flag procession.

Dr. Boltz addresses attendees at the Opening General Session of Optometry's Meeting in Philadelphia.

Roberta Beers, CPOT accepts the 2014 Paraoptometric of the Year Award presented by AOA President Dr. Mitchell Munson.

Former figure skater Scott Hamilton entertains and enlightens the audience after the awards ceremony.

Dr. James Spangler discusses the Kids Welcome Here® program with attendees in the Exhibit Hall.

Dr. Boltz, Dr. Lori Gray and Dr. Robert Owens (dressed as John McAllister) pose with Benjamin Franklin, the special guest invited to POA's member reception.

Have some photos from Optometry's Meeting® that you want to share? 
Email Kelsey@poaeyes.org and you might see your photo on this blog or our Facebook page!

Please only submit photos belonging to you.

Vision Expo East

For members heading to New York for Vision Expo East from March 27-30, don't forget about the benefits you receive as a POA member:

• Free exhibit hall pass – a $75 value 
• Complementary lunch in Club Vision on Friday, Saturday and Sunday 
• Exclusive discounts off CE 
• Dedicated desk in the registration area
• Discounts on Broadway shows and famous attractions

Also, don't miss Dr. Greg Caldwell's POA-sponsored CE on Friday, March 28: Oral Pharmaceutical Agents for the Treatment of Anterior Segment Pathologies (OD Course #21B1; 8:30 - 10:30 AM) and Thyroid Dysfunction and the Eye (OD Course #23B1; 11:00 AM - noon). POA members receive an exclusive discount on Dr. Caldwell's course as well.

See the flyer in the March/April Keystoner for more information.

Regulatory Reminder

DEA numbers cannot be preprinted on prescriptions

POA recently received a letter from the Pennsylvania Pharmacists Association (PPA) regarding invalid prescriptions that contain preprinted DEA numbers on their face. The letter reiterated the language of the Controlled Substances, Drugs, Devices and Cosmetics Act that prohibits the preprinting of DEA numbers on prescription forms. PA Controlled Substance Requirement 25.53(e) states:

“The Federal Drug Enforcement Administration registration number cannot be preprinted on the prescription form.”

Since preprinting DEA numbers on prescription forms is prohibited in Pennsylvania, DEA numbers must be added at the time the prescription is written.

PPA has reminded its membership about this issue and has asked professional health associations to remind their memberships of the requirements of the law.

POA’s blog, The POAeyes Post, contains a June 21, 2013 post dedicated to prescription requirements in Pennsylvania, which can be viewed at http://www.poaeyes.blogspot.com/2013/06/prescription-requirements-in.html. In addition to the DEA number issue, it includes detailed information on spectacle, contact lens, pharmaceutical and Medicaid prescription requirements.

PPA has advised that if a pharmacist receives a prescription with a preprinted DEA number, the prescription is considered invalid and the prescription should not be filled. Instead, the pharmacist should request that the patient obtain a new prescription or contact the prescriber directly, both options causing a delay that could harm the patient.

PPA has been informed that auditing entities are denying claims and recouping 100% of the claim or refills for prescriptions that have a preprinted DEA number.