I'm An Author!! COA Magazine May/June

C A L I F O R N I A
O P T O M E T RY
MAY / JUNE 2013 VOLUME 40, NUMBER 3 A comprehensive view of professional optometry in California today
OPTOMETRY IN FOCUS
Technology: Patient care apps

Government Affairs
Legislation update
CE@HOME
The case of the suddenly-monocular patient
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C A L I F O R N I A
O P T O M E T RY
MAY / JUNE 2013
VOL. 40 NO. 3
A comprehensive view of professional optometry in California today.
Executive Director Bill Howe Editor-In-Chief Julie A. Schornack, OD, MEd, FAAO Managing Editor Rachael Van Cleave Editorial Board Lee Dodge, OD Richard Kendall, OD Anne Mika Moy, OD, FAAO Jasmine Yumori, OD, FAAO Production and Design Waxbox and Grace Design Studio Contact California Optometry with your ideas or comments by sending an e-mail to contact@coavision.org, or for more information visit us online at www.coavision.org. California Optometry magazine (ISSN0273-804X) is published bi-monthly by the California Optometric Association at 2415 K Street, Sacramento, CA 95816. Subscription: Six issues at $50.00 per year. Periodicals postage paid at Sacramento, CA. Copyright 2013 by the California Optometric Association. All rights reserved. No part of this periodical may be reproduced without written consent of California Optometry magazine. Send subscription orders and undeliverable copies to the address below. Membership and subscription information: Write to address below or call 800-877-5738. Postmaster: Send address changes to California Optometry magazine, 2415 K Street, Sacramento, CA 95816. Views and opinions expressed in columns, letters, articles and advertisements are the authors only and are not to be attributed to COA, its members, directors, officers or staff unless expressly so stated. Publication does not imply an endorsement by COA of the views expressed by the author. Authors are responsible for the content of their writings and the legal right to use copied or quoted material. COA disclaims any responsibility for actions or statements of an author which infringe the rights of a third party. Contributions of Scientific and Original Articles: California Optometry is formatted by and published under the supervision of the editor. The opinions expressed or implied in this publication are strictly those of the authors and do not necessarily reflect the opinion, position or official policies of the California Optometric Association. The author is responsible for the content. The Association reserves the rights to illustrate, reduce, revise or reject any manuscript submitted. Articles are considered for publication on condition that they are contributed solely to California Optometry.
Content
4 Leadership Corner 6 COA Board Highlights 8 Editors Note 10 Eye Openers 14 COA Event Review 22 Membership Matters 27 Member Services 28 Government Affairs 34 All Eyes on You 37 Optometry in Focus 39 Product & Services 40 Health News & Views 46 CE@Home 51 When & Where 52 Market Place 54 The Back Page
A new beginning
Fred Dubick, OD, MBA, FAAO President
Editors note: Featured below is an abridged version of COA President Dr. Fred Dubicks inaugural address delivered at the 2013 COA House of Delegates meeting. It is my humble honor to lead the California Optometric Association as president for the next year. I appreciate the confidence that you have placed in me. I have been involved in organized optometry for more than 30 years. My theme for this talk is People, Passion and Purpose. People. Let me start by acknowledging some of our colleagues that have inspired me, motivated me, counseled me, criticized me and continue to hold me accountable for everything I say and do. I am ready to hit the ground running because my good friend and colleague, now past president Movses DJanbatian, included me in everything he did for all of us this past year. He allowed me to truly partner with him every step of the way. It is my intention to continue that policy of open management with our next president elect, John Rosten. Your board of trustees this past year and the new group for this coming year will all work together for the association. I have been fortunate enough to have served on boards and committees with some legends of California optometry. I have been in San Fernando Valley Optometric Society meetings with Tony Carnevali forever and served on his board when he was president of COA about 20 years ago. Tony now serves as the president of Public Vision League (PVL), our entity that oversees litigation, plays defense from attacks on California doctors and is on the offensive to protect your practice and our patients from outside sources that want to influence how you care for patients. I spent about 10 years serving on the Vision West Board of Directors and in that time I came to know a recent OD of the Year, Joe Mallinger, quite well. He is a good friend and confidante and I value his advice, which I get whether I ask for it or not. He continues to have our best interests at heart and guides Vision West successfully year after year to exceed their obligation as our Preferred Buying Group, funneling hundreds of thousands of dollars to COA year after year.
Leadership Corner
We are going to define the next generation of optometry here in California.
We are about to embark on redefining optometry in California and my right hand man in this, our most important project, is my old associate, past president Dave Redman. Dave worked in our office for three years immediately after graduating from UC Berkeley School of Optometry. Dave, along with the legendary Lee Goldstein, your board and Legislation and Regulation Committee are committed to moving this profession forward. Integral for our success this year and hopefully for many years to come is our good colleague, past president and current chair of the Senate Health Committee, Dr. Ed Hernandez. We are excited to have Dr. Hernandez as an author and partner for this year. I practice full time in the San Fernando Valley. These volunteer positions that I get myself into flow around a full and robust practice. I cannot get it done without our staff in the offices that are led by our office manager, the glue that has kept it going for over 30 years, our friend and family member, Barbara Valensky. Last and of course not least is my wife and partner, Dr. Ellen Shuham. She is the smartest person I know, my sounding board for ideas, my harshest critic and perhaps the strongest human being in the world to be able to put up with my nonstop spewing of ideas and thoughts that are mostly crazy, but occasionally work. Please help me thank my family for the sacrifices of the past many years and the upcoming year. Passion. I have a passion for this profession that has not waivered since I graduated from the Pennsylvania College of Optometry many years ago. My wife is an OD. This is how we feed our kids and send them to college. There is no alternative for us! We are not alone as spouses and ODs. On our board is Derron Lee whose wife Leanne is an OD. Look at the AOA Board of Trustees and you will find about
california optometry
Leadership Corner
half of those 10 volunteers are married to ODs as well Ron and Desiree, Mitch and Susan. Maybe it is that survival instinct that pushes us to work a little harder, give a few more days away from the family and office. All I know is that I care a lot, and that passion has not diminished over the years, it just continues to grow. Thirty-some years ago I was at my first House of Delegates meeting and the Sensitive Issues Forum that year was focused on whether the profession here in California should use TPAs. I stood up at the microphone and spoke in support of one of the panel members and was booed. I knew then that if we were going to stay and practice in California, I needed to contribute and be in the game. As I travel to other optometric meetings around the county and interact with our colleagues that practice in places like Oklahoma and Kentucky, I am torn between being excited and frustrated that what they call optometry is so completely different than what we call optometry in California. What happened when I moved to California? Did my brain and its potential shrink? When I graduated, my classmates were going back to North Carolina and West Virginia. PCO (Pennsylvania College of Optometry) was training all of us to practice current care at that time. I moved to California and practiced with one arm tied behind my back for 15 years! It is ridiculous that we cannot practice 2013 optometry here in California. Here are just a few examples of our colleagues in other states do on a regular basis: exams under sedation, injectables, chalazion excisions, intraorbital injections, iontophoresis, femtosecond lasers and radio surgery. We need to redefine optometry in California and set the standard for the rest of the country. We are tired of playing catch up. Our goal is to allow you to practice at your highest level. Your board of trustees is looking to the future to have a reasonable law in place that is open to change with the technology of the future no more laundry lists of procedures, drugs and diseases that we can and cannot diagnose and manage. There are technologies and pharmaceuticals in the pipeline that you and I have not even heard of, but when they are ready, we will be ready. I am tired of being told that doctors of optometry are second class players in the health care system. I am tired of being ancillary, secondary and subservient; not worthy of independent thought. We are going to define the next generation of optometry here in California. I hope you are all ready to be optometric physicians. I know the board and Legislative and Regulation Committee are. Purpose. We are responsible to our members to protect our profession, protect our access to patients and protect our independence from corporate control over decision-making in the exam room. We, all of us, have chosen to lead by example. We have taken the time and resources to work for positive change. No business or profession has the luxury of standing
still. You are either moving forward as you expand horizons or you are complacent and let others pass you by. COA members come from every conceivable type of practice: solo practitioners, group practices, employees of HMO, other ECPs, corporate entities, full-time, part-time, educators and researchers. All of our colleagues need the protections afforded to their jobs by the last line of defense, the COA. If the American Optometric Association had not been in Washington, DC to keep optometry in the changing health care market, we may very well have had school nurses doing vision screenings and ophthalmologists providing medical eye care. No optometry. The simple reality is that we can be legislated or regulated into obscurity at any time. Only COA and AOA protect your rights to practice. You know that I cannot let this opportunity go by without a reminder to all of you to make your contributions to CalOPAC, LSCOA-PAC and AOA-PAC. These are exciting times to practice optometry in California. I look forward to a productive year ahead as we redefine the profession, add membership and protect your livelihood and professional independence wherever you practice. The board of trustees and staff look forward to working with you this next year. Call on us anytime.
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may/june 2013
COA Board of Trustees meeting highlights

On November 8, 2012, the COA Board of Trustees (BOT) met at the Monterey Marriott Hotel in Monterey. The BOT discussed a number of issues and topics that included the following motions and items: Motion: To forward the proposed policy resolution, numbered two, relative to the COA Legislative Fund assessment, as amended to the 2013 COA House of Delegates with the recommendation for approval. Motion: To forward the proposed bylaws amendment, numbered three, relating to the COA Nominating Committee purpose and composition, as amended to the 2013 COA House of Delegates with the recommendation for approval. Motion: To forward the proposed policy resolution, numbered three, relating to the COA Nominating Committee operating procedures, as presented to the 2013 COA House of Delegates with the recommendation for approval. Motion: To forward the 2013 proposed COA budget as amended and the proposed 2014 COA budget to the 2013 COA House of Delegates with the recommendation for approval. Motion: To forward the proposed bylaws amendment, numbered four, relating to COA budget approval, as presented to the 2013 COA House of Delegates with the recommendation for approval. Motion: To forward the proposed bylaws amendment, numbered five, relative to COA membership classifications, as amended to the 2013 COA House of Delegates pending COA legal counsel review with the recommendation for approval. Motion: To forward the proposed policy resolution, numbered four, relating to COA member dues, as amended to the 2013 House of Delegates with the recommendation for approval. Motion: To forward the proposed bylaws amendment, numbered six, relating to COA approved sections, as presented to the 2013 House of Delegates with the recommendation for approval. Motion: To forward the proposed policy resolution, numbered five, relating to the review of 2008 and earlier resolutions, as presented to the 2013 COA House of Delegates with the recommendation for approval. Motion: To forward the proposed policy resolution, numbered six, relative to review of resolutions, as presented to the 2013 COA House of Delegates with the recommendation for approval. Item: In its desire to provide effective forums for societies to communicate to COA and amongst themselves, for COA to communicate to societies and for COA to reach the widest audience of interested member doctors possible, the BOT agreed that for 2013 to replace the COA Presidents Council and Leadership Conference with town hall meetings, quarterly BOT liaison conference calls with society leaders and quarterly COA staff conference calls with society leaders. Item: Directed that the HOD/OptoWest Task Force and staff review the 2014 OptoWest schedule, logistics and costs, and communicate their suggestions to the COA Education and Clinical Practice Committee relative to the BOTs desire for the HOD meeting to be during OptoWest at the Renaissance Esmeralda Hotel & Resort, with the possibility of some OptoWest classes at the nearby Hyatt Regencey Indian Wells Resort & Spa. Item: Asked that beginning in 2013, COA staff organizes quarterly calls for each BOT member to hold with their liaison societies on a pre-determined date. Item: Announced that COA had employed a new communications and social media manager. The COA BOT met on February 7 and 9, 2013, in Universal City. Minutes from this meeting are pending approval by the BOT and will be released in the next edition of California Optometry. The next meeting of the COA BOT is scheduled for April 4, 2013, at the Renaissance Esmeralda Resort & Spa in Indian Wells.
COA Board Highlights
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October 23-26, 2013
Moving the profession forward

Julie A. Schornack, OD, MEd
As this edition of California Optometry is published, we are likely to be in the thick of graduation season. Being in practice can isolate you from this annual cycle and celebration, but when you are in academics, it is the culmination of everything that we work towards. We get just four short years with each student to transform them from an eager, bright-eyed science major (apologies to those of you who chose another course) into a seasoned diagnostician and consummate health care professional. The graduates emerge on commencement day armed with the most cutting edge strategies for the treatment and management of every eye ailment. Then the diaspora begins. Cars filled with every scrape of a graduates life begin to leave the area on their way to families, homes and practices of optometry, both near and far, where their new life as doctors of optometry begin. It is at this time when an unusual stratification starts to occur.
Editors Note
Graduates who land in Kentucky, as an example, can practice optometry with significantly grander scope than graduates who remain in the State of California. Now, all of these graduates went through the same education, all received similar levels of clinical education, all passed endless examinations, all cleared the hurdle of national boards, and all were licensed in the states in which they practice. Yet the privileges that are allowed to them are widely diverse. What a crazy system!
The future of the profession lies in our hands and the hands of the newly graduated. They now stand as our peers.
Life is full of choices about the way we practice. I may choose to emphasize vision therapy in my practice and not offer low vision, but I wouldnt stand in the way of practices offering low vision. How can any of us be unsupportive of moving the profession forward and redefining the practice of optometry and allowing these graduates to practice to the full extent of their education? The future of the profession lies in our hands and the hands of the newly graduated. They now stand as our peers. Here is another moment when each of us needs to view the profession from outside of our own personal needs and desires and take a larger world view of what is best for the profession. What is best is a logical and progressive advancement of the practice of optometry to occur that reflects the most contemporary skills and knowledge that graduates are taught in school. We need to proceed in this direction to constantly elevate the level of care that is provided to our patients. By moving in this direction we will also be able to provide services and access more patients who are in need of intermediate and advanced eye care. At this time of celebration and reflection on the optometry graduates four years of education, I urge you to work with them to help them realize all their dreams and fight to move the profession forward and allow these graduates to practice to their highest level of training. We welcome all new optometry graduates to the profession. You have our heartfelt congratulations!
Mission Statement
The mission of the California Optometric Association is to assure quality health care for the public by advancing all modes of optometry and by providing members with the resources and support to practice at the highest levels of ethics and professionalism. 8 california optometry
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Study reveals link between hypertension and Alzheimers.

A new study shows a link between uncontrolled hypertension and Alzheimers disease, according to the Dallas Morning News. Texas researchers at the University of Texas at Dallas conducted a study of the aging brain in 147 healthy participants, ages 30-89, funded by the National Institute on Aging, measuring plaque and blood pressure at each visit. One of the most revealing findings showed that unmedicated, hypertensive adults who carried a genetic risk factor for Alzheimers disease showed much higher plaque levels than all other groups. The study will appear in an upcoming issue of JAMA Neurology. What the study indicates is that by controlling hypertension, doctors might be able to control the onset of Alzheimers. California doctors of optometry are working to expand patients access to quality health care with COA-sponsored Senate Bill 492, authored by Senator Ed Hernandez, recently introduced in the state senate. They hope to head off or mitigate issues like Alzheimers by being able to treat hypertension and other diseases with ocular manifestations.
Eye Openers
The Eye Openers section gives a quick look at the latest headlines and news surrounding optometry and eye care.
Patient factors tied to eye care wear and tear in study

A recent online study published in the journal Optometry and Vision Science has identified factors associated with the wear and care of contact lenses and a patients eye examination frequency and contact lens purchases. Researchers conducted a survey of more than 2,000 U.S. patients and their practitioners. The study revealed that patients who didnt comply with the manufacturer-recommended wear replacement intervals and had longer periods between seeing their eye doctor were less likely to purchase an annual supply of lenses. Researchers also found that patients who purchased contacts from their eye care practitioner had a higher household income, had eye examination insurance, and were female with shorter periods between eye exams. Patients who failed to replace their contacts when scheduled complied less with lens care procedures. The American Academy of Optometry recommends that eye care practitioners reinforce the importance of all aspects of lens wear and care with their patients, with the overall aim of reducing possible complications and retaining successful contact lens wearers in their offices.
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Eye Openers
Low-income glaucoma patients less likely to use topical medications

Medscape.com reported that a couple of recent studies revealed low-income patients are less likely to use their prescribed eye drops. Patients with low income were twice as likely as those with average or above average income to be nonadherent to their medication therapy in our research. Thats quite significant, lead investigator Victoria Leung said of the research presented at the American Glaucoma Society (AGS) 23rd Annual Meeting, according to Medscape.com. Researchers also found of the 126 patients treated at a hospital in San Francisco for glaucoma, those with the more severe form of the disease were more compliant than those with moderate forms of the disease. This surprised some researchers who expected non-compliance to be higher in more severe patients, inferring that the disease was further along because of non-compliance.
According to Medscape.com, non-compliance is still high in glaucoma patients and doctors are working to find ways to encourage these patients to use their eye drops.
More physicians texting patients

In recent reports on NBCs Nightly News and CBS, more doctors are using text messaging to keep in contact with patients. In the NBC story, Chief Medical Editor Nancy Snyderman, MD, said, At Mt. Sinai Health Center in New York, doctor/patient texting has become so popular, Dr. Katie Malbon has created a formal program to keep up with it called Text in the City, in which young patients can anonymously ask physicians medical questions and get a reply within 24 hours. In a CBS story, one doctor, Kansas City pediatrician Natasha Burgert, texts and emails between visits so she is available all day long and into the evening if need be. She said some of her colleagues shake their head at her. They dont have an understanding of the tools, said Burgert. For the next generation thats coming behind me, I think this will be much more common. Snyderman said, This technological trend is expected to change medicine as we know it. It has the potential to improve the doctor-patient relationship, in particular, by providing greater accessibility, a freer flow of information and more immediate responses. According to the CBS story, there are no hard numbers on how many doctors are using this technology to keep in touch with patients, but stories like these suggest the numbers are rising.
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COA House of Delegates review

The 2013 COA House of Delegates (HOD) was as busy as it was exciting. Nearly 200 doctors came out to make decisions to change the organization for the better. Here is a list of the different policies that were passed and what they mean. To read the entire bylaws amendments and policy resolutions adopted, log onto the House of Delegates page under CE/Events at the COA website. Passed Bylaws Amendments Bylaws Amendment One, relating to COA Board of Trustees (BOT) votes without a meeting. This bylaws amendment was passed as presented. Conforms COAs bylaws to California law to require unanimous votes for approval by the COA BOT when the vote is conducted without a meeting. Bylaws Amendment Two, relating to the quorum and voting power at COA Low Vision Rehabilitation Section annual meetings. This bylaws amendment was passed as presented. It revises the manner in which student members are counted for purposes of achieving a quorum. Bylaws Amendment Three, relating to the COA Nominating Committee composition. This bylaws amendment passed as amended by the HOD. It sets forth in bylaws the purpose and composition of the COA Nominating Committee. Bylaws Amendment Five, relating to COA membership classifications. This bylaws amendment passed as amended by the HOD. It largely conforms COAs membership classifications to those of AOA.
COA Event Review
COA Trustee Dr. Derron Lee (center) with AOA President Ronald Hopping, OD, MPH (right), and AOA President-Elect Mitch Munson, OD (left)
2012 Board of Trustees listening to the years reports
2013 delegates voting to pass Bylaws Amendment Two, relating to the quorum and voting power at COA Low Vision Rehabilitation Section annual meetings, as presented
Passed Policy Resolutions 1. Policy Resolution One, relating to the COA Low Vision Rehabilitation Section (LVRS) dues structure. Was passed as presented. It removes dues requirement for student members of LVRS. 2. Policy Resolution Two, relating to the extension of the Legislative Fund Assessment. Was passed as amended by the HOD. Extends authorization for the COA Legislative Fund Assessment and increases it by two dollars per month.
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COA Event Review
3. Policy Resolution Three, relating to the COA Nominating Committee and applicant interview process. Was passed as presented. Places in written policy the operating procedures for the COA Nominating Committee. 4. Policy Resolution Four, relating to COA member dues. Was passed as amended by the HOD. Sets the COA member dues schedule effective fiscal year 2014. 5. Policy Resolution Five, relating to the review of 2008 and earlier resolutions. Was passed as amended by HOD.
Continues to keep in place or delete, as determined by the HOD, HOD-policy resolutions adopted five or more years previous to 2013. 6. Policy Resolution Six, relating to review of policy resolutions. Was passed as presented. Revises the manner in which HOD-approved and standing policy resolutions five years or older are reviewed by the HOD. 7. Policy Resolution Nine, relating to the reinstatement of the COA Presidents Council. Was passed as amended by the HOD. Reinstated the COA Presidents Council for 2013 and beyond.
WesternU students came out in droves to learn about HOD proceedings
Kern County Optometric Society President Dr. Dawson Li bearing his flag in the opening ceremony of HOD
COA President Fred Dubick, OD, MBA, FAAO (left) greets Sen. Ed Hernandez, OD, before he speaks to the HOD
At COAs 2013 House of Delegates meeting, COA received checks from Joe Mallinger, OD, MBA, FAAO and CEO of Vision West, Inc. and Roy Lyons, the Managing Director of Marsh. (right photo) The checks represent the great support that COA received from these companies over the last year.
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may/june 2013
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COA Event Review
Meet the COA 2013 Board of Trustees
Fred Dubick, OD, MBA, FAAO President
John Rosten, OD President-Elect
Stevin Minie, OD Secretary/Treasurer
Derron Lee, OD Trustee
Sage Hider, OD Trustee
Steve Langsford, OD Trustee
Ranjeet Bajwa, OD Trustee
Jan Cooper, OD, FAAO Trustee
Barry Weissman, OD, PhD, FAAO Trustee
Movses DJanbatian, OD Immediate Past-president
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COA Event Review
Legislative Day 2013: Students and doctors of optometry energized for advocacy
Legislative Day 2013 was an exhilarating day for both doctors of optometry and optometry students. The energy in the room was electrifying as there was a large audience consisting of close to 100 doctors of optometry and 100 students. Guest speakers included: Senator Ed Hernandez, OD, California Department of Managed Health Care Director Brent Barnhart and Covered California External Affairs Director David Panush. The audience also heard from COA leaders, staff members and lobbyists about the importance of representing optometry through advocacy. COA named Senator Ed Hernandez, OD and Senator Bill Monning as Legislators of the Year for their work on SB 951 and AB 1453 that defined the essential benefits that all individual and small group health plans must cover in implementing the federal Affordable Care Act, which includes the pediatric vision benefit. Key Person of the Year was awarded to IEOS Key Person Coordinator Paul Kiyan, OD. Dr. Kiyan was recognized for his extraordinary political involvement. His legislator, Assembly Member Mike Morrell, presented Dr. Kiyan with a certificate of recognition for being named Key Person of the Year when Dr. Kiyan visited his office in Sacramento during Legislative Day. Fifty-four doctors of optometry participated in the Adopt-a-Student Program which paired students with a doctor of optometry for the day. The students went to legislative appointments with their mentor and learned the ropes of constituent advocacy; it also provided students and doctors the opportunity to network. The program was a large success that received high reviews from both students and doctors alike. Doctors were delighted to see students coming to Legislative Day in droves as they are the future of optometry and the laws being decided today impact how students will be able to practice in the future.
Doctors and students participating in the Adopt-a-Student Program at Legislative Day
COAs Legislators of the Year, Senator Ed Hernandez, OD and Senator Bill Monning pictured with COA President Fred Dubick, OD, MBA, FAAO and COA Trustee Sage Hider, OD
Senator Ed Hernandez, OD, speaks to Legislative Day attendees in the Senate Chamber
Legislative Day attendees listening to speakers
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Registration is open!
There are countless reasons to register for the 2013 Optometrys Meeting , but access to the most informative and enriching educational opportunities in the industry is at the top of the chart. Advance registration is the perfect way to maximize your experience, so be sure to begin the process today and start planning for what will unquestionably be an enriching week in San Diego.
Register today at optometrysmeeting.org
COA Event Review
Students photographed on the Senate Floor tour led by Senator Ed Hernandez, OD
Legislative Day had a few surprises and exciting outcomes. When SBOS Key Person Coordinator Scott Fleming, OD, boarded his flight to Sacramento on the morning of Legislative Day, he realized his legislator, Senator Ted Lieu was on the same flight. He chatted with Senator Lieu on the plane and ended up sharing a ride with him to the Capitol from the airport. During Legislative Day, SDCOS doctors met with Assembly Member Rocky Chavez. They gave Assembly Member Chavez their contact info and business cards during the meeting. Shortly after Legislative Day, they were contacted by Assembly Member Chavez to invite SDCOS to meet him and his staff in his district office in Carlsbad. OCOS and RHOS doctors and students visited with Assembly Member Travis Allen and took photos with him. Their photos landed on Assembly Member Allens
SCCOS doctors and students with Senator Jim Beall
website. You just never know what exciting event will occur in Sacramento at Legislative Day! Everyone has a unique experience at Legislative Day. We had students, first time OD attendees, and seasoned Legislative Day veterans who attended this year. To highlight the different viewpoints, Legislative Day attendees wrote about their experience in Sacramento.
Assembly Member Travis Allen meets with Legislative Day attendees
Key Person of the Year, Paul Kiyan, OD, pictured with IEOS President Jason Flores, OD and COA Trustee and IEOS member Jan Cooper, OD, FAAO
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COA Event Review

Adam Shupe, OD, COA SVOS Member
the system, especially in rural and inner city communities where the distribution of physicians is low. With so many qualified NP, OD, PharmD, and PA providers already in place in the vast majority of California counties, it is imperative that these professions, which have proven their ability to provide trusted care for patients, now be trusted via legislation with broadly redefined scope of practice laws to help fill the provider gap for 3-4 million new patients.
attendee, it took a few minutes to suppress the butterflies that accompanied speaking with Dr. Adam Shupe (left) and Dr. Matt Earhart actual legislators. on the Senate floor. But once I actually sat down in front of my first audience, I realized that the situation was not much different than what we experience every day. Just as I sit across from my patients and educate them about the health of their eyes, I was now sitting across from an interested party, educating them about our profession. After that realization, the dialogue became more natural, the answers came easier and the nervousness faded away. Our legislators are just normal people, charged with making decisions and eager for information to help them make those choices just like our patients.
As a first-time Legislative Day
Follow the online discussion on Twitter by watching this hash tag: #ProviderGap.
Daniel Brinchman, SCCO Student (right) with Sacramento Valley Optometric Society doctors.
Daniel Brinchman, Southern California College of Optometry Student
Dr. Paul M. Dobies (left photo) talks with legislative staff. Student, Diane Lee (center of right photo), gearing up to talk with lawmakers on Legislative Day.
Diane Lee, Western University College of Optometry Student & Paul M. Dobies, OD, FAAO, Western University Assistant Professor, COA RHOS Member
On February 27, UCBSO, SCCO and WesternU students joined optometrists from all over California in Sacramento. Having students from all three schools attend the meeting sent a powerful message of commitment to the future of Covered California patients. Four spot bills authored by Senator Ed Hernandez, OD, set the stage for an important discussion with legislators of how nurse practitioners (SB 491), optometrists (SB 492), pharmacists (SB 493), and physician assistants (SB 494) can help fill the provider gap by removing legislated restrictions on the primary care they can provide for future Covered California patients. Our discussions focused on the realities of caring for a sudden near-term influx of patients into
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On Legislative Day 2013, practicing optometrists and students from across the state flocked to Sacramento. They looked forward to sitting down with our state senators and key people to discuss the important role of optometry in the upcoming redesigned California health care system. As an optometric professional, taking part in this dialogue with elected officials can be an intimidating task. With this in mind, the California Optometric Association (COA) hosted an enlightening morning educational program where lobbyists and leaders from the profession, including the distinguished Senator Ed Hernandez, OD, Chair of the Senate Committee on Health, thoroughly explained the details of the legislation, how to effectively communicate our message and the goals of the meetings we were to attend . Additionally, COA reinstated the Adopt-aStudent program that paired students with doctors from the same districts. These teams of students and doctors then attended afternoon meetings with members of the Legislature. Being able to take an active role in shaping the future by partaking in the legislative process as a student has been an eye-opening experience. This unification is the essence of why optometrists will continue to make strides toward providing complete care for their patients.
Thank you to all who attended Legislative Day 2013. You showed Sacramento optometrys strength in numbers and made a difference for the optometric profession!
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Why Join?
The Top Reasons to Join the California Optometric Association (COA)

Everyone has their reasons for being a part of a professional organization and thats true for COA members as well. Optometry Jodi Haas, is a legislated profession, meaning what you can or cannot do is Membership controlled by law, e.g., what the Legislature gives, it can take away. Development COA is working to give you more freedom in practicing and to Manager provide patients better access to quality health care by working with lawmakers. However, it takes our members and their passion for moving the profession forward to make this happen. The following are the reasons our members have joined COA: The #1 reason to join and maintain membership in COA is to protect and enhance the practice of optometry, both individually and collectively, in California. Barry Weissman, OD, PhD, FAAO, Los Angeles County Optometric Society As an optometrist, with the privilege of practicing optometry in California, it is my duty and responsibility to be a member of the only organization in the state, being the California Optometric Association (COA), that has the power and ability to protect the rights of optometrists, the needs of our patients, and the future of the profession in health care delivery. Jan L. Cooper, OD, FAAO, Inland Empire Optometric Society Strength in numbers! Steve Langsford, OD, Tri-County Optometric Society
Membership Matters
COA is the only reason you are able to practice to the level that you are today, and to the level you wish to practice tomorrow.
Its your profession; its your association; its your obligation. COA is the only reason you are able to practice to the level that you are today, and to the level you wish to practice tomorrow. Otherwise, we would all be well trained and glorified refractionists. Movses DJanbatian, OD, San Fernando Valley Optometric Society The feeling of camaraderie. COA gets people to listen. They are constantly working for you and always have your back. Marina L. Rocchi, OD, Golden Empire Optometric Society Membership benefits are multifaceted. The appeal of the tripartite membership is that it keeps you involved in all aspects of optometry. Youre in the know on the legislative side and professionally regarding your scope of practice. Membership keeps you informed of whats going on. The publications COA produces are a great benefit, especially being able to get CE through them. Carrie R. Turley, OD, San Diego County Optometric Society COA is passionate about supporting its members legislatively, but also about offering the best resources for their businesses and providing essential networking opportunities. We need your involvement to help us continue to do this!
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Membership Matters
Be rewarded & update your member profile!
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So, recruit and be rewarded: The top three members who recruit the most eligible new members from January 1 December 31, 2013, will get their 2014 COA dues paid for by Vision West, Inc.! Check out the member recruitment incentives link Member Resources under the Membership tab on www.coavision.org for more information. Member Update Member Update is a feature on COA Online, which allows members to view and edit their own information and member profile as it appears in the COA database. This feature assists in keeping COAs member database current as well as the Doctor Locator listing that appears on the Eye Help section of the COA web site. Also through Member Update, COA members have the ability to view any continuing education credits they have earned through COA and pay their dues online. For logon assistance contact Jenny Peterson at jpeterson@coavision.org.
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Membership Matters
Students making a difference through advocacy

Optometry students are prepared and ready to mobilize as advocates for their future profession! In order to prepare for the very important year in California as decisions are being made on how health care reform is implemented, COA conducted grassroots advocacy trainings at UC Berkeley School of Optometry and Western University of Health Sciences College of Optometry. In these training sessions students learned key skills that are needed to effectively advocate for optometry. At the Western University meeting, there was a large group of attendees consisting of students, faculty, local doctors of optometry, COA leadership and COA staff. Western University student and COA representative Diane Lee organized the very successful event. COA President Fred Dubick, OD, MBA, FAAO, attended the meeting and explained to students some of the key issues at the helm of the optometric profession. While in Berkeley, students attended the meeting along with local doctors of optometry and COA staff. Berkeley students and COA representatives Kevin Tong and Hannah Chu organized the pre-Legislative Day meeting with the hopes of making students feel more confident when speaking with legislators about optometry and health care reform in
Pictured at Western University grassroots advocacy meeting are: (L-R) WesternU faculty member Robin Drescher, OD, MS, FAAO, WesternU student Diane Lee, College of Optometry Founding Dean Elizabeth Hoppe, OD, MPH, DrPH, COA President Fred Dubick, OD, MBA, FAAO, WesternU student Julia Chu.
IEOS President Jason Flores, OD, is joined by WesternU students.
Meeting attendees watching a short video about the importance of student advocacy for optometry.
Page Yarwood, OD, MS, FAAO (center) is pictured with Berkeley students.
Sacramento. COA Past President Page Yarwood, OD, MS, FAAO, told the students about his experience advocating for optometry over the years. Students at both schools rallied together at their respective meetings to participate in the interactive discussion about the impact of health care reform on optometry. They learned many tips on how to successfully communicate with legislators and participated in role playing legislative meeting scenarios. The students were enthused after these meetings and ready to make a difference for the future of optometry. This was apparent when close to 100 students attended Legislative Day. Students are the future of the optometric profession, so it is essential for them to participate in the dialogue between optometry and the Legislature.
Berkeley grassroots advocacy meeting participants.
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Membership Matters
Few California doctors take advantage of meaningful use incentive

The Medicare Electronic Health Record (EHR) Incentive Program (Program) provides incentive payments for certain health care providers, including doctors of optometry, to use EHR technology in ways that can positively impact patient care. The Program asks doctors of optometry to utilize EHRs to achieve certain benchmarks that can lead to improved patient care. If the benchmarks are achieved, doctors of optometry can be compensated up to $44,000 per year. In order to receive compensation, doctors of optometry must prove that they are meaningfully using their EHRs. It is simply not enough for them to own an EHR system; they must prove to the Centers for Medicare & Medicaid Services (CMS) that they are using their EHRs in ways that can positively affect the care their patients receive. To demonstrate meaningful use of their EHR system, doctors of optometry must meet all of the objectives that have been established by CMS for the Program. While doctors of optometry from other states have already taken advantage of this opportunity by successfully attesting to meaningful use of EHRs, thereby receiving compensation from CMS, doctors of optometry in California have yet to fully embrace the Program. A recent report shows that from January 2011 to October 2012, only 187 doctors of optometry in California successfully attested to meaningful use. States that have a much smaller population than California had a
much higher per capita rate of participation, including Wisconsin with 132, Indiana with 174 and Missouri with 180 doctors of optometry meeting the meaningful use standards. There is still plenty of time for doctors of optometry in California to sign up for the Program and take advantage of an opportunity to receive extra compensation while at the same time having a positive impact on patient care. To learn more about how you can sign up for Program and the specific meaningful use objectives, please go to the following links on the CMS website and the American Optometric Association (AOA) website. www.cms.gov/Regulations-and-Guidance/Legislation/EHR IncentivePrograms/index.html?redirect=/ehrincentiveprograms www.aoa.org/x18599.xml
WELCOME! New COA Members
Alameda/Contra Costa Counties Optometric Society Melanie L. Mason, OD Inland Empire Optometric Society Linda S. Pang, OD Jadyn Evans, OD Kern County Optometric Society Cache Crawford, OD Joseph Figazolo, OD Los Angeles County Optometric Society Marc Simmons, OD Lilia Gelfand, OD Mojave Desert Optometric Society Kimberly A. Michel, OD
Orange County Optometric Society Diane M. Almanza, OD Arlene Huynh, OD Rio Hondo Optometric Society Jack S. Kim, OD Sacramento Valley Optometric Society Nguyen H. Quach, OD Katrina A. Gallardo-Chang, OD San Diego County Optometric Society Stephanie T. Le, OD Afsaneh Amini, OD San Francisco Optometric Society Leona Landers, OD Connie Kim, OD
San Joaquin Optometric Society Thy Mim, OD Santa Clara County Optometric Society Anita Gor, OD Christopher B. Ngo, OD Somayeh Semati, OD Melody L. Flores, OD Timothy S. Coughlin, OD Rahul K. Singh, OD Kimberly C. Cheng, OD South Bay Optometric Society Tracy Wong, OD
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Membership Matters
Technology and your practice

So, youve taken the plunge and you now have a Facebook page for your practice or organization. Now, what do you do with it? Aside from setting your Rachael Van Cleave, Communications goals for the page and assigning a & Social Media person to handle the day-to-day Manager, COA posting, you need to know the types of posts that will help you get the most out of social media. Some types of posts are more successful than others. The following will detail the types of posts and the media formats youll want to have depending on whether you are representing a private practice or an organization. Types of Posts: 1) Questions/Polls People love to give their opinion. Surveys show that questions that start with how and fill-in-the-blanks encourage the most interaction. People also like to see how their answers compare to others. 2) Informational People like to learn about the practical, the silly and the amazing of optometry. Otherwise, they wouldnt have liked your page. How-tos are a great way to show your patients and potential patients the exciting latest technology in optometry or things as mundane as paperwork processes. 3) Testimonials Patient testimonials are the great, real-world way to show your potential patients that other people trust you, so they should too! Obviously, youll want to get their permission to use it. If you want an example video or comment release form contact Rachael Van Cleave at rvancleave@coavision.org. Media Formats: 1) Pictures According to a study done by Wildfire Social Marketing, a subsidiary of Google, pictures are the number one type of content any private or retail business can post. This picture popularity phenomenon has encouraged the interaction of millions on Facebook and accounts for the explosion of picture-based social media in recent years like Instagram and Pinterest. Both organizations and private businesses should use pictures whenever possible with the above types of posts. 2) Video Wildfire Social Marketing came to the conclusion that video is the number one type of content any organization, institution or non-profit can post. When it comes to organizations, people dont have a wall up against a sales
Types of Facebook posts and formats- driving customer interaction

pitch. They want to dive into more depth. Think emotional connection here. However, this is a great way to push out those patient testimonials. Both private business and organizations can benefit from this as well. 3) Links Links are probably one of the least engaging types of posts aside from just pure text. However, if you dont have the time to come up with original content, this could be a life saver. You can link to a how-to someone else created, or to a video or creative picture. While it is better to have original content, this is a great way to supplement your posting. Another great way to supplement your posting is clicking the share button. For example, the California Optometric Association posts all sorts of informational content and COA encourages its members and partners to share its links, videos, pictures and more. This article should help you get started creating content for your Facebook page. Congratulations on moving forward with social media! Keep an eye out for future articles about social media and how to use it for your practice or organization. We want your feedback! Please email Rachael Van Cleave at rvancleave@coavision.org to submit your social media questions, comments and concerns. These will shape future articles.
Membership begins with me!

Membership Begins with Me emphasizes the can do spirit of COA members. We need all members to acknowledge and recognize their role in recruitment, whether it is to welcome new members or to reconnect former members with the Association. BE AWARDED FOR YEAR-ROUND RECRUITMENT The top three members who recruit the most eligible new members from January 1 December 31, 2013, will get their 2014 COA dues paid for by Vision West, Inc! Check out the member recruitment incentives link under member resources on www.coavision.org for more information.
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Are there gaps in your professional liability coverage?

While many employers provide professional liability coverage for their employees, chances are that coverage may have some serious gaps, including: Policy limits may not be high enough to protect you and all your co-workers. You may not be provided with coverage for lost wage reimbursement, licensing board hearing reimbursement and defense costs. You may not be covered outside of the workplace, such as when you engage in volunteer or part-time work. You may not be covered for suits filed after you have terminated your employment. Patients count on you for expert advice and professional services. But no matter how well-trained or careful you or your employees are, mistakes can and do happensometimes resulting in a lawsuit. Professional Liability Insurance protects you against claims arising from real or alleged errors or omissions, negligence, breach of duty and misleading statements in the course of conducting your professional duties. Most professional liability policies provide coverage limits of up to $2,000,000 per incident and up to a maximum of $4,000,000 in aggregate in any policy year. Many policies also include legal fees and court costs paid for covered claims, lost wages if you are required to appear in court due to a claim filed against you and your performance of services as a member of a professional board or organization. To request a free, no-obligation quote, call Marsh/Seabury & Smith Insurance Program Management at 1-800-775-2020 and speak with a Marsh Client Advisor.
Take advantage of special pricing or services offered to COA members. For more information on these member services, visit the Member Resources section of COAs website at www.coavision.org.
Member Services
COA sponsored insurance programs

Marsh 800-775-2020 coa.insurance@marsh.com www.COAMemberInsurance.com
COA preferred buying group

Vision West 800-640-9485 www.vweye.com
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I.C. System 800-279-3511 www.icsystem.com/associations/coa.htm
Discount credit card & payroll processing services

Heartland Payment Systems www.heartlandpaymentsystems.com
Classified ads
California Optometry Magazine COA Member News 800-866-5737 ext. 237 bhowe@coavision.org
*Marsh and the Association do not provide tax, investment or legal advice. Please consult with your professional advisors for guidance on these issues. 60955 (5/13) Seabury & Smith, Inc. 2013 d/b/a in CA Seabury & Smith Insurance Program Management CA Ins. Lic. #0633005 AR Ins. Lic. #245544 777 South Figueroa Street, Los Angeles, CA 90017 800-775-2020 COA.Insurance@marsh.com www.COAMemberInsurance.com
Continuing education
COAs CE@Home 800-877-5738 education@coavision.org www.coavision.org
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may/june 2013
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The latest news for optometry-related legislative and advocacy issues in California. Government Affairs
Legislation Update
The 2013 bill introduction deadline has passed and many measures are now in print. Several of these bills, called spot bills, dont include actual bill language yet. They will be amended Kristine Shultz, COA director of with that actual language before they government & are heard in their first policy external affairs committee. COAs Legislation and Regulation Committee is reviewing the mountain of new bills to determine COAs official positions. Below is a summary of legislation that would directly impact doctors of optometry: Senate Bill X1 1 by Senator Ed Hernandez, OD, and Assembly Bill X1 1 by Assembly Speaker John A. Prez were both introduced in the special session to expand Medi-Cal eligibility and simplify the enrollment process. This legislation, which is important to optometry, provides the newly eligible Medi-Cal beneficiaries the states essential health benefit package, meaning a comprehensive eye exam and glasses for kids, and the potential for adult eye exams to also be covered. Senate Bill 266 by Senator Ted Lieu would prohibit a provider group from holding itself out as being within a plan network or a provider network unless all of the individual providers offering services within the provider group are within the plan network. Senate Bill 430 by Senator Rod Wright would require the current vision appraisal done in schools to also include a test for binocular function. The appraisal could include a validated symptom survey. Senate Bill 492 by Senator Ed Hernandez, OD, will redefine the practice of doctors of optometry in California. Senate Bill 588 by Senator Bill Emmerson would change fees for producing paper and electronic copies of medical records, record search and retrieval, as well as record delivery for a third party and provides that an electronic copy of a patients medical record is required only under specified conditions. Senate Bill 724 by Senator Bill Emmerson would provide immunity to a church; nonprofit charitable organization; or participating licensed optometrist, ophthalmologist, or volunteer working with a nonprofit charitable organization for any damage or injury resulting from the provision of vision screening and the distribution of donated or recycled eyeglasses, if specified conditions are met. Senate Bill 809 by Senate President Pro Tempore Darrell Steinberg and Senator Mark DeSaulnier would upgrade a database that monitors the prescribing and dispensing of controlled substances. To pay for the changes, the legislation would establish fees on health plans, workers compensation insurers, drug manufacturers and prescribers. Fees for doctors of optometry could go up by 1.16 percent under the legislation. If you have any questions or comments about the legislation above, please contact Kristine Shultz at kshultz@coavision.org.
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Government Affairs
Senator Hernandez holds press conference and provider workforce joint informational hearing
March was a big month for optometry. Senator Ed Hernandez, OD, hosted a press conference and the Senate Health Committee and Senate Business, Professions and Economic Development Committee held a joint informational hearing on utilizing the health care continuum to increase patient access. Speakers discussed ways to address the health care workforce shortage expected in 2014 when the Affordable Care Act fully takes effect. Aaron Lech, OD, FAAO, from Sacramento testified on behalf of COA. Dr. Lech stated
Senator Ed Hernandez, OD, talks to media at press conference about provider gap.
Aaron Lech, OD, speaks at press conference about diseases that doctors of optometry are qualified to treat.
Senator Ed Hernandez, OD, points out the only county where there isnt an optometrist.
that California faces a serious provider gap now, which will only get worse in 2014. He provided irrefutable evidence explaining how doctors of optometry complete a rigorous education and are uniquely situated to help ease the provider shortage. All of this and more was tweeted live! Follow us on Twitter for live updates about the latest in optometry.
Stay connected to government affairs!

Government Affairs Weekly Update
For weekly information on COAs government and external affairs activities, watch your e-mail inbox each Wednesday for the Government Affairs Weekly Update. Archives are available on COAs website (in the Members Only section, click Government Affairs, then Weekly Updates).
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Government Affairs
California patient protection laws prevail in legal challenge from LensCrafters

COA is pleased to announce that the U.S. Supreme Court upheld Californias laws prohibiting optical companies from providing eye exams. LensCrafters had challenged the laws in court as an unconstitutional violation of the Commerce Clause. LensCrafters argued the rules put optical companies at a competitive disadvantage because California doctors of optometry are allowed to sell eyewear as part of their services, offering their patients the option of one-stop shopping. The state argued the laws had a legitimate purpose and were enacted to ensure eye exams arent influenced by commercial motivations. Over the past 11 years, COA and its members have assisted the state attorney general in this case by providing background and testimony. COA has also submitted amicus curiae briefs to the court. We are pleased with the U.S. Supreme Courts decision to not take up this case. If these laws were overturned, it would have made it easier for corporations to pressure doctors of optometry into prioritizing company profits over patient care, said COA President Fred Dubick, OD, MBA, FAAO. In accordance with an agreement reached in 2006, the California attorney general will not institute any enforcement action against LensCrafters for a
period of six months from the date of the Courts decision to allow it to change their business model to comply with California laws. LensCrafters now has two options. It can either reorganize its business similar to other California corporations that have independent eye doctors next to their optical store like Costco, or it may seek to reintroduce legislation to exempt their business structure from Californias law. Last year, LensCrafters withdrew similar legislation because of lack of support in the Senate.
Extension of the COA Legislative Fund Assessment

A big boost for optometry that cant buy you a latte
Big changes are coming for doctors of optometry in California. Health care reform is coming into full effect in 2014, causing the provider gap in this country to grow wider. That means that doctors of optometry need to have a scope of practice that allows them to treat that influx of patients. That is one thing that COA is committed to fight for this year. In light of that, the 2013 House of Delegates (HOD) approved to extend the Legislative Fund Assessment. That assessment will help COA expand the scope of practice of optometry in the State of California. In addition to extending the assessment, the HOD determined it necessary to raise the amount from $14 to $16 per month. While the two-dollar difference wouldnt even buy you a latte, the small individual investment will be a big boost to the legislative promotion and defense of optometry. For updates on the latest in the fight for optometry, watch our social media and keep an eye out for our Government Affairs Weekly newsletter. Follow us: www.facebook.com/Californiaoptometry www.twitter.com/coa_vision
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Government Affairs
AOA-backed Medicaid, NHSC improvement bills introduced; ODs encouraged to contact elected officials for support
AOA doctor and student advocates helped secure record levels of support for optometry-specific legislation in the last Congress. Thanks to their efforts, the National Health Service Corps Improvement Act HR 920 and the Optometric Equity in Medicaid Act HR 855 have been introduced into the new 113th Congress with broad bipartisan support.
COA urgently recommends members to contact your member of the U.S. House of Representatives to urge their co-sponsorship of these critical measures.
COA urgently recommends members to contact their House Representatives to urge his or her co-sponsorship of these critical measures. HR 920 is sponsored by Representatives Cathy McMorrisRodgers, R-WA, and Kathy Castor, D-FL, and would enact the AOA-backed National Health Service Corps Improvement Act to bring doctors of optometry into more underserved urban and rural communities by ending the misguided exclusion of doctors of optometry from the National Health Service Corps student loan repayment and scholarship programs. California Representative Jerry McNerney, D-Stockton, has joined five other members of Congress as a bill co-sponsor. HR 855, sponsored by Representatives Ralph Hall, R-TX, and Jan Schakowsky, D-IL, would enact the AOA-backed Optometric Equity in Medicaid Act. This bill seeks to avert a potential crisis in access to primary eye care for Medicaid patients by amending the federal Medicaid statute to fully recognize doctors of optometry as
physicians. California Representatives Zoe Lofgren, D-San Jose, and Jerry McNerney are among the 13 members of the House co-sponsoring this needed legislation. With a few keystrokes, AOA has made it easy to seek your congressional representatives co-sponsorship of HR 920 and HR 855: Go to the AOA website at aoa.org. In the right column on the homepage under For Doctors, click on Federal Advocacy. Click on the top link on the page, AOAs Legislative Action Center. Click on Take Action under the heading Expand Access to Eye and Vision Care and End the Exclusion of ODs from National Health Service Corps programs: Co-sponsors Needed for HR 920 and complete the steps for sending an e-mail to both senators and your House member. On the same page, click Take Action under the heading Safeguard access to optometric care for vulnerable seniors, uninsured working men and women and schoolaged children; Co-sponsors needed for HR 855 and complete the steps for sending an e-mail to the above federal elected officials.
Logged on Yet? COA Needs You!
The Government Affairs segment of California Optometry magazine is sponsored by Vision West, COAs preferred buying group.
Contact Kara Corches at kcorches@coavision.org to be linked up!

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Government Affairs
The art of legislative correspondence

I think we all remember learning the proper mechanics of letter-writing in elementary school. We learned the key components of writing a letter such as: you need to address the person to Kara Corches, COA whom you are writing, date the letter, grassroots and close the letter with sincerely and fundraising manager sign with your John Hancock. Even though we now live in the technological age where letters have often been replaced with Facebook posts and tweets, a skillfully crafted letter to a legislator is still a very powerful tool for grassroots advocacy. As you may know, legislators receive hundreds of e-mails and letters from constituents daily. Thus, it is important for COA Key Persons to write letters that stick out amongst the piles of mail and full inboxes of legislative offices. Tip 1: Utilize COA as a resource for letter/e-mail writing. COA will provide a template letter when you receive Key Person advocacy alert e-mails urging you to take action and contact your legislators. We will provide all of the statistics and important information in the template letter so you do not have to do any research, saving you a great deal of time. Tip 2: Properly address the legislator. If you are utilizing COAs e-mail based advocacy software program, it will automatically address the legislator correctly when the e-mail is sent. If you are writing a letter or addressing an envelope, be sure to use the correct way to address a legislator. Here is an example of the proper way to address a letter to a lawmaker: staffer, understand that you, as a constituent, took time to personally write the letter/e-mail. Remember, a personal letter is always valued more than a form letter. Tip 4: Check your spelling and grammar. Just as you doublecheck your business documents, it is equally important to make sure you do not submit a letter to a legislator with errors. We need legislative offices to know that we are serious about our advocacy efforts, so make sure your letter reflects your professionalism. Tip 5: Sign your name. This tip doesnt apply to e-mails. If you are sending your legislator a letter in the mail, be sure to sign your name and sign it legibly! Not everyone recognizes your signature so it is important to sign very clearly so the legislative office can track who wrote it. A legislators office could receive a fantastic letter but may not know how to respond or take action when they cannot accurately determine who wrote it. Signing the letter is also another way to personalize the letter and show that it is not just a form letter. Tip 6: Include your contact information. If you are writing an e-mail, make sure you include your name, address, phone number and e-mail address. If you are utilizing COAs online advocacy software, it will automatically add your name and address to the e-mail. It is important to add an e-mail address or phone number in the hopes that a legislator and/ or legislative staff will contact you in the future to follow up or get your opinion on health care related matters. If you are sending a letter in the mail to a legislator, insert your business card in the envelope. If you insert your business card, legislative offices have your contact information on hand. By writing letters and e-mails to legislators, you are playing an active role in the political process. Legislators want to hear from their constituents, so speak out on behalf of optometry by sending letters and e-mails to your lawmakers. The more correspondence Key Persons have with decision makers in California, the greater the chance for legislative success.
May 1, 2013 The Honorable Jackie Jones Member, California State Senate State Capitol, Room 1001 Sacramento, CA 95814 Dear Senator Jones,
Tip 3: Personalize, personalize, personalize! Even though you will receive a template letter from COA, it is crucial to personalize the letter. As legislative offices get dozens of mass-produced form letters, if you want your letter to stand out, you need to show the reader that you took a few minutes to personalize the correspondence. Tell a story, write about your practice, mention some common characteristics you and the legislator share (i.e., went to the same school, involved in the same community organization, etc.). Your goal is to make the reader, who is usually a legislative
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Government Affairs
If you would like to send a letter to your legislators, please utilize the sample letter included in California Optometry to create your own personalized letter and mail it to your legislators!
If you would like to join forces to advocate for optometry, please contact Kara Corches at kcorches@coavision.org to sign up to be a Key Person.
Sample Letter
May 1, 2013 The Honorable Jackie Jones Member, California State Senate State Capitol, Room 1001 Sacramento, CA 95814 Dear Senator Jones, I urge you to support the package of legislation that improves access to health care in California, including SB 491, SB 492 and SB 493. These bills expand the practice of pharmacists, doctors of optometry and nurse practitioners to address the health care provider workforce shortage in California. As you may know, many of the over 7 million people in our state without health care insurance will be eligible for new coverage in 2014 under the Affordable Care Act (ACA), and will begin flooding the health care system. The health care system is unprepared to meet this increased demand. The Association of American Medical Colleges says that by the year 2020, the United States will face a shortage of 90,000 doctors. Policy experts including the Institute of Medicine recommend using each provider to their maximum level of competence as part of the solution to physician shortages. ACA will be a false promise if we expect MDs only to provide all primary care to new patients. Californians deserve access to high quality primary care offered by a range of safe, efficient, and regulated providers. Physician assistants, nurse practitioners, pharmacists and optometrists have all significantly advanced their educational, testing, and certification programs over the past decade. Theyve enhanced clinical training, moved to graduate or advanced degrees, and upgraded program accreditation processes. Ensuring that there are enough health care providers is key to keeping medical costs low. Passing this package of legislation is something that you can do immediately to increase the number of qualified practitioners who are willing to treat the huge influx of patients expected in just a few short months. Please consider supporting SB 491, SB 492 and SB 493 to increase access for all Californians by filling the health care provider gap. Please feel free to contact me if you or your staff have any health care related questions. Thank you for your consideration. Sincerely, (Signature) Printed Name Address City, State Zip
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New requirements from the U.S. Citizenship and Immigration Services (USCIS)
USCIS has issued a new I-9 Form and new employment law posters
The U.S. Citizenship and Immigration Services (USCIS) recently published a revised I-9 Form for Employment Eligibility Verification. What Employers Need to Know: As of March 8, 2013 employers should be using the revised form for all new hires and re-verifications. Employers may continue to use previous versions, dated February 2, 2009 and August 7, 2009, through May 7, 2013. After May 7, 2013, employers will be required to use the recently released form, dated March 8, 2013. After May 7, 2013, employers must use the revised I-9 Form for new hires AND to re-verify the employment authorization of current employees. If a current employee requires re-verification after May 7, 2013, employers must complete Section 3 of the new form and attach it to the employees existing I-9 Form. Reasons for change: The government directed that the form change because the old form expired, which gave USCIS the chance to implement the following to the form: Fields such as the employee email address and telephone number Revising Section 1 to improve readability and clarity Adding a 3D barcode area to promote the modernization of USCIS forms More space for employers Revising instructions for readability and clarity You can find the new form at www.uscis.gov/i-9. Note: Did you know that failure to post the USCIS Discrimination Notice in the workplace can result in severe civil financial penalties? It is one of the 16 employment-related posters required to be placed in the workplace by every employer. COA makes these posters available to members at a significant savings. To learn more and order, go to Benefits and Services under the Member Resources link at the Membership tab on COAs website at www.coavision.org or call 916-441-3990.
All Eyes on You
All Eyes on You features the latest news about COA members.
CVF Spotlight
Get involved!
California Vision Foundation, COAs charitable foundation, needs your help. If you would like to become involved in the California Vision Project and provide free eye exams to eligible low-income families, or contribute financially to the Foundation, please contact Sarah Harbin, California Vision Foundation administrator, at 800-877-5738 ext. 222, via e-mail at sharbin@coavision.org or mail checks payable to the California Vision Foundation, 2415 K Street, Sacramento, CA 95816. To find out more, visit our website at californiavision.org.
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All Eyes on You
Key Person corner

COA Trustee Jan Cooper, OD, FAAO, and IEOS Key Person Coordinator Paul Kiyan, OD, attended a fundraising event for Assembly Member Mike Morrell at the Ontario Double Tree Hotel. Assembly Member Morrell appreciated COAs attendance at the event to support his campaign for re-election. Dr. Cooper stated, Our dinner table included one of his sons, Matt Morrell. Karl Rove was the keynote speaker and gave away his newly published book, Courage and Consequence, with the authors signature. The book was available to those who attended the event. Dr. Kiyan and I both have a copy of his new book! SVOS Key Person Coordinator Nick Gutierrez, OD, and COA President-Elect John Rosten, OD, attended a fundraising reception for Senator Ed Hernandez, OD, in Sacramento. COA REOS members Ronald Harris, OD, FAAO, and Karen Griffith, OD, attended a fundraising reception for Assembly Member Marc Levine in San Rafael. Assembly Member Levine represents Assembly District 10 which stretches from Sausalito to Santa Rosa. COA Trustee Derron Lee, OD, attended a meet-n-greet event for the Mayor of Stockton, Anthony Silva. Meeting your local elected officials at a community networking event is a great Key Person activity and is highly encouraged.
Meet COAs new membership development manager

Originally from Cleveland, Ohio, the California Optometric Associations (COA) new membership development manager, Jodi Haas, is an avid sports fan. Haas collects sports memorabilia and loves attending sporting events like football, hockey and basketball. In that order, she said.
Pictured (L-R): Dr. Nick Gutierrez, Senator Ed Hernandez, OD and Dr. John Rosten
Jodi Haas, COA membership development manager
Pictured (L-R): Dr. Ronald Harris, Assembly Member Levine and Dr. Karen Griffith
Haas, who attended Boston University, has also been the corporate sales manager for the Sacramento Kings and the development director with the Leukemia and Lymphoma Society. COA is happy to add such an energetic, outgoing and sports-loving member to our team. Speaking of sports, Haas said shes ready to tackle her new position. I really hope to help your local societies grow by increasing representation for the association, Haas said. Haas said thats her focus growing COA. I want to expand our membership so we can have a greater influence for optometry, she said. If you have any membership or event sponsorship questions, please feel free to direct them to Jodi Haas at 916-266-5038 or jhaas@coavision.org.
Pictured (L-R): Derron Lee, OD and the Mayor of Stockton, Anthony Silva
SDCOS Key Person Coordinator Richard M. Skay, OD, attended a fundraising dinner for Senator Mark Wyland in La Jolla. Senator Wyland represents Senate District 38, which is comprised of portions of Orange Pictured (L-R): Governor Pete Wilson, Gayle County and San Diego Wilson, Dr. Richard Skay, and Senator Wyland County. Former California Governor Pete Wilson was also in attendance at the event.
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All Eyes on You
Key Person spotlight: the backbone of COAs political program

COA Key Persons are the backbone of COAs political program. As we work to increase the power of our grassroots program, it is important to highlight the outstanding work COA Key Persons are doing. Paul Kiyan, OD, was named COAs 2013 Key Person of the Year. Dr. Kiyan has tirelessly advocated for optometry in the Inland Empire. He has built many personal relationships with legislators over the years. As Key Person Coordinator for Inland Empire Optometric Society, Dr. Kiyan has strengthened advocacy for optometry by attending numerous political functions and often bringing other IEOS members with him to these events. Thank you, Dr. Kiyan for advocating for optometry as a COA Key Person! What is the benefit of being involved in grassroots advocacy for optometry? I think the benefit of being involved in advocacy is the opportunity you have to play a part in the community. You are able to really influence the community by building relationships. A lot of people complain but dont take action. Building personal relationships with lawmakers and decision makers is very important because they will listen to you since they know and trust you, so your opinions can make a difference.
All of the legislators I have known, from both political parties, have a heart for making a difference for society.
Have your Key Person relationships with legislators impacted the way you view politics? Definitely. Many of the legislators I have known over the years, I actually knew before they were in the public limelight. I have known legislators when they were patients of mine in their youth and it makes me very proud to see them grow up and make a difference in the community and state through their elected offices. Many people view politics in a negative light. I disagree with this view. Because I have been active in advocacy for many years, I have had the opportunity to get to know many legislators personally. All of the legislators I have
Assemblyman Mike Morrell (right) honors Paul Kiyan, OD (left), with a commendation for being named Key Person of the Year
known, from both political parties, have a heart for making a difference for society. Through my Key Person relationships, I have seen that legislators genuinely want to make things better for others and that is why they get involved in politics. Legislators want to make informed decisions on public policy and they want to take input from all different sides of the debate to make a balanced decision. Do you think that it is important for students to get involved in grassroots advocacy? It is very important to students to be involved now. I have seen tremendous changes in the optometric profession since the time I began practicing. Most recently, the TPA bill and the Affordable Care Act have been large forces of change for optometry. There is a new generation of doctors of optometry and they need to get involved and advocate for the future of the profession. From my experience, the future is always better than the past. Students can ensure the future is better by getting involved today.
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Technology: Patient care apps & increased practice efficiency

Apps are everywhere, and have the potential to play an important role in patient care. Downloading apps will soon be an American tradition, similar to back in the day when fathers chased their kids around with power tools. I told my boss I was turning 30 and getting my first smartphone, he smiled and said he had socks older than me. So, I did what any new associate would do. I bought him new socks. He chased me around the office with an alger brush. Turns out your smartphone and sock drawer have more in common than you think. When I was a youngster, not a whole lot went into the sock drawer. It wasnt hard to reach in and grab a matching pair. The older I get though, more socks go into the drawer and its much harder to find two that go together. In fact, I have a lot of lonesome socks. Studies have shown if the missing sock does not reappear within the first 24 hours, your chances of finding that sock decrease by 75 percent. Sounds like my practice consultant on uncollected co-pays. The same applies to my phone; the longer I have it, the more junk it collects. I have a bunch of old apps cluttering my wallpaper in the hopes that one day Ill actually use the abdominal workout app I downloaded months ago. Therefore, if you havent updated your smartphone or tablet devices this year, youre likely in the floppy disk age of apps. So, if youre like me, its time to ditch those lonely socks, stop living life in the cheap seats and get yourself some sexier apps! Parks 3-step Have a patient with double vision? Theres an app for that, seriously. There can be many reasons patients have diplopia. Its possible they need prism, vision therapy or need to lay off the eyeball martinis. Or they may have a paretic extraocular muscle and you need to diagnose it. If youve forgotten everything about the Parks 3-step except it involves hypers, obliques and head tilts you need the Parks 3-step app. It utilizes your devices built-in gyroscope and accelerometer to predict the paretic EOM in two swift movements. Enjoy! Pros: Simple, quick, accurate way of performing the Parks 3-step without diagrams. Cons: Needs option to input data manually, in addition to turning phone and some updated animations. Rating:
Kris Skromme, OD
Optometry in Focus
Kristopher Skromme, OD, graduated from the New England College of Optometry in Boston, Massachusetts. He is in private practice in Ventura, California and President-Elect of the Tri-County Optometric Society. He volunteered in Haiti last year on a medical mission providing free vision care and is a Paul Harris Fellow of Rotary International. In addition, he maintains his own blog, Doctoronsight. com, which presents fun facts and articles about eyes. He can be reached at skrommeod@gmail.com.
Medical Lab Tests Medical Lab Tests was designed primarily for doctors, nurses and medical students. It can also be used by anyone who wants to know the meaning of different blood tests. This app is packed full of very detailed and easy to find information. Can you recall the normal value of TSH or the reference value for triglycerides? This application will help you! This app isnt free but will cost roughly the
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Optometry in Focus
equivalent of a side of guacamole at Chipotle. You may need it sooner than later because signed into law last year was AB 761, which in a nutshell, allows ODs to perform CLIA-waived tests in their office, rather than having to order these tests from a lab. You can read more about AB 761 on the COA website. Pros: Offers you short and concise information, including normal lab values of the most common clinical laboratory tests. Cons: Cost. Im debating over that side of guacamole at Chipotle. Rating: Pros: Easy to use RGP calculations, vertex converting, oblique cross-cylinder calcs. Eye Handbook Optometry, being one of the areas of medicine that people outside of the field know very little about, has often been given the short end of the stick when it comes to the number of apps available. However, unquestionably the front-runner among apps for optometry is Eye Handbook. It will raise your eye Q. Its my absolute favorite optometry app and its free! Its a comprehensive app with plenty of useful resources and the most frequently used app on my iPad. Its loaded with an ocular disease atlas, ICD-9 codes, patient education videos on LASIK, multifocal IOLs, punctal plugs, uveitis, and much more. It even has a built-in fluorescein light, color vision and amslers grid. Yuppp! This is the party favor app you pull out to show your friends. But really, this app has it all. Its a great resource tool for clinical applications as well as networking in forums with other ophthalmic professionals. Eye Handbooks collaboration with the American Academy of Ophthalmology also gives it an instant injection of credibility. To top it off, for those in need of some new pediatric resources, they have pediatric fixation targets and an optokinetic drum. Pros: Plenty of useful resources, patient education, OC disease Atlas, ICD-9 codes etc. Cons: Few compared to the advantages. The media center is a bit of a mixed bag, rough around the edges, not everything is particularly useful. Rating: Cons: Cost. I would love to see enhancement of adding the hybrid lens designs like the synergeyes A or Duette Lens. Rating: membership. Are you a little rusty on those RGP calculations? This is a great tool for those that dont see RGPs on a consistent basis. Its especially useful for the initial start on designing an RGP lens including bitorics. The diagrams are clear and concise. Overall, its easy to use. Its best utilized for designing an RGP, vertexing tool for spectacles, post-surgical keratometry conversions - all in the palm of your hand. The oblique cylinder over-refraction tool is very helpful. Its a good app, especially for those offices that dont have any contact lens reference materials like a TQ. It also provides contact lens calculators and much more. In addition, this is an excellent app for designing other contact lenses.
Epocrates Epocrates Rx is a free drug reference application featuring thousands of drug monographs, drug-to-drug interaction checker, pill identifier, and health plan formularies. Theres a reason its the #1 mobile drug reference among U.S. physicians. I use this app often at work and it is much easier and convenient than searching through a drug book. You can check drug interactions with OTC medications and also has a great pill ID if you need it. This product also includes free continual updates and medical news. It is simple to download and easy to use. The product is also available in versions that include information on disease diagnosis, including images, diagnostic tests, insurance codes, alternative medicines, and a medical dictionary. Epocrates Rx is a great clinical reference for quickly accessing information regarding drugs, adult and pediatric dosage information, interactions, and contraindications. The information is always current and accessible instantly. I suggest everyone get comfortable with the software and take advantage of all it has to offer. Pros: Quick access to reliable drug, disease, and diagnostic information.
CL Calcs This app is a lite version of the EyeDock app without the need for an EyeDock
Cons: Doesnt work well on older phones, mechanism of action is generally sparse. Rating:
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Product & Services
Allergan
With a 60-year heritage in discovering and developing therapeutic agents to help protect and preserve vision, eye care professionals and patients rely on Allergan products to treat a variety of eye conditions. We are a leader in this area and are one of the fastest-growing eye care companies worldwide.
APC63RP10
800-433-8871 www.allerganoptometry.com
CooperVision
CooperVision manufactures a full range of monthly, two-week and daily disposable contact lenses, featuring advanced designs and materials that will satisfy almost any patient need.
1-855-5-COOPER www.coopervision.com
VSP Global is a complementary group of leading companies, working together to meet and exceed the needs of eye care professionals, clients, and our 58 million members. Combining the strength and expertise of each of these companies, VSP Global provides benefits, services, products, and solutions that are unparalleled in the optical industry. Eye care professionals, who are on the front line of patient care, look to VSP Global as a trusted partner to deliver the very best patient experience and to ensure an exceptional relationship between eye care provider and patient. www.vspglobal.com
VSP
Alcon
Alcon develops, manufactures and markets surgical equipment and devices, pharmaceuticals and vision care products in more than 180 countries. At the heart of Alcons ability to deliver best in class products year after year is our Research & Development organization. All of our many engineers, scientists and medical professionals are dedicated to meeting the worlds eye health needs. Over the next five years, Alcon plans to invest approximately $5 billion to discover and develop new treatment solutions for vision conditions and eye diseases. www.alcon.com
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The latest health care issues that affect doctors of optometry. Health News & Views
Sun protection
Martha Mijares, ABOC Optical Director, SCCO Eye Care Center
Considering the potential damage to eyesight that UV exposure can cause, everyone should be wearing sunglasses that block UV rays coming directly on front of the lens. Lenses that absorb 90% of UVA and 99% of UVB are one of the best defenses against eye damage and damage to the surrounding eyelid area. Because the human eye is subject to various potential eye diseases including vision loss, protecting the eyes should be just as important as preventing skin cancers. In the past, emphasis has been placed on the protection from UVA and UVB rays and it has been focused simply in blocking the transmittance of solar radiation to the eye with a pair of sunglasses that absorb UV light. The transmittance value alone may be deceptive if there is too much space between the face and the frames. We must also consider the radiation entering peripherally from around the lenses. This potentially harmful radiation can be reduced by selecting the proper fit and shape of the frame. The best protection is achieved by maximizing a close fit around the eyes. Consequently, frames that wrap around the eye can effectively reduce the side exposure and UV transmission. There are three main categories of sun lenses for UV protection: 1. Photochromic lenses. The most common are Transitions, and Photofusion. As these lenses adapt to the surrounding UV, they help wearers see their best in all lighting conditions. The lenses block 100% UVA and UVB rays while reducing glare. The benefit for all patients is the convenience and practical aspects accommodating to their busy lifestyle.
2. Polarized lenses. Polarized light is created by the sun or an artificial light source. When it bounces off of horizontal surfaces like water, snow or highways, it can cause intense glare that makes it difficult or impossible to see. Polarized lenses can be beneficial for situations such as driving, skiing and fishing. a. Drive wear. Polarized lenses that block glare in all light conditions. The lenses change color for optimum vision in bright light and overcast conditions. It is also an excellent lens for patients who drive the majority of the day, and a practical lens for golfers due to its enhanced color contrast benefits. b. Coppertone. Polarized lenses provide more of high energy visible light (HEV) protection than ordinary sun lenses. They block 100% of UVA/UVB rays. These lenses also eliminate 97% of reflected glare. c. Xperio uv. Polarized lenses eliminate 100% of glare and they offer an anti-reflective coating on the back of the lens providing maximum UV protection. These lenses are typically recommended for fisherman, outdoor sports, skiing, etc. 3. Fixed tint sunglasses. May be a single solid color or gradient tints. Fixed tints are designed to absorb UVA and UVB rays. However, not all sunglasses block 100% of UV rays. Therefore, these lenses may not be effective in preventing sun damage to the eyes. Another drawback with fixed tint
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Health News & Views
sunglasses is they dont adapt in changing light condition so they may seem too light or too dark in certain situations. Grey tones are the most popular with the most benefits in reducing brightness with the least amount of color distortion. The general public still is not fully aware of the magnitude of the threat that UV exposure represents. The different forms of protection are very important in safeguarding the health of patients. As eye care professionals, our goal is to provide the best optical services possible. One of our most valuable tools in accomplishing our professional responsibility is patient education. While we may understand what the best options
are for our patients, the patient will ultimately make the final decision. Through education, we can make our patients aware of the hazards of UV radiation. Thus, they may be properly informed to decide on the best UV protection lenses for their individual needs.
References: 1. Transitions Healthy sight in every light www.Transitions.com 2. Superior Polarized lenses; www.XperioUVusa.com 3. Ultraviolet And Sun Protection; www.Coppertone.com 4. Benefits of Drivewear Lenses; www.Drivewear.com
Ultraviolet radiation and the eye

Patrick D. Yoshinaga, OD, MPH, FAAO
Throughout our lifetimes we are all exposed to sunlight which includes a broad section of the electromagnetic spectrum. Included in this section are ultraviolet light (UV), with wavelengths from approximately 295 nm to 400 nm, visible light (400-800 nm) and infrared (800-1200 nm).1 Sunlight and UV radiation can have both beneficial and detrimental effects on humans.2 When considering UV rays we understand that the UV spectrum is divided into UVC rays (100-280 nm), UVB rays (280-315 nm), and UVA rays (315-400 nm). It has been well documented that UV radiation can damage the eye. Factors that affect the damage that the eye may incur include the wavelength of light, the intensity, duration of exposure, cumulative effect, angle of incidence, solar elevation in the sky, ground reflection, altitude, and the anatomy of the eyebrow and eyelids.1, 3 Because of these factors, UV protection can be even more critical for those who spend long hours in the sun as well as during certain activities with high reflectance such as being in the snow or on the water.4, 5 In addition, individuals who use certain medications such as tetracycline, sulfa drugs, birth control pills, diuretics and tranquilizers should consider the use of UV protection due to the increased light sensitivity caused by these treatments.5 The higher energy, shorter wavelengths of UV light are the most harmful, but fortunately, the earths atmosphere absorbs and scatters most of these. In addition, the various structures of the eye have different filtering and absorption characteristics. It has been reported that of the shorter wavelengths that reach the eye, the cornea absorbs 100% of UVC, approximately 90% of UVB, and 60% of UVA incident rays. The majority of the UVA that is not absorbed by the cornea is absorbed by the crystalline lens and only a small portion of the UVA reaches the retina. The cornea and lens do not significantly filter short, high energy visible wavelengths such as violet and blue. The majority of
these wavelengths reach and are absorbed by the retina and retinal pigment epithelium.1 When the eye is damaged from UV and high energy visible light, the damage is a result of solar radiation, oxidation and heat causing deterioration.6 Research studying the detrimental effects of UV light on the eye has been ongoing for decades. Some evidence is not conclusive and some controversial. Excessive UV exposure has been linked with photokeratitis, solar retinopathy, skin aging and cancer.3,6 It has also been reported to show some evidence as a possible causative factor in the development of pterygium, climatic droplet keratopathy, and cataract formation.7 According to the United States Environmental Protection Agency (EPA), overexposure to UV light may lead to skin cancer, premature aging of the skin, cataracts and other eye damage such as photokeratitis and pterygium. In addition, they also note that children are particularly at risk. The EPA has developed the SunWise Program which provides environmental and health education. Through this program, in partnership with Prevent Blindness America, they strive to develop continued sun-safe behaviors in children. Their recommendations include good fitting frames that shield the eye from most angles and lenses that block 99-100% of UVA and UVB rays. In addition, they recommend wide brimmed hats to reduce the amount of eye exposure to UV light.4,8 The Centers for Disease Control and Prevention also recommends wrap-around sunglasses with UV protection which blocks UVA and UVB for children when outdoors.9 A recommendation by the National Eye Institute of the National Institutes of Health also suggests sunglasses that block 99-100% of UVA and UVB radiation to protect the eyes.10 When considering retinal damage, it has been shown that short wavelength and blue light can cause notable oxidative stress to the retinal pigment epithelium. When investigating UV light
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Health News & Views

exposure and macular degeneration, some studies have found a clinical correlation yet others have not.11 However, in individuals who are aphakic or pseudophakic with incomplete UV absorbing intraocular lenses (IOLs), UV energy may be more damaging and protection is indicated.6, 12 Another consideration are children, who may spend more time outdoors than adults, and whose young lenses do not absorb as much UV light as adult lenses.6,13 Others have noted that sunlight exposure has not been definitively established as an age-related macular degeneration (AMD) risk factor and suggest that further investigation is needed in this area, particularly clinical trials to investigate the possible preventative effects of blue light filtration on AMD. They do note, however, that it could be reasonable to wear UV filtering sunglasses to provide comfort, decrease exposure to ocular structures, and possibly provide protection against cataract development.14 A review of the literature reveals conflicting opinions on the exact relationships between solar UV exposure and ocular damage. The World Health Organization (WHO) recognizes that solar UV radiation has shown a causative role in photokeratitis, photoconjunctivitis, pterygium, squamous cell carcinoma of the cornea and conjunctiva, cortical cataracts, and acute solar retinopathy. WHO notes conflicting evidence concerning posterior subcapsular cataract and solar UV exposure, and insufficient evidence to solidify a causal relationship between solar UV exposure and climatic droplet keratopathy (spheroidal degeneration), pinguecula, nuclear cataract or with ocular melanoma. Finally, WHO also concluded that the evidence connecting solar UV exposure and acute macular degeneration is very weak. WHO, however, suggests that further evaluation is needed to investigate possible associations between excess solar UV exposure and acute macular degeneration.15 While the literature may report conflicting results on the effects of UV exposure and some ocular conditions, further studies are needed to understand these relationships more definitively. Many ocular conditions, however, reveal a consensus on the detrimental effects of UV radiation. When it comes to providing ocular protection against UV exposure, there are many options. Lens materials such as polycarbonate, Trivex and many high index materials used today filter a large percentage of UV light.16 Many IOLs and contact lenses also provide some protection against UV light.17-19 However, in these situations, UV sunglasses are recommended in addition to the IOLs and contact lenses as they provide a broader area of protection, especially to the eyelid skin, sclera, and conjunctiva. In the case of IOLs, in addition to the structures stated, sunglasses can also provide protection to the cornea and iris. The style and shape of the frame are also important to provide adequate protection from peripheral light exposure. There are currently many lens choices available to provide added protection and comfort to UV light and sunlight in general. References 1. Dawson, D.G., Ubels, J.L., & Edelhauser, H.F. Cornea and Sclera. In Levin, L.A., Nilsson, S.F.E., Ver Hoeve, J., & Wu, S.M. (Eds.), Adlers Physiology of the Eye, 11th ed. 2011; 114. Saunders/ Elsevier, New York, N.Y. 2. Mead, M.N. Benefits of sunlight: A bright spot for human health. Environ Health Perspect. 2008 April; 116(4): A160-A167. 3. Sliney, D.H. Photoprotection of the eye UV radiation and sunglasses. Journal of Photochemistry and Photobiology B. 2001 Nov 15; 64(2-3): 166-175. 4. U.S. Environmental Protection Agency. Prevent Eye Damage, 2010. Retrieved from www.epa.gov/sunwise/doc/eyedamage.pdf 5. Prevent Blindness America. Eye Health & Safety, 2011. Retrieved from www.preventblindness.org/whos-risk-eye-damage-sun-0 6. Young, R.W. The family of sunlight-related eye diseases. Optometry and Vision Science. 1994; 71(2): 125-144. 7. Johnson, G.J. The environment and the eye. Eye. 2004; 18(12): 1235-1250. 8. U.S. Environmental Protection Agency. Action Steps for Sun Safety, 2013. Retrieved from www.epa.gov/sunwise/actionsteps.html 9. Centers for Disease Control and Prevention. Protecting Children from the Sun. Retrieved from www.cdc.gov/cancer/skin/basic_ info/children.htm 10. National Eye Institute. Information for Healthy Vision. Retrieved from www.nei.nih.gov/healthyeyes/eyehealthtips.asp 11. Chalam, K.V., Khetpal, V, Rusovici, R., & Balaiya, S. A review: Role of ultraviolet radiation in age-related macular degeneration. Eye & Contact Lens. 2011; 37(4): 225-232. 12. Mainster, M.A. Violet and blue light blocking intraocular lenses: photoprotection versus photoreception. Br. J Ophthal. 2006; 90: 784-792. 13. Werner, J.S. Childrens sunglasses: Caveat emptor. Optometry and Vision Science. 199; 68(4): 318-320. 14. Au Eong, K.G., Maheshwar, B., Beatty, S., & Haller, J.A. Risk Factors for Age-Related Macular Degeneration and Choroidal Neovascularization. In Lim, J.I. (Ed.), Age-Related Macular Degeneration, 2nd ed. 2008; 68-78. Informa Healthcare, New York, N.Y. 15. Lucas, R., McMichael, T., Smith, W., & Armstrong, B. Solar ultraviolet radiation: Global burden of disease from solar ultraviolet radiation. Pruss-Ustun, A., Zeeb, H., Mathers, C., & Repacholi, M. (Eds.) World Health Organization, 2006. Pp. 89-94. Retrieved from www.who.int/uv/health/solaruvradfull_180706.pdf 16. Frames Data Inc. Lenses Product Guide Winter 2012. Vol XXXIX (27). Jobson Medical Information LLC. New York, NY. 17. Tanito, M., Okuno, T., Ishiba, Y., & Ohira, A. Measurements of transmission spectrums and estimation of retinal blue-light irradiance values of currently available clear and yellow-tinted intraocular lenses. Jpn J Ophthalmol. 2012; 56: 82-90. 18. Van de Kraats, J. & Van Norren, D. Sharp cutoff filters in intraocular lenses optimize the balance between light reception and light protection. J Cataract Refract Surg. 2007; 33: 879-887. 19. Tylers Quarterly Soft Contact Lens Parameter Guide 2012. Tylers Quarterly Inc. 2012; 29 (3). Little Rock, AR.
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Health News & Views
Medi-Cal update
By Donny Shiu, OD, Medi-Cal Vision Care Program Consultant
The past few months have been quite challenging for Medi-Cal vision care providers due to the National Correct Coding Initiative (NCCI) coding and reimbursement edits that were initiated by the Centers for Medicare and Medicaid (CMS). The NCCI edits are intended to prevent improper payments when inappropriate code combinations or unlikely units of service are reported, such as claims for excision of more than one gall bladder or more than one appendix. These edits have resulted in claims denials for spectacle fitting/dispensing codes greater than one. Medi-Cal claims processing structured these services as per eye and claims were being denied for billing units of two (or more with proper diagnosis codes) which had always been allowed. The providers have been very understanding and patient with this frustrating situation. Finally, the fix was implemented effective April 1, 2013 to allow providers to bill the spectacle fitting/dispensing codes as per lens services and bill two units (or more with proper diagnosis codes). In addition, previously denied claims for two units will automatically be reprocessed. I have the most frequently asked questions during the last few months for you to review. DEAR DR. SHIU: The dispensing fee reimbursement has been denied for the last several months; can you give me an update? Do I need to rebill? Chuck from Cresent City DEAR CHUCK: The NCCI dispensing code edit that prevented the billing of two units has been solved. Effective April 1, 2013, providers have 90 days to rebill previously denied and partially paid claims dated retroactively to November 1, 2012. CPT-4 codes 92340 92342, 92352 and 92353 are again billable for two units (or greater with qualifying diagnosis justifications). No, you do not have to rebill since an Erroneous Payment Correction will be issued to reprocess previously denied claims for two units after the 90-day rebilling process. However, you may choose to rebill (up to 90 days from April 1, 2013) under the following circumstances: May rebill both units if the previously denied claim billed for two units (Denied claims billed for two will be automatically reprocessed, but rebilling would be faster.)
May rebill the second unit if the previously paid claim billed for one unit May rebill the second unit if the previously paid claim billed for two units paid for one The total paid units shall not exceed the two allowable units without justification of qualifying diagnosis. DEAR DR. SHIU: Can I order and bill for eyeglasses for adults 21 and over who are exempted from the eliminated optician services? Jan from Daly City DEAR JAN: Yes, adult beneficiaries 21 years of age or older who reside in an Intermediate Care Facility-Developmentally Disabled (ICF/DD), Skilled Nursing Facility Level A or B (SNF-A or SNF-B) are covered for eyeglasses. The service does not need to be performed in the facility for it to be a covered benefit. 1) It is important to verify the beneficiarys residency exemption. You will need the nursing facilitys name and nursing facilitys National Provider Identifier (NPI). When determining beneficiary eligibility, providers are encouraged to access the California Department of Public Health (CDPH) Health Facility Page (http://hfcis.cdph. ca.gov/servicesAndFacilities.aspx) to verify that the facility where the beneficiary resides belongs in one of these categories and is licensed by the CDPH. To determine the NPI of the facility, providers should contact the facility directly or access the National Plan and Provider Enumeration System (NPPES) website (https://nppes.cms.hhs.gov/ NPPES/NPIRegistryHome.do ). 2) You may then place the order through the PIA Optical Online website, https://optical.pia.ca.gov/pool To submit the order, you must enter the qualified Facilitys Name, and Facilitys National Provider Identifier (NPI), on the bottom of the order screen. (Hint: do not enter your own NPI) 3) To bill for optical services such as frames and dispensing fees: On the CMS-1500 claim form, the nursing facilitys name must be entered in the Name of Referring Provider or Other Source field (Box 17) and the nursing facilitys National Provider Identifier (NPI) entered in Box 17B.
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If the nursing facility is not a Medi-Cal provider, use modifier KX to indicate that the beneficiarys residency exemption has been verified. I hope you find the information useful. If you have suggestions, comments, or would like to submit questions to COA Medi-Cal, please use the following address:
Department of Health Care Services Pharmacy Benefits Division / Vision Services Branch 1501 Capitol Avenue, Suite 71.5144 PO Box 997413, MS 4604 Sacramento, CA 95899-7413 Attn: Donny Shiu, OD Phone: 916-552-9539 E-mail: Donny.Shiu@dhcs.ca.gov
Secrets of coding
Implementing the ICD-10 codes Part 2
With October 1, 2014 approaching, doctors of optometry still have plenty of time to prepare for the switch over William Rogoway, from ICD 9 codes to ICD 10 codes, but OD, DABFE we have to start now. There is much preparation and knowledge necessary to get our offices ready for when CMS flips the switch and this change will require a significant effort to implement. Not only do we have to learn the new system but we will need time to assess and evaluate for the impact that those changes will have on our office model and general business plan. We will need to make allowances for doctor and staff training, technology upgrades and adjusting our offices to fit the new system. All of this takes time, so we need to start the process now. The need to change coding system from the ICD-9 to the ICD-10 codes came mainly from HIPAA and Medicare. HIPAAs goal is to streamline electronic data transfer where Medicares goal is to accurately measure, report and track specific disease information and data for quality, safety, and effectiveness of patient care and treatment outcomes. In order to accomplish the goal of a more specific coding, the 5-digit ICD-9 coding system was revised to a 7-digit system that holds more codes. The number of diagnostic codes under ICD-10-CM will swell from 13,500 to 69,000. For inpatient (hospital) procedures codes, the number jumps from 4,000 codes to 71,000 codes. (These hospital procedure codes, however, will have little effect on private practice.) The ICD-9 diagnostic code gives a good reference to the disease, but pays little attention to the conditions severity and specificity. The ICD-10 on the other hand, goes into much more detail and does account for laterality and severity (Glaucoma Codes). Furthermore, the ICD-10 codes will allow growth to include newly discovered disease processes. For example, to bill for a common nuclear sclerotic cataract as coded with the ICD-9 codes would be 366.16 nuclear sclerosis. This is all we need; one condition gives us one code. There is really not much to think about here. In the ICD-10 codes, our choices for this conditions would become more specific and have to account for laterality. H25.10 Age related nuclear cataract, unspecified eye H25.11 Age related nuclear cataract, right eye H25.12 Age related nuclear cataract, left eye H25.13 Age related nuclear cataract, both eyes The ICD-10 codes for glaucoma become more specific and more complicated. These codes not only account for laterality, but also for the severity of the condition, which is embedded into the code. In order to bill for low-tension glaucoma with the ICD-9 codes, all we need is glaucoma code 365.12. The ICD-10 codes now give us codes that look like this for the same condition: H40.12 Low-tension glaucoma H40.121 Low-tension glaucoma, right eye H40.1210 stage unspecified H40.1211 mild stage H40.1212 moderate stage H40.1213 severe stage Currently, about 20 diagnostic codes are in use for the ICD-9 system. With the ICD-10 codes, however, we now have to think about the specific type of glaucoma, as well as which eye and the severity of the condition. Since new types of glaucoma have been added to the list combined with the complexity of the new codes, those 20 or so ICD-9 codes have expanded to well over 300 ICD-10 glaucoma codes. With these codes there is much more to think about.
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The following medical records and coding resources are available through AOAExcel Visit: www.ExcelOD.com/Coding. Medical records and coding webinars are provided as a no-cost AOA member-only benefit to educate doctors and staff on medical record keeping and coding. AOACodingToday.com is an AOA member-only benefit available to AOA members at no cost (previously $349). AOACodingToday.com is a web-based resource for information related to procedure and diagnosis codes, national and local coverage rules and Medicare relative value information. Codes for Optometry, is available in print and searchable CD formats from the AOA order department. This two-volume set includes Current Procedural Terminology from the American Medical Association, and a separate volume of diagnosis codes used in eye care, Medicares Correct Coding Initiative, the HCPCS codes for reporting materials in Medicare, and the Documentation Guidelines for the Evaluation and Management Services. Coming in 2013: An EHR & Medical Records Compliance Program. Visit www.ExcelOD.com for integrated professional resources to improve patient quality of care, operational practice excellence and informed business decision-making. For more information: AskTheCodingExperts@AOA.org.
Keep an eye out for our ICD-10 courses at Monterey Symposium.
November 8-10, 2013!

may/june 2013 45
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Gary W. Asano, OD
The case of the suddenlymonocular patient

Abstract
When one eye has very poor visual acuity, it is usually considered a balance eye and not considered functional. Once the loss of vision occurs in one eye, binocularity is typically no longer considered, and eye dominancy is often automatically associated with the eye that has the better visual acuity. The following is an example of a fictitious patient that mimics a number of cases I have seen. The etiologies include monocular branch retinal vein occlusion (BRVO) and dry age-related macular degeneration (ARMD) in both eyes (OU). The patient was seen by several eye care practitioners before the diagnosis was correctly addressed and the rehabilitative process facilitated.
CE@Home
Key words
Visual field, Retinoscopy, Balance Eye, Binocularity
Introduction
A graduate of the Southern California College of Optometry, Dr. Gary Asano has been a staff low vision rehabilitation staff optometrist at the Center for the Partially Sighted (CPS) since 1981. He is an Assistant Professor, SCCO, being Outreach Clinical Coordinator at CPS, and Coordinator of Low Vision at the Optometric Center of Los Angeles (SCCO Outreach). He is the Founding Chair of the Low Vision Rehabilitation Section of COA. He is also a staff optometrist specializing in low vision rehabilitation at Kaiser Permanente, Los Angeles Metro Medical Center. He has authored several articles in California Optometry and contributes to the AOA Vision Rehabilitation Section newsletter. Too often a patients visual acuity is used as the only criterion of functional vision and is assessed by a nearly 100 percent contrast chart. Visual field testing is frequently not performed by practitioners as they see even a low vision evaluation as being driven primarily by a patients visual acuity status of the better eye.1
Case report
A 70-year-old Caucasian female presented with a six year history of ARMD in both eyes. She now has a three month history of BRVO in the right eye, which has been her better-seeing eye for the past five years. The left eye has a 1+ posterior subcapsular cataract (PSC) and 2+ nuclear sclerosis (NS), OD has + nuclear sclerosis (NS). The distance unaided visual acuity (V/A) in that eye is OD 10/140, OS 10/30+, OU 10/80, and near unaided visual acuity (V/A) is OD 6M and OS 2.0M at 40 cms. Her family ocular history of maternal ARMD was diagnosed at the age of late 70s; paternal cataract extraction diagnosed at 80s-years-of-age. The only systemic medication is Xanax 0.5mg as necessary (PRN) for the past 2.5 months for episodic anxiety over ocular problem. The patient has been worked up for carotid artery insufficiency or stenosis that is negative. Additionally, the patient has never been diagnosed hypertensive. She has seen three ophthalmologists one general practice and two retinal specialists (latter for a second opinion) with no treatment suggested other than a low vision rehabilitation referral by second retinal specialist. The patient has seen a primary care doctor of optometry referred to by the first retinal specialist that resulted in a progressive multifocal spectacle prescription of OD -2.00-1.50x090 and OS -2.25-1.50x080, +3.00 add for full-time wear. The corrected distance VA with these is OD 10/225, OS 10/20-2, OU 10/40- and the near point is OD 6.0M, OS 1.6M at 33 cms. Additionally, laptop computer viewing distance VA is OD 4.0M, OS 2.5M at 50 cms. She reported formerly wearing over-the-counter (OTC) readers, one for using a computer and another for reading. The visual field of the right eye is shown in Figure 1. Retinal photos of the right eye shows 3+ large blot intraretinal hemorrhages extending beyond the superior arcade and involving the superior macula, including the foveal avascular zone (FAZ). The macula area of this eye also
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shows 1+ small drusen. The left eye has 1+ small drusen in the FAZ, but is otherwise unremarkable except for slight blurring of details due to the lenticular opacities.
Figure 1: Visual Field OD of Right Eye
She could not have been this myopic in the right eye formerly without symptoms for driving and hiking. An autorefractor will not even operate if the patient is not fixating centrally and cannot measure at an eccentric field angle, whether it is the patient trying to fixate, or we are trying to measure off-center. Also, the patients binocularity does not simply vanish and she then becomes monocular, especially if there is at least 50 percent of the field available. A progressive multifocal, even with digital surfacing, still has mid-peripheral distortions which cannot be helpful when a significant area of the dominant eye cannot help compensate, especially in the inferior fields. On the computer, it is not surprising she is nauseous, especially with screen magnification, compared to a single vision lens equivalent.
The patient is having extreme coping problems with her vision status, namely: She cannot discern faces beyond 20 feet. She is having problems with even two-step stairs in judging depth and in locating the doorknob as if eye-hand coordination is impaired. Reading is described as the text is moving and episodic vertical diplopia is increasing in frequency. Computer is almost impossible to orient - screen magnification software makes her nauseous (she is a semi-retired management consultant). She used to go day hiking with friends, but cannot discern the trail boundaries now. She has a real problem in changing lanes while driving and judging the distance of the car ahead of her, even though she has a self-limited driving period. Curiously, she has little problem with street signage, except when driving near dusk or before 9 a.m. There are at least several key elements in this case that have not been taken into account. One has to remember that the patient says that the right eye was the better eye prior to the BRVO event. This means that it was the dominant eye, and probably not only because of the visual acuity. She did not wear any spectacle correction habitually and the left eye assumedly had the lenticular opacities, so it was blurred for distance. One cannot change eye dominancy instantaneously just because the left eye has a better field and better acuity. Another factor is measuring with a retinoscope in the patients better visual field (superior) to ascertain the refraction measure. This is especially important because it appears that the progressive multifocal has a balance lens power in the right eye.
Although the traditional visual acuity test is excellent for quantifying foveal vision, it tells the clinician nothing about the peripheral retina
Although the traditional visual acuity test is excellent for quantifying foveal vision, it tells the clinician nothing about the peripheral retina, and in measuring the peripheral retina, rather than asking the patient to identify letters, the patient is just asked to respond to the presence or absence of a spot of light. 2 When holding a Feinbloom Distance Chart in the patients intact superior field, it was determined, to her delight, that she could discern optotypes that were at a 10/40 level, which is obviously 3.5 times that found in primary gaze or on a chart that is on a stand/chair that is lower than eye level. In taking this one step further, when utilizing what some regard as archaic, a retinoscope with a lens bar in her superior field (that means we are standing up and measuring), the refraction measured +0.75-0.25x020, and although this did not further increase the objective acuity beyond the 10/40 level, it certainly did not blur the vision, as the balance lens described
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above, by over-minussing the right eye by an equivalent sphere of 3.12D. This can be a major etiology for the patients mobility problem in trying to ambulate on stairs, driving problems and locating the distance of a doorknob. Studies by Burg, et al., found that static visual acuity has an extremely weak relationship to traffic accidents; good acuity is helpful when the vehicle is stopped or moving slowly since unlike real scenes which vary in complexity, contrast and illumination, the stimuli used to measure visual acuity are small, high contrast and low complexity.2 With this patient, the Pulfrich Phenomenon seems to be invoked, not only because of the inferior hemianopsia, but also because of the blur caused by the balance lens. The Pulfrich Phenomenon states that if a neutral density filter is placed before one eye, an object moving in the horizontal plane will appear to have a rotational movement instead.3,4 Image manipulations via monocular blur, monocular luminance reduction or disjunctive image motion have been recently found to result in a significant decrease in perceived depth (elevated the stereothreshold by 3.7-5.5x) compared to a pair of clear images; stereotargets that are blurred in either one or both eyes generate a broader potential image of retinal image disparities.5 Walking provides a common source of retinalimage motion.6 While it was stated in the initial referral information that the left eye visual field was unremarkable, we are starting to see that a binocular assessment is necessary to assess general orientation. The only visual field technique that can be easily adapted for binocular testing is a tangent screen (Figure 2) without occlusion. When this was performed, a relative scotoma was found in the inferior field OU. Equally important is that the tangent screen can be instructive to your patient in showing them where the field is intact and where it is not. In identifying faces, older adults are at a disadvantage in
Figure 2: Tangent screen without occlusion.
...most low vision patients lack the highest form of binocularity: depth perception by parallax or stereopsis.
The best psychophysical measure of recognizing faces is obviously not visual acuity, but spatial contrast sensitivity.2 In principle, stereopsis could be a useful binocular cue in recognizing ground-plane irregularities, but stereoacuity declines at low spatial frequencies and unequal contrasts between the two eyes.5 Her difficulty in orienting on a day hike trail was partly age-related in that the binocular visual field declines from approximately 180 degrees to 140 degrees by age 702, but obviously over-minussing her in the dominant eye and having the Pulfrich Phenomenon to deal with becomes additive in creating a deficit. In demonstrating the field to her, we discussed having her eccentrically view downward as if the patient was wearing a bow tie to further decenter the inferior field. The patient was quite delighted at this simple tactic, and this, along with much-needed rehabilitative training, was referred to the low vision occupational therapist for daily living skills application. Given the situation and findings, we also were able to refer her to an orientation and mobility specialist once we converted her spectacle to the correct anisometropic state and a single vision lens. A yellow filter of 450nm was found to be efficacious in enhancing contrast in the right eye, a 511nm filter was found to be such in the left eye, but in OU testing, a 450nm filter was utililzed. The filter helped to decrease her just noticeable difference (JND) in the trial frame refraction of the right eye by 50 percent when taking into account the superior field. A BPI Total Night tint can be utilized thusly, or if photochromatic is preferred, an X-Cel Autumn Gold lens, the latter being made in Trivex only. In addition, binocularity at distance and near point should not be overlooked; most low vision patients lack the highest form of binocularity: depth perception by parallax or stereopsis. Gross stereopsis is present. When two dissimilar images are presented, retinal rivalry exists, especially with recent macular changes in one eye.1 In this instance, the patient generally complains about words running together or that print appears blurred even when they are at the exact focal point of the low vision system. For those patients who have a visual acuity difference of about 1.5, investigation of binocularity is important.1 Binocularity has certain advantages, including: 1) psychological, 2) the visual acuity and visual fields are larger, 3) contrast sensitivity should be enhanced
recognizing faces at lower ambient light levels than younger adults, needing approximately twice as much contrast to detect and discriminate. 2
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and 4) stereopsis of any shape or form is only possible in a binocular state.1 The practitioner should evaluate both motor and sensory binocularity. Motor binocularity includes cover test, Hirschberg test and vergence testing. Sensory includes Worth 4-dot, Maddox Rod (on poorer vision eye), 4 prism test (rotating until diplopia), stereo fly or reindeer.1 Our case found, by Maddox Rod presented to the right eye (larger target than a transilluminator or penlight), that she measured a right hypophoria of 6 prism diopters and 2 exophoria. Because of the large amount of vertical phoria, the patient was informed that some of the measurement could be attributed to her altitudinal hemianopsia, but that the practitioners experience showed it was an exaggeration of a pre-existing binocular condition; she was fortunate to only have episodic diplopia when reading since even 50 percent of this amount should be causing other problems. She then admitted that she had been experiencing occasional diplopia when viewing television, but this had been going on for years prior. At that point, because of the uncorrected myopia of the left eye, one of the diplopic images was quite blurred and she could easily suppress it. It turned out that her professional eye care prior to the BRVO event had been quite infrequent, with the diagnosis of the left eye cataract five years previously when at the state Department of Motor Vehicles she noted the inequality of vision that caused her to seek a diagnosis. The dry ARMD was also noted then, and fortunately her eye care practitioner had informed her of lutein and antioxidants research. The provider addressed the hypophoria with 2.5 prism diopters of vertical prism. The computer problem was addressed with single vision lenses and prism, which then eliminated subjective word movement. In a low vision assistive technology evaluation, reverse polarity (white print on black) was deemed much easier and she was given a simplified assistive technology regimen to implement.
practitioners. Utilizing our knowledge of visual psychophysics demonstrates why patients have more daily problems than a high-contrast visual acuity chart would purport to exemplify. This patient certainly benefitted from a multifaceted optometric and multi-disciplinary approach for successful rehabilitation.
References 1. Brilliant, R. Essentials of Low Vision Practice. Woburn, Massachusetts: Butterworth-Heinemann. 1999. Pp. 41-43. 2. Norton, T., Corliss, D., Bailey, J. The Psychophysical Measurement of Visual Function. Woburn, Massachusetts: Butterworth-Heinemann. 2002. Pp. 68, 318-321, 421. 3. Lit, A. The magnitude of the Pulfrich Phenomenon as a function of binocular differences of intensity at various levels of illumination. American Journal of Psychology. 1949: LXII: 159-167. 4. Bedell, H., Gantz, L., Jackson, D. Perceived suprathreshold depth under conditions that elevate the stereothreshold. Optometry and Vision Science. 2012: 89: 12: 1768-1773. 5. Bochsler, T., Legge, G., Kallie, C., Gage, R. Seeing steps and ramps with simulated low acuity: Impact of texture and locomotion. Optometry and Vision Science. 2012: 89: 9: 1299-1307.
Conclusion
This case exemplifies how low vision care does not always involve telescopic or magnifying aids, whether optical or electronic. A thorough and unbiased approach to rehabilitation that does not emphasize visual acuity as the determinant is paramount in a high percentage of cases. Utilizing a functional visual field, retinoscopy and assessing binocularity, were extremely important facets of her rehabilitation. Visually impaired patients require more than visual acuity assessment to diagnose their impairment. Over-simplifying the case by dismissing binocular input and eye dominancy is a mistaken generalization, as is often done by non-low vision
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CE@Home CE Questions
1. What are important tests in determining an LV patients case in assessing ambulation, daily living skills? a. Dominant eye b. Phoria measurements c. Interpupillary distance d. a and b e. c and d 2. Which of the following is most important when there is an altitudinal visual field defect? a. D-15 color vision b. Retinoscopy c. Topography d. Pachymetry e. B-scan ultrasound 3. When measuring visual fields, which of the following are best in prognostic value for application in general orientation? a. Goldmann perimetry b. Tangent screen fields c. Confrontation fields d. Amsler Grid e. SITA-Fast 4. Which of the following lens types are advisable when the patient is essentially monocular? a. Progressive addition multifocal b. Executive seg bifocal c. Single vision d. Round top bifocal e. Blended seamless bifocal 5. Which of the following are motor binocularity tests? a. Maddox Rod testing b. Unilateral cover test c. Worth 4-Dot test d. a and c e. none of the above 6. Which of the following is the most important in low vision evaluations? a. Visual acuity b. Visual field c. Color vision d. Response to telescopic magnification 7. Which of the following is most important in low vision ambulation when considering both eyes? a. Metacontrast b. Critical flicker frequency c. Pulfrich Phenomenon d. Inverse Square Law of illuminance e. Useful field of view
8. What can we state about the visual field of a 70-year-old patient compared to a 20-year-old? a. It expands due to learned experiences b. The binocular visual field declines from approximately 180 to 140 degrees c. It is fraught with more testing errors as the patient ages, even without pathology d. a and c e. b and c 9. The binocularity state of a low vision patient: a. Is not a critical test due to a low vision patient often having only one functional eye b. Is not germane to low vision testing because the inherent high exo created by high adds needed by low vision patients c. Does not exhibit stereopsis of any degree d. All of the above apply e. None of the above apply 10. What psychophysical measures of visual function correlate best with facial recognition by the elderly? a. Visual acuity decreases with normal aging b. Color vision testing c. Radiometry d. Contrast sensitivity e. Retinal illuminance
COA Members: No Charge Non-Members: $30 One Hour CE Credit. The deadline for receipt of answers is August 15, 2013. Send your answers with your license number to: COA Education Coordinator 2415 K Street, Sacramento, CA 95816 Fax: 916-448-1423 Email: education@coavision.org Transcripts will be mailed out after the submission deadline. CE@Home May/June 2013 issue
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June 27-29, 2013

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If you have an event you would like to promote, please send your listing to Rachael Van Cleave at rvancleave@coavision.org. View more upcoming events at: www.coavision.org.
November 8, 2013
Presidents Leadership Council

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November 8-10, 2013
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Monterey Marriot Hotel & Conference Center
When & Where
May
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Candidates should be outgoing with ability to build patient base. The successful candidate will join a practice with a team of MDs that practice in an environment that provides the latest technology (fully supported) including EMR and will work with their own independent schedule with the support of assistants. To Apply: Prospective candidates should email their CV to sgabelich@medvistech.com. Visit our website at www.medvistech.com. We offer a competitive salary.
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Rancho Cucamonga, CA: Sale Pending. Practice Consultants. Ridgecrest & Yucca Valley, CA: Two-locations. Revenue $515,000. Practice Consultants. San Diego, CA: Sale Pending. Practice Consultants. San Francisco, CA: Upscale storefront. Great upside for full-time OD. Practice Consultants. San Francisco, CA: Comprehensive Ophthalmology practice. Practice Consultants. San Jose, CA: Revenue $267,000. Great location in South San Jose medical building. Practice Consultants. Santa Barbara County, CA: Revenue $295,000 Real estate available. Practice Consultants. Santa Cruz, CA: Optical shop with room for exam lane. Practice Consultants. Westlake Village, CA: Coming soon. Practice Consultants. We also have practices available in CO, CT, FL, GA, HI, LA, NV and NJ; see PracticeConsultants.com for more information. ________________________________ Practice for sale in Merced (home of the newest UC campus). Price and terms negotiable.Established 1983. Interested parties please send email to: bettymiller49@msn.com
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Coastal California Priced to sell, started 1993, new equipment, large inventory, average revenue $188K on part-time OD schedule, growth opportunity, picturesque, culturally vibrant small port city. Contact: Gerald Bendix, Broker. DRE#01472068. 530-917-6600. ________________________________
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Doctors of Optometry in Orange County Eye Exam of California is seeking affiliate Doctors of Optometry in Orange County San Diego, LA, Central California Visalia, Sacramento, Carlsbad, West Covina, Palm Desert, San Bernardino, Fresno, Lakewood, Hemet, Folsom, Clairmont, and Victorville. We offer a very competitive compensation package for Employed Optometrists. In addition to base salary, you will receive a very generous incentive program for our Full-time and Part-Time Doctors. F/T Employed Doctors working at least 1,000 hours each year are eligible for our 401 K plan. Positions at FullTime status, qualify you to receive comprehensive medical, dental, and vision benefits, life insurance and short-term disability plan. For more information Ms. Christy Johnson at Cjohnson@luxotticaretail.com, or by phone at 469814-0085. ________________________________ MVT has been serving the Sacramento Valley since 1989 with a commitment to excellence that is demonstrated on a daily basis by our doctors and staff. Practice consists of eight MDs specializing in the area of general ophthalmology, plastics, and refractive surgery. Applicants should be a fully credentialed Optometrist, preferably with a Residency in either Primary Care Optometry or an Optometric Specialty, or at least 3 years in Optometric practice. Practice experience should be primarily with an adult patient base. Candidates should be capable of managing a full scope of patient care within the licensure of Optometry in California.
Practice for Sale in San Francisco This is a unique opportunity to purchase a prestigious Financial District, San Francisco practice. It is a high-volume retail location that does a significant amount of VSP and EyeMed business as well as lots of walk-in traffic. The practice is not open evenings or weekends! I look forward to hearing from serious, qualified buyers since this will be an all cash sale. Please reply to: maudesfca@gmail.com ________________________________ San Bernardino County REDUCED ASKING PRICE: $199,000 Grossing $450K+ for last 3 years with 1 fully-equipped exam lane & much more! 100% Acquisition Financing Available Call ProMed 888-277-6633 www.promed-financial.com info@promed-financial.com ________________________________ Practice Concepts offers a better approach to buying and selling practices. Alissa Wald, OD, a successful practice owner, with her husband, Scott Daniels, and their national team of agents bring over 75 years combined experience in management, financing and the hands-on skills of building a large private practice. Practice Concepts is the only west coast company offering this winning combination of business and practice expertise. Were in practice to advance your practice. Nationwide Practice Sales Extensive business management expertise Advanced marketing strategies National database of qualified buyers Doctor Owned Agents located nationwide
Advertise with California Optometry

Are you looking to hire an OD, find a job or sell a product or practice? Consider our classified ads. Classified listings also appear on the COA website at www.coavision.org. To place any ad, simply contact Rachael Van Cleave at rvancleave@ coavision.org or call 916-266-5037.
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OPTOMETRY PRACTICE FOR SALE: San Fernando Valley, CA This great practice is located in the heart of the San Fernando Valley in a busy shopping center. The practice specializes in eye care services as well as designer eye wear and contact lenses. Extensive inventory and well-maintained equipment included. Annual gross revenue is over $850K with a strong net. (ID# 76091) OPTOMETRY PRACTICE FOR SALE: San Fernando Valley, CA This practice was established over 56 years ago in the heart of the San Fernando Valley. The office is located on the corner of a busy main street in town with high visibility. Annual gross revenue is over $410K with plenty of room for expansion. (ID#73243) OPTOMETRY PRACTICE FOR SALE: Central CA This well-established practiced started cold 17 years ago. Annual average gross revenue is $300K. Current owner chose this location due to the affluence of area and beautiful location. Located in a strip center, surrounded by restaurants, gym and retail stores (ID#70531) COMING SOON! RETAIL OPTICAL STORE FOR SALE: Los Angeles, CA Over $250K gross. More details coming soon. COMING SOON! OPTOMETRY PRACTICE FOR SALE: North LA County, CA Over $450K gross. More details coming soon. OPHTHALMOLOGY / OPTOMETRY PRACTICE FOR SALE: Atlanta Suburb, GA This 50-year-old practice is located in an upscale suburban community just outside of Atlanta, GA. This practice provides full-scope eye care (ophthalmology, optometry and retail optical) with compassionate customer service to their patients. The office boasts $800K revenue without any surgeries. (ID#75349) COMING SOON! OPTOMETRY PRACTICE FOR SALE: Near Akron, OH Over $440K gross. More details coming soon. (ID#76495) NEW LISTING! OPTOMETRY PRACTICE FOR SALE: Near Anchorage, Alaska This great, 9 year old practice is located near Anchorage in picturesque Alaska. Situated on a busy street in town in a stand-alone building with high visibility from the street. Annual gross revenue is over $365K with plenty of room for growth. Equipment is well maintained and has continually been upgraded through the years. (ID#76492) OPTOMETRY PRACTICE FOR SALE: Atlanta, GA Location, location, location! This great practice was opened cold 3 1/2 years ago on the 1st level of a high rise building in the Midtown Atlanta. Gross revenue was $805K in 2012 with strong increases the last 2 years. Low rent, strong adjusted net profit, a great location and beautiful interior appointments make this a stellar practice. (ID#76564) SOLD! OPTOMETRY PRACTICE FOR SALE: Dallas-Fort Worth Metro Area, TX Location, location, location! This growing practice is situated in a prime retail strip center in the Dallas-Fort Worth metro area of Texas, with excellent visibility from the street. This upscaled designed space includes 1 exam room, stylish dispensary and an extensive inventory collection including Chanel, which no other practice in the area carries. Gross revenue was just over $255K in 2012, and is on track for much more in 2013. (ID#75350) OPTOMETRY PRACTICE FOR SALE: Upstate NY This practice was started cold 71 years ago and has been family owned since. This office is situated in a historic area with high visibility and high foot traffic. Over $285K gross. Plenty of room for growth. Practice offers easy weekday hours. Doctor only works about 20 hours average per week. (ID# 71028) NEW LISTING! OPTOMETRY PRACTICE FOR SALE: Northeastern New Jersey This busy practice is located in suburban Bergen County, NJ. Highly sought after location - 30 minutes from the beach, mountains and NYC. Annual gross revenue was over $800K in 2012 and is on the rise. Remodeled last year with new displays and decor. (ID#76493) OPTOMETRY PRACTICE FOR SALE: Vermont Location, location, location! This great, 40 year old practice is located near the state capitol in a professional building surrounded by breathtaking views. The space includes 2 well-equipped exam lanes and extensive inventory. Annual gross revenue is over $550K with plenty of room for growth. (ID#76491) OPTICAL PRACTICE FOR SALE: Near Philadelphia, PA Amazing $1 million grossing, well established office thats steady, ready and positioned for continued growth. This store is located in an upscale, suburban area near Philadelphia. Located in a busy strip center with high visibility. Annual gross revenue in 2011 was over 915K with a strong net. (ID#76602) OPTOMETRY PRACTICE FOR SALE: Near the Twin Cities, MN Established in 1952, this great practice has been under current ownership for the past 7 years. Located near the Twin Cities area of Minnesota, the office is situated at the crossroads of three major travel arteries. Annual gross revenue is over $845K. This practice is one of the largest optometric glaucoma practices in the Twin Cities area. (ID# 73062)
Buying? Growing? Selling?

Whether you are ready to buy, grow or sell a professional business, Practice Concepts practical approach, experience and straight forward thinking provides the support you need and proven results that you can always rely on for success!
Practices For sale Buyer services aPPraisals Partner Buy-ins coaching
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Bill Howe Executive Director California Optometric Association
Collectively, the sequel

I never did anything alone. Whatever was accomplished in this country was accomplished collectively. Golda Meir As I have admitted in these pages previously, I have worked at professional and trade associations a long time (Ill stop there before further aging myself). All of my employers have been state-based associations. All of the professions and industries represented by those associations also had national association representation (or two) and some had local societies, districts or chapters. In all cases, the California association for which I worked was the largest in the nation just like COA. Whatever the organizational structure, inevitably the state association would oppose something the national association did, and likewise the national association would take issue with some decision by the state leadership. I also recall the countless times the national association rode in to save the day for the state association on a legislative, regulatory, legal or membership issue, along with the victories it achieved on the national level for the industry or profession I represented. Similarly, the state association and its members collectively saddled up to successfully push over the finish line the particular goal or issue pending nationally. This personal review of my professional background leads me to the recount of a recent journey I took. I visited the St. Louis headquarters of the American Optometric Association for an orientation on AOA programs, services, etc. Over the course of more than a day, I learned of the plethora of resources available to the profession be they documents or human experts all there for the asking, exchanged ideas for growing membership and better serving the profession and discussed new joint initiatives by the associations to position doctors of optometry for greater practice success and patient service.
The Back Page
The person who figures out how to harness the collective genius of his or her organization is going to blow the competition away.
But, the indelible imprint made on me was the singular, collective focus literally voiced by each member of the AOA staff with whom I met on their collective desire to serve and move the profession of optometry forward. As I wrote in the last issue, political and COA presidents whom I referenced all knew they could not succeed alone in achieving the collective goals of those they represented. Likewise, state and national associations would be hard pressed to attain the collective goals of their membership without each other. So I believe it is with AOA and COA. Walter Wriston, former chair and chief executive officer of Citicorp and Presidential Medal of Freedom recipient, stated, The person who figures out how to harness the collective genius of his or her organization is going to blow the competition away. It cannot be written or spoken too often that the optometric profession is at the edge of a momentous shift in vision care and eye health delivery. Four to six million Californians will come under insurance coverage in 2014 and children will be eligible to obtain care from doctors of optometry under the mandatory pediatric essential benefit coverage. These are collective wins for the profession and the public. To assure that the public has unimpeded access to the full scope of care afforded by doctors of optometry, it is crucial and thats an understatement that we harness the collective genius of COA and AOA in blowing away any impediments to this noteworthy goal. As we march toward 2014, I hope COA members collectively join with their state and national professional associations in working in collective unity to attain this universal goal.
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Technology: Patient care apps

The case of the suddenly-monocular patient

2014 is around the corner

Please call Marsh at 800-775-2020.

Scan to learn more!

60921 (5/13) Seabury & Smith, Inc. 2013

We are going to define the next generation of optometry here in California.

COA Board of Trustees meeting highlights

COA Board Highlights

Soar to the Peak of Exceptional Knowledge with the Academy!

Academy 2013 Seattle

October 23-26, 2013

Moving the profession forward

We Bring More to Your World

National and Regional Meeting Support

Dedicated Sales Team

Teaching and Residency Support

Practice Management Resources

Study reveals link between hypertension and Alzheimers.

Patient factors tied to eye care wear and tear in study

Earn CE credit online!

Overall diameter 14.5mm Peripheral curves

A revolutionary design for keratoconus and other irregular corneas.

Front optic zone 8mm

Laser mark Solid Line OD

Laser mark Split Line OS

Posterior Fitting Zone

Available from: Metro Optics, Inc. 800-223-1858

Low-income glaucoma patients less likely to use topical medications

More physicians texting patients

Work smarter, not harder.

Your Rebate Headquarters

COA House of Delegates review

COA Event Review

2012 Board of Trustees listening to the years reports

COA Event Review

WesternU students came out in droves to learn about HOD proceedings

COA Event Review

Meet the COA 2013 Board of Trustees

Fred Dubick, OD, MBA, FAAO President

John Rosten, OD President-Elect

Stevin Minie, OD Secretary/Treasurer

Derron Lee, OD Trustee

Sage Hider, OD Trustee

Steve Langsford, OD Trustee

Ranjeet Bajwa, OD Trustee

Jan Cooper, OD, FAAO Trustee

Barry Weissman, OD, PhD, FAAO Trustee

Movses DJanbatian, OD Immediate Past-president

It Finally Feels Like Spring This Year...

National Credit Union Administration, a U.S. Government Agency

www.visionone.org (800) 327-2628

FREE FITTING SETS IN OFFICE TRAINING 6 MONTH WARRANTY

YOUR SCLERAL LENS SPECIALISTS 800-525-2470 WWW.ACCULENS.COM

COA Event Review

Doctors and students participating in the Adopt-a-Student Program at Legislative Day

Legislative Day attendees listening to speakers

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COA Event Review

Students photographed on the Senate Floor tour led by Senator Ed Hernandez, OD

SCCOS doctors and students with Senator Jim Beall

Assembly Member Travis Allen meets with Legislative Day attendees