optometry optometry - California Optometric Association

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C A L I F O R N I A
O P T O M E T RY
NOVEMBER / DECEMBER 2014
VOLUME 41, NUMBER 6
A comprehensive view of professional optometry in California today
OPTOMETRY IN FOCUS
Health care reform: Year one in review
GOVERNMENT AFFAIRS
With an eye toward the future
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C A L I F O R N I A
A comprehensive view of
professional optometry in
California today.
O P T O M E T RY
NOVEMBER / DECEMBER 2014
Executive Director
Bill Howe
VOL. 41 NO. 6
Editor-In-Chief
Lee Dodge, OD
Managing Editor
Kale Elledge
Editorial Board
Julie Schornack, OD
Michael Mayer, OD
Anne Mika Moy, OD, FAAO
Jasmine Yumori, OD, FAAO
Palmer Lee, OD
Cindy Wang, OD, FAAO
Ellin Wu, OD, FAAO
Meredith Whiteside, OD, FAAO
Production and Design
Grace Design Studio
Contact California Optometry with your ideas or comments by
sending an email to contact@coavision.org, or for more
information visit us online at www.coavision.org.
California Optometry magazine (ISSN0273-804X) is published bimonthly by the California Optometric Association at 2415 K St.,
Sacramento, CA 95816.
Subscription: Six issues at $50.00 per year. Periodicals postage
paid at Sacramento, CA. Copyright © 2014 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 St., Sacramento, CA 95816.
Content
4 LEADERSHIP CORNER
6 COA BOARD HIGHLIGHTS
8 EDITOR’S NOTE
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.
10 EYE OPENERS
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 or advertisement submitted. Articles are
considered for publication on condition that they are contributed
solely to California Optometry.
20 ALL EYES ON YOU
COA Champion Supporters:
12 MEMBERSHIP MATTERS
16 GOVERNMENT AFFAIRS
18 MEMBER SERVICES
23 PRODUCT & SERVICES
24 OPTOMETRY IN FOCUS
26 HEALTH NEWS & VIEWS
30CE@HOME
36 MARKET PLACE
38 WHEN & WHERE
A blueprint for the future
John Rosten, OD
President
As an association, we have two imperatives: to know where we’re going, and to know how to
get there. These two imperatives come together in a process known as strategic planning,
which results in a blueprint for the future known as the strategic plan.
A strategic plan is a living, breathing document, which serves as a guide for association
leaders, staff and volunteers to move ahead together for the benefit of the membership. It’s a
document that captures the establishment of goals, development of strategies, measurement
of progress and achievement, and identification of needed personnel and finances to attain the
collective goals. As John Carver stated, “Strategic planning is a useful management tool… to
plan the allocation and use of resources over a multiple year period in order to fulfill organizational purpose.”1
Leadership Corner
In June of this year, a group of 20 individuals consisting of the COA Board of Trustees, committee chairs and senior staff met in Sacramento for a two-day session for the purpose of updating
COA’s strategic plan. The meeting, led by a very effective moderator, was highly interactive and
created great enthusiasm for all participants.
One attendee, COA Membership Chair Jason Flores, said, “This process provided a unique
atmosphere for the board of trustees, long-standing committee members and staff to share our
visions with each other. We all were able to give input and collaborate on issues facing our
association. I’m excited to have a solid foundation in place to guide our committee over the next
three years.”
I’m excited to
have a solid
foundation in
place to guide
our committee
over the next
three years.
The strategic planning process led to establishment of the following organizational goals:
Goal 1: Grow, engage and retain member doctors while improving overall member satisfaction.
Goal 2: Maintain and enhance our advocacy effort.
Goal 3: Encourage our members to practice at the highest legislated level.
Goal 4: Educate the public of the importance of vision and eye health and the role of doctors
of optometry.
Goal 5: Improve communications with our members.
The completed 28-page COA Strategic Plan outlines in detail our goals, strategies, action items,
required resources and dates of completion. A published version of the plan will be available
and posted on our COA website in the very near future.
I am truly grateful to our committee chairs who have been such an invaluable part of this
process. Each has provided excellent input and discussion, and each continues to provide
sincerely appreciated leadership for their respective committees. Thank you!
The COA Presidents’ Council meeting will be held in Monterey on Sunday, November 9, during
which time our updated COA Strategic Plan will help guide an even more effective COA-local
society partnership in the areas of membership growth and development, enhanced communication with our members and legislative advancement for our profession.
The best thing about a strategic plan? It allows us to move ahead — together. And an even
better thing? It allows us to create an even better future for all!
REFERENCE
1. Carver Policy Governance Model website (www.carvergovernance.com)
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COA Board of Trustees
meeting highlights
The COA Board of Trustees (BOT) met at the COA Sacramento office on June 5, 2014. The
BOT discussed a number of issues and topics that included the following items and motions:
• Motion: To accept the 2013 COA audit report as presented.
• Motion: To accept the April 2014 year-to-date COA financial statements as presented.
• Motion: To confirm COA’s volunteer travel policy and reimbursement procedures.
• Motion: To endorse Dr. Jim DeVleming of Washington State for election as AOA trustee.
COA Board Highlights
• Item: It was reported that the COA Optometrist Resource Guide had been updated and is
available on the COA website.
• Item: Kale Elledge was introduced as COA’s new communications and social media manager, and it was announced that Kara Corches had been promoted to COA external relations
manager and Erin Kauffman Taylor was hired as the new COA grassroots manager.
• Motion: To confirm the appointment of Scott Kamena to the COA Cal-OPAC Board.
• Motion: To table the motion to create a COA Leadership Task Force pending review after
the June 6-7, 2014 COA Strategic Planning Meeting.
Item: It was reported that the COA Optometrist
Resource Guide had been updated and was
available on the COA website.
• Item: Agreed to Allergan’s request to write a letter of support from COA against an unsolicited purchase of the company.
The COA BOT met September 9, 2014, by webinar. Minutes from that meeting are pending
approval by the BOT and will be released in the next edition of California Optometry. The next
BOT meeting is November 6, 2014, at the Monterey Marriott Hotel in conjunction with the
COA Monterey Symposium.
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.
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Lee Dodge, OD
New digital magazine provides
convenient resource for busy ODs
It’s no secret that optometrists live busy lives. When talking with my colleagues, it seems like
we are always doing something. Whether it is for the office, for our families or just for fun, we
are on the go. In the office, not only do we have patients, but we have responsibilities as
business owners as well. We are marketing, taking inventory and working on staff development. Many of my friends also participate in optometric, political and volunteer organizations. There is rarely a free moment. I have been dating someone for three years, and I am
constantly being told to slow down, take a break and rest awhile. But you and I know how
difficult that can be sometimes. To help ease the demands on our time, COA’s magazine —
the one your are currently holding — will be going digital beginning with the January-February 2015 edition to give us busy doctors the (expanded) resources of the magazine on your
digital device.
Editor’s Note
Last week was
my eighth year
of owning my
practice and I still
have to remind
myself daily to
take some time
out of the busy
day to relax and
breathe.
So what other tricks or programs are you using to stay busy with patients while alleviating
some of the other work-related stress? Are you utilizing some of the help that different
vendors are implementing to make your job easier? Are you in an optometric alliance group
and leaning on your colleagues for help and answers? Are you using different websites
available and outside companies to help? Do you just leave everything to the staff? I think the
answer lies with combining a little bit of everything above. Last week was my eighth year of
owning my practice, and I still have to remind myself daily to take some time out of the busy
day to relax and breathe. I need to remind myself that I do not have to do everything on my
own. I have a staff who would help. I have many other avenues of assistance. Lately, I have
been utilizing these resources more and I am finding that it is working!
Earlier I mentioned websites. There are many sites available on the Internet to help with
patient education and help with research of a subject that you want to learn more about or a
procedure that could bring added revenue to your practice. I just became certified in corneal
refractive therapy (CRT) and am looking to add that service to further help my patients. It is
great to think about the amount of information that is within reach on our computers, phones
and tablets. I heard once that there is more information on our cell phones, with more
technology, than existed in the computers that put a man on the moon. I am kind of nerdy
and find that fascinating. I have many “optometric apps” on my phone that help me with
contact lens selection, drug referencing and aiding me with the Parks 3-step (don’t laugh — I
know you don’t remember that either).
Now, being able to have the knowledgebase and resources of California Optometry magazine
available on the new electronic platform will serve as another tool in my digital toolbox.
Delivered electronically, it will feature links to more information on topics we find interesting,
as well as a product or service advertised that appears appealing. And, it goes with us
anywhere we have our digital devices, 365/24/7.
What else is COA doing to help us in our busy lives? Have you been on the website lately? It
has many areas to help us; anything from continuing education, information on laws and
legislation, and a link to get patients searching for optometrists in our seats. We will soon be
able to access the magazine online in a new forum to help us get the articles that we love
even quicker. This is definitely something that will help all optometrists with a busy lifestyle.
So when you find yourself with too much on your plate, it might be worth taking a few steps
back to look at your schedule so that it may be run with more efficiency. Utilize your resources. Take some deep breaths. Keep chugging along!
8
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Could ODs become a key to
diagnosing ADHD?
Eye doctors may play a future role in detecting Attention Deficit Hyperactivity Disorder (ADHD)
after researchers find a correlation between involuntary eye movement and the behavioral
disorder in a new study published in Vision Research.
The study, from Tel Aviv University in Israel, used an eye-tracking system to monitor the eye
movements of ADHD-diagnosed adults and a control group — in conjunction with an ADHD
diagnostic test — to detect involuntary movement. The results found not only a direct
correlation between ADHD and the inability to control eye movements, but the effectiveness
of ADHD medications.
Eye Openers
The Eye Openers
section gives
a quick look
at the latest
headlines and
news surrounding
optometry and
eye care.
“Optometry has always stated that eye movements are linked to reduced attention, often
leading to a misdiagnosis of ADHD,” says Dr. Glen Steele, OD, AOA InfantSEE® Committee
chair. “Parents of children with suspected attention disorders should be encouraged to have
their children undergo a comprehensive eye examination by a doctor of optometry in order to
determine the extent that vision might play in the overall process.”
Turning pages sideways may help people
with macular degeneration to read better
According to the results of a 21-participant study published in
the September 2014 issue of the journal Optometry and Vision
Science, turning pages sideways may help people suffering
from loss of vision due to macular degeneration to be able to
read better. Reported by The Wall Street Journal, turning the
page 90 degrees clockwise significantly improved people’s
ability to read words using the peripheral vision surrounding
the central field of vision after a period of training. The study
was small and involved young subjects with normal vision. A
flexible training schedule may be required for older people,
researchers said.
CONNECT WITH COA!
Why should you connect with COA? Because we
are the source for everything optometry-related
in the State of California! We have informational
and entertaining videos, tweets, posts and more!
“LIKE” US ON FACEBOOK AT:
www.facebook.com/CaliforniaOptometric
“FOLLOW” US ON TWITTER:
@COA_Vision
10
www.coavision.org
november/december 2014
11
Please read — it’s about you
and your investment
Jodi Haas,
Membership
Development
Manager
Membership Matters
The end of 2014 is fast-approaching, and at the California Optometric
Association, that means we’ll soon be mailing your 2015 membership
packet, including your annual dues statement and overview of member
benefits. With enhanced membership benefits and strong legislative
efforts, there has never been a more exciting time to be a COA member! We need your continued support to move the optometric profession forward in 2015.
In an ongoing effort to be “green” and invest the monies that were being used for printing and
mailing statements back into your association, this will be your only mailed statement for the
next year. COA will continue to email your 2015 monthly statements until which time your
annual dues investment is paid in full.
COA has put new resources in place so that you can easily manage your dues account online.
You may now log in at www.coavision.org/Dues. Here, you can:
• View your detailed dues statement
• Enroll in automatic payments
• Update your credit card information
• Pay your dues online
• Add an additional contact to receive your monthly dues statement (This allows statements to
be emailed directly to your office manager or billing/bookkeeping department)
Our goal has been, and will always be, to provide you — our valued members — with a robust
variety of benefits and services, and a greater return on your dues investment. Some highlights
of new, additional membership benefits include:
Now all staff are able
to enjoy complimentary
Paraoptometric
Membership and have
access to training, tools and
resources when enrolled by
a member-doctor.
Free COA and AOA membership for OD’s staff
Our bylaws have changed. Now all staff are able to enjoy
complimentary Paraoptometric Membership and have
access to training, tools and resources when enrolled by a
member-doctor.
Enroll your staff today:
1. Go to www.aoa.org
2. Under the “Optometrists” tab, click on My Profile and log in
3. Click on “MyAOA”
4. Click on the “Manage Staff” tab
5. Enter information for each staff person (non-OD)
Warren G. Bender Co. Personal Lines of Insurance
Warren G. Bender Co. (WGBCO) offers COA members a variety of insurance companies to
choose from, which allows you to receive the best possible price for the coverages you need.
There are discounts for COA member-doctors and WGBCO gives back to COA to help keep
your membership dues low.
The WGBCO personal lines team products include homeowners, personal auto, income/rental
properties, personal excess/umbrella, earthquake, flood, recreational vehicles, watercraft and
an optometrist discount program!
12
Membership Matters
Hear what a long-time COA member has recently experienced
while working with Warren G. Bender Co.:
“I decided to look into COA’s new benefit for Personal
Insurance with the Warren G. Bender Co. I spoke with
Marianne Lukenda in their New Accounts Department. She
was able to provide me with a review of my current insurance coverage and a competitive quote with one of the
many companies they represent. I was impressed with her
knowledge and the recommendations she made regarding
my coverages and how best to protect my personal assets.
Recently, I needed assistance with one of my policies and
spoke to Ruby in WGBCO’s customer service department
who was prompt and efficient in taking care of my situation
— something that is unusual in today’s busy world. No
phone trees or call centers!
Although the coverage and service provided were excellent,
it is the people that truly made the difference for me.”
—Michael Goldsmid, OD, FAAO
Arena Eyeworks Optometry
To take advantage of this program and start saving, please
contact Warren G. Bender Co. to receive a no-cost quote
on your personal lines of insurance. Reach WCBCO at
916-380-5300 or COA@wgbender.com, or visit their
website at www.wgbender.com.
Heartland Payment Systems Payment Processing and
Payroll Solutions
Heartland provides businesses with products, solutions and
resources that will help reduce expenses, improve operations
and increase profitability — all from one source with integrated technology product platforms.
Read what one COA member who recently converted to
Heartland Payment Systems has to say:
“Saving money on your credit card processing could not
be any easier. Recently, I converted our two offices’ credit
card processing over to the COA-endorsed program
provider, Heartland Payment Systems. I have heard from
colleagues that this process can often times be inconvenient, time consuming and costly. I am pleased to tell you
that my staff encountered no issues as Heartland and their
representative, Dana LeBlanc, guided us seamlessly
through the process.
The team at Heartland is professional, friendly and expedient. By making the smart choice to use Heartland for your
www.coavision.org
credit card processing and/or payroll services, you will be
helping to keep your COA dues to a minimum while also
generating non-dues revenue for the association.
I encourage you to contact Dana LeBlanc for a free evaluation of your current situation. He will be able to quickly
calculate any potential savings you may be missing out on
and will answer any questions you may have.”
—Brent P. Chinn, OD
Precision Eye Care Centers
For more information on Heartland Payment Systems, visit
www.heartlandpaymentsystems.com or contact the COAdedicated representative, Dana LeBlanc, at 916-599-8689 or
dana.leblanc@e-hps.com.
Please be sure to review all your member benefits frequently to get the best return on your dues investment. Your
support of COA helps ensure the protection and expansion
of optometry for you and your patients in California!
COA ‘Town Hall’ meetings are a
collaborative success!
COA representatives from Sacramento have been
traveling to several COA local optometric societies
this fall and winter to provide an update on
government affairs issues and to provide updates on
COA-AOA membership benefits and services. It has
been a terrific opportunity for members ask questions
and provide feedback on COA activities. The locations
that have been visited and/or scheduled thus far are
listed below.
September
Santa Clara County Optometric Society
San Fernando Valley Optometric Society
October
Tri-County Optometric Society
Orange County Optometric Society
Sacramento County Optometric Society
Golden Empire Optometric Society
November
San Diego County Optometric Society
December
San Gabriel Valley Optometric Society
Los Angeles County Optometric Society
13
Membership Matters
SGVOS hosts the next generation of ODs
It was
informational
and a good way
to meet local
optometrists
in a casual
environment.
WELCOME!
New COA Members
The COA San Gabriel Valley Optometric Society (SGVOS) hosted a Fall Fiesta on Sunday, September
7, at Live Oak Park in Temple City that brought together local doctors of optometry and students
from SCCO at Marshall B. Ketchum University and Western University College of Optometry.
Meeting and mingling over freshly grilled tacos, the students learned from practicing doctors about
the importance of joining our association.
Myron Jimenez, third-year student at SCCO commented, “It was informational and a good way to
meet local optometrists in a casual environment.”
Students also gained tips for purchasing malpractice insurance upon graduation. “Our society hosts
a student/doctor mixer every one to two years because we want to meet our future colleagues.
They are bright and driven individuals, the future of our profession; we want them to know that we
recognize and value their contribution. Hopefully, this will foster continual involvement upon
graduation,” SGVOS board member Cindy P. Wang stated.
The society thanks sponsors of the event and our profession’s future, ABB Concise, Bank of the West,
Kate Spade, COA-endorsed Mercer Commercial Insurance Services and Oliver Peoples.
Alameda Contra
Costa County
Nathan Louie
Julie Kim
California Optometry going digital
All the articles you love now on your digital device
Humbolt-Del Norte
Richard Clompus
Inland Empire
Munish Sharma
Naiza Jakirlic
Richard Bozner
Kern County
Tiffany Risner
Orange County
Raymond Chu
Shora Ansari
Rio Hondo
James Cohen
Brandon Sanchez
Sacramento Valley
Jenelle Palmer
San Diego
Patty Cheng
Bijal Desai
Lydia Torres
San Francisco
Anna Szeto
Anna Abolian
Santa Clara County
Wenjun Huang
14
Kale Elledge,
Communications
& Social Media
Manager, COA
Beginning in 2015, the California Optometric Association (COA) will launch
its first edition of the online California Optometry bi-monthly magazine. This
transition comes from the recommendation of the COA Communications
Committee as a means to better deliver relevant content to the membership.
“The new online magazine is going to change the way doctors retrieve
information,” says Dr. Cindy Wang, chair of the COA Communications
Committee. “By staying ahead of the technology curve, we will be addressing the growing
need of our members to have the magazine available to them at their convenience and on their
mobile devices.”
Not only will the new digital platform serve as a more convenient way to read the content, it will
also allow COA and the Communications Committee to more easily receive feedback on the
content to better tailor future editions of the magazine.
Out with the old and in with the new
We’re saying farewell to the print version of the magazine. COA understands that some members
prefer print to digital media. However, the ability to analyze the content being read in the digital
magazine will allow the content to better serve as a resource to our membership. The value of
delivering relevant information to our readers is of the highest importance to COA and the Communications Committee.
If you’re a subscriber to COA content, you will receive an email announcing the launch of the
first digital magazine. Check the COA website at www.COAVision.org in the New Year for
more information.
The latest news for optometry-related legislative and advocacy issues in California.
Government Affairs
With an eye toward the future
Erin Kauffman Taylor,
Grassroots Manager,
COA
As the year comes to a close, and we
bid adieu to another legislative
session, it is important to take stock
of the lessons we’ve learned over the
past two years and set our sights on
the possibilities of the future.
We certainly saw our share of
struggles and frustrations throughout the legislative process with Senate Bill 492. What we can
take away from that experience is a better understanding of
what is necessary to move forward with our legislation next
year. Given this opportunity to regroup and focus on what is
most important to our members will enable us to deliver an
even stronger message to legislators as we continue to
pursue the ability for doctors of optometry to practice to
the full extent of your training.
Perhaps the greatest inspiration to be found amongst the
legislative hurdles is the dedication of our grassroots members who took on a more significant role in our legislative
efforts than ever before. The countless meetings, phone calls
and letters undertaken by COA’s extraordinary grassroots
network were a large part of the reason SB 492 made it as far
through the legislative process as it did. To each of you who
took the time away from your practice and patients in order to
advocate for optometry, we at COA send our utmost thanks. It
is because of your hard work that we are emboldened to
continue reaching greater heights.
It is because of your
hard work that we are
emboldened to continue
reaching greater heights.
With an eye toward the future of optometry, it is our hope that
our grassroots members will be ready to step back into the
ring and mount an even fiercer fight in the 2015-2016 legislative session. A new year, a new bill and a renewed sense of
excitement for the possibilities that lay ahead for your profession — this is the recipe for our next great success, and each
of you are the key ingredient.
Stay connected to government affairs!
Government Affairs Weekly Update
For weekly information on COA’s government and external affairs activities, watch your
e-mail inbox each Wednesday for the Government Affairs Weekly Update. Archives are
available on COA’s website (in the Members Only section, click Government Affairs,
then Weekly Updates).
16
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Member Services
COA-sponsored insurance programs
Mercer — Commercial
800-775-2020
coa.insurance.service@mercer.com
COAMemberInsurance.com
Warren G. Bender Company — Personal
916-380-5300 or 800-479-8558
coa@wgbender.com
wgbender.com
COA’s preferred eyecare
business group
Vision West Inc.
800-640-9485
vweye.com
As doctors of optometry are aware, workers’ compensation insurance is
required by law and covers your employees in the event of a job-related
injury. Coverage is standardized by state law and includes hospital and
medical expenses, work-related disability income and a death benefit.
There are many things to consider when purchasing your workers’ compensation protection each year. Certainly the rate you pay is one of the most
important, especially in these difficult economic times. But there are other
factors that should be included in any evaluation. Members who participate
in the California Optometric Association (COA) sponsored workers’ compensation program benefit from favorable treatment of those other factors:
• Receive consistently competitive rates.
• Were protected during the past workers’ compensation crisis when rates
exploded and insurers were few and far between.
• Are not penalized or cancelled by the insurer simply for having a claim.
Members benefit from COA and Mercer working together with Zenith
Insurance Company (Zenith)* to properly manage the program so members
have access to a program that is stable over the long-term.
Importantly, Zenith makes available loss control tools that help you manage
future costs. Because safer workplaces contribute to lower workers’ compensation premiums and less lost time for employees, the importance of
effectively preventing injuries and managing claim costs is clear.
Debt collection services
Zenith also assists policyholders with on-line access to a comprehensive
library of loss prevention tools, OSHA logs, safety posters and other valuable
resources—at no additional charge.
Discounted credit card & payroll
processing services
We’re here to help! Please contact us in whatever manner is most
convenient for you.
I.C. System
800-279-3511
icsystem.com/associations/coa.htm
Heartland Payment Systems
916-599-8689 • dana.leblanc@e-hps.com
heartlandpaymentsystems.com
Email & social media services
Constant Contact
constantcontact.com/index.jsp?pn=coavision
Employment law posters
800-877-5738 ext. 221
coavision.org/i4a/pages/index.
cfm?pageID=3597
Classified ads
California Optometry Magazine
800-877-5738 x221 • awinans@coavision.org
awinans@coavision.org
Continuing education
COA’s CE@Home
800-877-5738 • education@coavision.org
coavision.org
18
Mercer Health & Benefits Insurance Services LLC ∙ CA Ins. Lic. #0G39709
777 South Figueroa Street, Los Angeles, CA 90017
Phone: 800-775-2020 (8:00 a.m. to 5:00 p.m. Pacific, M-F)
Fax: 213-346-5946
Email: COA.Insurance.service@mercer.com
Website: www.COAMemberInsurance.com
*ZNAT Insurance Company, a wholly owned subsidiary of Zenith Insurance
Company, is the underwriter for the California Optometric Association
workers’ compensation program.
72545-66545 (10/14) Copyright 2014 Mercer LLC. All rights reserved.
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Key Person corner
Dr. Hilary Hawthorne,
Assemblyman Sebastian
Ridley-Thomas, and Dr.
Richard Hoffman. COA Key
Persons, Drs. Hawthorne
and Hoffman, met with
Assemblyman RidleyThomas during COA’s Local
Legislative Days.
All Eyes on You
All Eyes on You
features the latest
news about COA
members.
Dr. Phil Smith, Legislative Aide Jazmyne
Thomas and Dr. Greg Hom. Dr. Smith and
Dr. Hom advocating for their profession with
Assemblywoman Shirley Weber’s legislative
aide, Jazmyne Thomas.
Dr. Timothy Ng and Dr. Vikram Girn. A new
generation of ODs on their way to advocate
for COA’s sponsored legislation, SB 492.
Dr. Robert Meisel,
Assemblywoman Lorena
Gonzalez and Dr. Phil
Smith. Local Legislative
Days bringing out the best
and brightest! Dr. Meisel
and Dr. Smith encouraged
Assemblywoman Lorena
Gonzalez to support
SB 492.
20
All Eyes on You
Assemblywoman Marie Waldron
and Dr. Scott Lewis. Dr. Lewis
enjoyed a productive meeting with
Assemblywoman Waldron
regarding SB 492.
Assemblyman Wagner using the YAG laser on simulated tissue. Guidance
provided by Dr. David Sendrowski with Ketchum University President Dr. Kevin
Alexander and Dr. Barry Weissman assisting with Q&A about SB 492.
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21
All Eyes on You
Key Person spotlight
Students of optometry are not only the future of the profession, they are the future
leaders of COA. As students are educated and trained with the tools necessary to make
them skilled doctors of optometry, they are also learning how California’s legislative and
regulatory bodies play an integral role in their ability to practice in the state. Because it
is students who will carry the future of optometry, they are a highly valued resource as
part of the grass roots network of advocacy.
Students of optometry who choose to act as COA Key Persons are able to provide
valuable insight into the current education and training they receive as they work to
build relationships with their legislators. It is important to highlight the contributions of
students of optometry within our Key Person network to underscore the impact of their
involvement, as well as encourage others to become active leaders.
Catherine Huang, a student in UC Berkeley’s School of Optometry Class of 2016, sets a
wonderful example of a student whose involvement in her school and COA influences
those around her. As the 2014-2015 Beta Sigma Kappa president, Catherine has a
powerful voice within the student community at UC Berkeley. She is also the current
COA representative from Berkeley, as well as the vice-chair of the COA Optometric
Student Section. It is from these platforms Catherine is able to embolden others to take
an active role in shaping the future of their profession.
Catherine Huang
UC Berkeley’s School of
Optometry, Class of 2016
Q: Why did you choose optometry as a profession?
CH: I chose optometry as profession because it allows me to foster long-term patient
relationships as well as hone my problem solving skills. I find the complexity of the visual
system very interesting to solve and the eyes are truly windows into the rest of the body.
In all, optometry is a very rewarding profession because it has the ability to restore sight
and potentially save lives.
Q: Why is it important for you, as a student, to be an advocate for optometry?
CH: Students will be the future of optometry and it’s important that they protect the
profession. With each year, the curriculums at optometry schools are evolving to include
the most current research on eye conditions, treatments and advances in technology. As
a current student and advocate, I believe that in order to practice in the future the skills
our current education has provided us, we must create a dialogue with our legislators to
educate them about the field of optometry.
Q: Were you intimidated the first time you met with your legislator?
CH: The first time I met with my legislator, I was a bit intimidated because I was worried I
would say something wrong. However, with the help of the COA talking points, the
meeting was quite conversational and the legislator was very receptive to the ideas
expressed by COA doctors and students.
Q: Do you have any advice for other students who are unsure if they would like to
be a Key Person?
CH: If you are unsure about being a Key Person, take the opportunity to attend a local
society meeting or meet with a COA doctor to gain a perspective on the legislative
challenges that optometry faces today. Also, feel free to contact COA Grassroots
Manager Erin Kauffman Taylor at ektaylor@coavision.org or 916-266-5041, to answer any
questions you may have regarding the Key Person Program.
22
I find the
complexity of
the visual system
very interesting
to solve and the
eyes are truly
windows into the
rest of the body.
Product & Services
Mercer
Save 10% on your Professional Liability insurance by taking qualified courses at Monterey Symposium! Visit Mercer in Booth 108C
for more information. (One discount annually).
Mercer Health & Benefits Insurance Services LLC serves as the
insurance broker and administrator for the COA-sponsored insurance programs. We have a wide variety of programs available to
protect yourself, your family and your employees. Call a Client
Advisor for information on individual and small group health insurance, professional liability, workers’ compensation, level term life,
disability insurance, business owners package and much more.
800-775-2020
www.COAMemberInsurance.com
COA.Insurance.service@mercer.com
66755 (9/14) Copyright 2014 Mercer LLC.
All rights reserved.
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Vision West
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VSP
VSP Global® is a complementary group of leading companies, working together
to meet and exceed the needs of eyecare professionals, clients, and our 70 million
members worldwide. 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. Eyecare 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
eyecare provider and patient. The VSP Global companies include: VSP® Vision
Care, Marchon® Eyewear, Altair® Eyewear, Eye Designs and VSP Optics Group.
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23
Health care reform:
Year on in review
The implementation of the Patient Protection and Affordable Care Act
(ACA) will soon hit the one-year mark. This monumental piece of
legislation was passed in 2010 with expanded insurance coverage
Kara Corches,
going into effect in 2014. The ACA was the most significant change to
External Relations
Manager, COA
the United States health care system since the creation of Medicare
and Medicaid in 1965. Through mandates, subsidies and insurance
exchanges, the ACA sought to decrease the number of uninsured individuals.
Optometry in Focus
The legislation also substantially expanded the Medicaid program for most low-income adults
up to 138 percent of the federal poverty level. While the ACA required most individuals to
obtain health insurance by 2014 or pay a tax penalty, the law also provided one trillion dollars
in subsidies for low- to middle-income Americans to help them pay for health insurance. The
ACA also was a mechanism for providing further patient protections such as the prohibition of
increased rates or denials for individuals with pre-existing conditions.
Federal and State Exchanges Create Insurance Marketplace for Consumers
The ACA gave the US Department of Health and Human Services (HHS) the authority to create
insurance exchanges, also known as marketplaces, where consumers could shop and register
for health insurances by phone, online and in-person. Each state was given the option to create
its own exchange. If a state opted not to, the federal government would administer the
exchange. Partnering exchanges, which were a hybrid of state and federal government control,
also were able to be enacted under the ACA.
Open enrollment for all exchanges began on October 1, 2013, with health coverage starting for
enrollees on January 1, 2014. Of the 50 states plus the District of Columbia, 17 have created
their own exchange. Twenty-seven states have federally-run exchanges and seven have federal/
state partnership exchanges.
During the first
year of the ACA
implementation,
eight million
Americans
received coverage
from insurance
exchanges across
the nation.
The California Health Benefit Exchange, also known as Covered California, had a very
successful inaugural year. California was the first state in the nation to pass legislation that
created an insurance exchange, after the passage of the ACA. The exchange’s website,
www.coveredca.com, was a joint venture between the California Department of Health
Care Services and Covered California. The exchange’s website, customer service call center
and certified enrollment counselors help potential enrollees determine whether they are eligible for subsidies based on income levels to help reduce insurance costs or whether they
are eligible for Medi-Cal, the state’s Medicaid program. If an individual is not eligible for
subsidies, they will pay the full premium rate which is set annually by Covered California’s
board of directors.
In 2014, Covered California offered insurance plans from ten different private companies.
These companies were required to offer benefits following the Covered California standard
benefit design. Covered California offered a wide range of plans, including low premium
“bronze” plans which cover 60 percent of medical costs to higher premium “platinum” plans
which have greater coverage.
Millions of People Gain Coverage in California and Across the Nation
Prior to health care reform, there were an estimated 50 million uninsured Americans. During the
first year of the ACA implementation, eight million Americans received coverage from insurance
exchanges across the nation. Three million more received coverage for the first time through the
Medicaid expansion.
24
Optometry in Focus
The first open enrollment period was not without controversy.
The federal government’s insurance marketplace website,
www.healthcare.gov, was plagued with serious errors that made
it very difficult for consumers to shop for health care online.
state exchanges. Pediatric vision was named as one of the ten
“essential” health benefits. The benefit allows for a comprehensive eye examination, follow-up care, treatment and
eyeglasses or contact lenses for children up to the age of 18.
Although there were also flaws in the Covered California’s
website and customer call center involving very long wait
times and computer glitches, the state exchange announced a
very successful enrollment period with just over three million
individuals gaining coverage. Over one million people enrolled
in private plans offered through the exchange and nearly two
million people enrolled in Medi-Cal.
Senate Bill 951 by Senator Ed Hernandez, OD, and Assembly
Bill 1453 by Assembly Member Bill Monning established the
Kaiser Small Group HMO plan contract as California’s benchmark plan that defines the “essential” benefits that all health
plans must cover in implementing the federal Affordable Care
Act. The bills also defined the pediatric vision essential benefit
as a comprehensive eye examination and eyeglasses benefit for
all QHPs offered by Covered California.
Forty-one percent of enrollees signed up online through
Covered California’s website and 39 percent gained insurance
coverage with the help of certified insurance agents.
Optometry is Impacted by Health Care Reform
Key provisions relating to the ACA have had a large impact on
optometry specific to provider discrimination and the coverage of pediatric and adult vision.
An amendment to the ACA introduced by Senator Tom
Harkin (D-Iowa), also known as the Harkin Amendment,
prohibits an insurance plan from discriminating with respect
to participation under the plan or coverage against any
health care provider who is practicing within his or her scope
of practice. While this measure is considered a big win for
optometry as it potentially increases access to patients and
third-party payers, it does not require reimbursement parity,
nor does it guarantee that every provider will have access to
medical panels.
Pediatric vision benefits greatly impacted optometry as
children now had mandated vision coverage through health
care reform. HHS issued rules on what were considered to be
the ten essential health benefits that must be embedded in
any Qualified Health Plan (QHP) offered through the federal or
www.coavision.org
However, supplemental adult vision coverage is currently not
available in the federal exchange or within Covered California.
Because HHS specifically prohibited states from including adult
vision care as an essential health benefit, Covered California
was uncertain how to provide that coverage within federal
guidelines. Thus, Assembly Bill 1877 was introduced by
Assembly Member Ken Cooley in April 2014. VSP sponsored
the legislation that would have established the California Vision
Care Access Council within state government. The bill required
the council to establish a marketplace for the purchase of
vision plans through Covered California. After passing in the
State Assembly and Senate in September 2014, Governor Jerry
Brown vetoed the measure as he thought it may be impermissible under federal rules.
While health care reform has had both fervent supporters and
opponents, no one from either side of the debate can deny that
it has had a transformational effect on the health care market.
The creation of the exchanges and the expansion of Medicaid
has given millions of Americans the opportunity to gain insurance coverage for the first time ever. The ACA has made
substantial changes to health care in its first year of implementation, but it is still too early to tell how and if it will continue to
change the practice of optometry over the long-run.
25
The latest health care issues that affect doctors of optometry.
Health News & Views
CMS releases new quality reporting aides to help
ensure satisfactory 2014 reporting
The federal Centers for Medicare and Medicaid Services (CMS)
has unveiled three new resources to help make reporting
simple under the 2014 Physician Quality Reporting System
(PQRS). CMS has added beginner, intermediate, and advanced
PQRS training modules to its eHealth University (cms.gov/
eHealth/eHealthUniversity.html). The modules, designed by
level for quick and easy use, are (links to the modules can be
found on the eHealth University home page):
• Quality Measurement 101 (www.cms.gov/eHealth/downloads/eHealthU_PQRSQualityManagement101.pdf) — A
beginner module that provides the basics of quality reporting, specifically for PQRS.
• 2014 PQRS Reporting Requirements (www.cms.gov/
Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014_PQRS_GPRO_Requirements_010314.pdf) — An intermediate module that explains
the steps to satisfactorily reporting and earning an incentive
for the 2014 PQRS program. The module also walks you
through the steps on how to avoid the 2016 PQRS payment
adjustment and the 2016 value modifier (VM) adjustment.
• How to Report Once for 2014 Medicare Quality
Reporting Programs (www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/PQRS/
Downloads/How-to-Report-Once-for-2014.pdf) — An
advanced module that explains how to report quality
measures one time during the 2014 program year and satisfy
26
quality reporting requirements for several Medicare quality
reporting programs. These programs include PQRS, the
Medicare EHR Incentive Program, the VM, and Accountable
Care Organizations.
Each module is divided into sections and provides helpful tips
and graphics to explain different quality topics. The modules
can be easily shared with your staff to help your practice
satisfactorily participate in PQRS.
REMEMBER!
• 2014 is the last year eligible doctors of optometry
can earn an incentive payment for satisfactorily
reporting PQRS quality data to CMS
• This year’s participation in PQRS determines the
2016 PQRS payment adjustment
• AOAExcel’s EyeLearn page (excelod.com/
eyelearn) features a new e-resource, “PQRS 2014
— Are you Reporting? New Rules and Guidance
Handout” on the Eyelearn home page under
“My Courses” (member login required)
• AOAExcel’s EyeLearn page (excelod.com/
eyelearn) is loaded with addition e-resources for
PQRS, HER and other federal incentive
programs; login to the page and type “pqrs” in
the “search” function
Health News & Views
Feds looking at revisions to contact lens guidance
With microbial eye infections among contact lens wearers on
the rise, AOA participated at a September 2014, US Food &
Drug Administration workshop to begin work to examine
current microbiological testing methods for contact lenses and
accessories to see if updates were necessary. It’s anticipated
that the agency will eventually issue additional guidance on
contact lens disinfection efficacy evaluations. AOA will remain
engaged in the process and any revised guidance is anticipated to affect ODs who provide advice to their patients on risks
and how best to care for their contact lenses.
Among the areas examined were:
• Pathogens in contact-lens-related keratitis;
• The role of soil as a model to mimic the human tear film in
assessing disinfection efficacy; and
• Acanthamoeba organism and host considerations and
testing methods.
“Data suggests that the risk of corneal keratitis may actually
be increasing over time. This may be due in part to elevated
exposures to pathogens as a result of poor hygiene practices,
the quality of available U.S. drinking water, and the imperfect
sterilization of reusable contact lenses,” says AOA’s Chief
Public Health Officer Michael Dueñas, OD, who moderated
the panel on the role of soil in disinfection efficacy.
Medi-Cal update
Donny Shiu, OD, Medi-Cal Vision Care program consultant
Back-to-school season is over and students are settling into a new
exciting school year. The referral of students to doctors of optometry by schools, physicians and parents for eye exams is common
during this time of year. Medi-Cal supports optometry services to
school-aged beneficiaries and provides eyeglasses to those who
qualify. As a reminder, eye exams and/or refractions more frequent
than every 24 months are allowable if beneficiaries experience
vision related symptoms. Replacement eyeglass lenses are also
allowed with a change of at least 0.50 diopters in prescription. The
details are in the Medi-Cal vision care provider manual.
The following are providers’ questions for you to review:
DEAR DR. SHIU: The Treatment Authorization Request
(TAR) was approved for lenses to be made at a private lab
by Medi-Cal for our patient. How do I submit claims for TARapproved services?
—Erica from Eureka
DEAR ERICA: To ensure proper processing of TAR-approved claims, make sure that the procedure codes,
modifiers and dates of service on the claim match exactly those
www.coavision.org
indicated on the Adjudication Response (AR) that is faxed or
mailed back to you when the TAR is adjudicated.
• The cumulative number of units billed must not exceed
the number of approved units indicated on the AR.
• Enter the 10-digit TAR Control Number (TCN) followed
by the Pricing Indicator (PI) from the AR in the Prior
Authorization Number field (Box 23) on the CMS-1500
claim form. Providers are not required to submit copies of
the AR with the claim as proof of authorization.
• Enter the TCN and PI on all claims for services authorized on the same TAR, even if the services are billed on
separate claims.
• Attach invoices or manufacturer’s catalog pages as
appropriate for TAR-approved items.
• Bill approved items and/or procedures with different
TCNs on separate claim forms.
• Bill TAR-approved and non-TAR services on separate
claim forms.
DEAR DR. SHIU: I have a few claims that appear to be
incorrectly reimbursed or denied. What can I do?
—James from Santa Cruz
27
Health News & Views
Providers who want to pursue further action may file a formal
appeal. Refer to the Appeal Process Overview section of the
vision care provider manual for more information. An appeal is
the final step in the administrative process and a method for
Medi-Cal providers with a dispute to resolve problems related
to their claims. The necessary support documents required are
listed in the manual as well.
Send the Appeal Form (90-1) to the same address above and
add “Attn: Appeals Unit.”
The forms are available by contacting the Medi-Cal telephone
call center at 800-541-5555.
Important Notes for Appeal and Claims Inquiry Forms:
Vision Care
DEAR JAMES: After you have thoroughly checked your
claims for errors with the aid of Remittance Advice
Details (RAD) code message(s), you may consider filing claim
inquiries or appeals with the Medi-Cal Fiscal Intermediary (FI),
which is Xerox.
The Claims Inquiry Form (CIF) is used to: 1) request an adjustment for both an underpaid and an overpaid claim, 2) request a
Share of Cost (SOC) reimbursement or 3) request reconsideration of a denied claim. The CIF can also be used to trace a “lost
claim” that does not appear on a RAD.
An appeal is the final step in
the administrative process
and a method for Medi-Cal
providers with a dispute to
resolve problems related to
their claims.
Appeal:
An appeal received on or after September 22, 2014, by the
Medi-Cal FI will require an ICD indicator of “9” on the claim
attached to it if the attached claim is submitted with an
ICD-9-CM diagnosis code. If the ICD indicator is not on the
claim, the appeal will be rejected.
CIF:
CIFs received by the Medi-Cal FI on or after September
22, 2014:
• Require an ICD indicator of “9” in the diagnosis area of
the claim if the initial claim contained an ICD-9-CM
diagnosis code
CIFs accompanied by claims (as supporting documentation)
without an ICD indicator will not be processed
To update an attached CMS-1500 claim form if the initial claim
was submitted on an 08/05 version, billers must:
• Transfer all info from the initial 08/05 version to an 02/12
version and insert a “9” in the ICD Ind. area of Box 21
To update an attached UB-04 claim:
• Insert a “9” in the white space below DX Box 66
I hope you find this information useful.
Requests for reconsideration of denied claims must be submitted within six months following the date of denial on a RAD.
However, submitting a new claim within the original six-month
billing limit may be a faster process.
Providers should mail the CIF to the FI at the
following address:
Xerox State Healthcare, LLC
PO Box 15300
Sacramento, CA 95851-1300
28
If you have suggestions, comments or would like to submit
questions to COA Medi-Cal update, please use the following address:
Department of Health Care Services
Pharmacy Benefits Division
Vision Services Branch
PO Box 997413, MS 4604
Sacramento, CA 95899-7413
E-mail: vision@dhcs.ca.gov
Health News & Views
Secrets of coding
Medicare guidelines for eyelid surgery
William Rogoway,
OD, DABFE
As a consequence of living healthier and longer lives, our patients are increasingly in need of eye lid
surgeries, blepharoplasty and brow lifts. Seeing this need, Medicare has proposed new policies and
regulations to cover these procedures. Medicare policies are known as LCDs (Local Coverage Determinations). The proposed title of this new LCD will be Blepharoplasty, Eyelid Surgery and Brow Lift, with a
proposed LCD-ID number of DL33512.
Even though optometry in California does not perform these surgeries, our patients will need counseling
and advice when a surgical appointment might be necessary. Since 70 percent of eye care appointments
are performed in an optometric office combined with California’s ever graying population, it will be up to
the doctor of optometry to sort these patients out. So knowledge of this LCD by ODs is important.
Like always, Medicare is looking for medical necessity and proper documentation for valid claims. Blepharoplasty, blepharoptosis repair and brow ptosis repair (brow lift) are eyelid surgeries that restore faulty lid
function to normal. If done for that purpose, they are considered reasonable and necessary for Medicare
and are billable. Surgery just to enhance appearance is considered cosmetic in nature and not billable.
Medicare is looking for patient symptoms such as interference with vision or visual field that affects an
activity of daily living such as difficulty reading, driving or difficulty fitting spectacles. Debilitating eyelid
irritation could also qualify along with difficulty fitting or wearing an ocular prosthesis. In addition, the
documentation should show that the eye being considered for surgery has physical signs consistent with
a functional deficit or abnormality.
Upper eyelid surgery is considered functional when overhanging skin or upper lid position secondary to
dermatochalasis, blepharochalasis, blepharoptosis or pseudoptosis is sufficiently low to produce visual
field impairment. Other functional indications for upper eyelid surgery include chronic dermatitis due to
blepharochalasis (excess skin associated with chronic recurrent eyelid edema that physically stretches
the skin) due to severe allergy or thyroid eye disease that results in debilitating irritation.
Although lower lid functional indications for these procedures are thought to be rare, there are issues
concerning the fitting of eyeglasses that suggest impairment for both the upper and lower lids. For
example, a significant difficulty in fitting or tolerating spectacles due to excessive eyelid tissue causing
glasses induced skin irritation or ectropion could be an indication for the surgery.
Medicare wants the documentation to come from the surgeon’s clinical notes to prove the medical
necessity rather than from visual field testing. Furthermore, most of this documentation is achieved with
the use of a camera that will confirm the problem. The photos should be sharp and distinct, that clearly
indicate the anatomical features involved. This needed documentation often requires several pictures of
both front and side views.
Also needed is the MRD or margin reflex distance. This is the distance from the corneal light reflex to the
upper eyelid margin. In conditions such as blepharoptosis or pseudotosis, an MRD of 2.0 mm or less is
necessary and is an indication to Medicare of the medical necessity for surgery.
Hope this helps and keep on coding.
For a complete copy of this proposed LCD, please see Noridian’s Healthcare Solutions website at
https://med.noridianmedicare.com/web/jeb/article-detail/-/view/10525/draft-lcds-published-for-reviewand-commen-1
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29
Vision and learning
Raymond Chu, OD, MS
Kristine Huang, OD, MPH
CE@Home
Dr. Raymond Chu is an associate professor at
the Southern California College of
Optometry at Marshall B. Ketchum
University. Dr. Chu serves as clinical faculty
in the Studt Center for Vision Therapy and
Pediatric Optometry Services. He received
his Doctor of Optometry degree from SUNY,
State College of Optometry, and went on to
complete a residency at the Southern
California College of Optometry in pediatric
optometry and vision therapy. Dr. Chu also
holds a Master’s Degree in Instruction
Design and Technology and is a fellow of the
American Academy of Optometry.
Dr. Kristine Huang is chief of Pediatric Vision
Services in the Studt Center for Vision
Therapy at the Southern California College of
Optometry at Marshall B. Ketchum University.
She received her Doctor of Optometry
degree from SUNY, State College of
Optometry, where she also completed a
residency in vision therapy and rehabilitation.
Dr. Huang also holds a Master’s Degree in
Public Health and is a fellow of the American
Academy of Optometry. Dr. Huang serves as
a clinical investigator in several National Eye
Instutute-supported studies.
Introduction
Visual impairment is one of the most prevalent chronic conditions of childhood
and may affect educational achievement and self-esteem.1–4 The Centers for
Disease Control and Prevention (CDC) reported the prevalence of visual impairment and blindness among children <18 years of age to be 2.5%.5 However, the
number of children with reduced acuity is significantly under-represented as
the CDC estimate is based on visual impairment defined by best-corrected
visual acuity of 20/70 or worse in the better eye. Healthy People 2020 sets
10-year national objectives to reduce childhood prevalence of visual impairment through prevention, early detection, timely treatment and rehabilitation:6
V-1 Increase the proportion of preschool children aged 5 years and under who receive vision screening
V-2 Reduce blindness and visual impairment in children and adolescents aged 17 years and under
V-5.1 Reduce visual impairment due to uncorrected refractive error
Identifying and managing refractive error is the first step in making sure a child
is visually ready for school. Other conditions that have the potential to affect
academic performance are disorders in vergence, accommodation, fine eye
movements and visual perception. The purpose of this presentation is to detail
how refractive error, visual efficiency and visual information processing disorders can interfere with the normal learning process.
Ametropia and Visual Impairment
It is estimated that over 80% of all visual impairment is treatable with refractive
correction.7 Among school-aged children there is a high prevalence of refractive error conditions which impact the quality of vision and, potentially, a child’s
ability to learn.8,9 We are familiar with the notion that significant amounts of
uncorrected refractive error can result in reduced acuity at distance and/or
near. Hirsch originally reported this relationship between reduced acuity and
uncorrected myopia and astigmatism.10 Though the relationship is somewhat
variable, a -1.00D uncorrected myopia can reduce distance acuity anywhere
from 20/30 to 20/100. Langford and Hug reported that most visual demands in
grades 3 to 5 ranged from 20/60 to 20/100.11 The relationship between visual
acuity and uncorrected hyperopia is more challenging to predict as it is
dependent on the child’s ability to use their accommodation to compensate for
blur induced by the uncorrected hyperopia. However, high amounts of uncorrected hyperopia (> +3.00D) has been shown to increase a child’s risk for the
development of amblyopia and strabismus.12–14
Ametropia and Learning
Studies have found links between uncorrected refractive error and development. Atkinson et al., reported on the visual development of 9-month-old
infants and found that those with significant amounts of hyperopia had modest
yet consistently poorer performance on visual-cognitive and visual-motor tests
as compared to age matched peers.15 Rosner and Rosner corrected hyperopia
in a cohort of children before their fourth birthday and found fewer delays in
visual-motor skills as compared to hyperopic children that were corrected at a
later date.16
Eames reported on 1,000 reading-disabled children and 150 controls and
found a significantly larger prevalence of hyperopia among the reading-dis-
30
CE@Home
abled children.17 Shankar et al., found that within a sample of
children with uncorrected hyperopia (+2.00D to +3.50D),
performance on tests of letter and word recognition,
receptive vocabulary, and emergent orthography (spelling)
was less developed than in a cohort of children with emmetropia (+0.25D to +1.75D).18 Williams et al., found that
eight-year-old students, who failed a +4.00D fogging test
and were confirmed to have hyperopia, scored lower on
standardized assessment tests (English, mathematics and
science) and the National Foundation for Education Research
English test (reading and writing skills).9 Although we assume
that the increased accommodative demand results in a
child’s inability to optimally sustain near demands such as
reading, this relationship has yet to be determined. In their
meta-analysis, Grisham and Simons noted improved reading
progress across studies when children received correction
for hyperopia and anisometropia.19
among a cohort of children who were struggling in school.27
Vergence facility in particular was correlated with reading
speed and the number of fixations made when reading.
Convergence insufficiency (CI) is a common binocular vision
disorder that is defined by a constellation of findings: greater
exophoria at near than distance, reduced near point of
convergence and reduced compensatory positive fusional
vergence.28 Rouse et al., found the prevalence of CI with all
three findings to be 4.2% among school-aged children (10-12
years old).29 Children suffering from CI often report a higher
frequency of symptoms that include loss of place, slow reading
and poor concentration when reading as compared to children
with normal binocular vision.30 Children with symptomatic CI
also report a significantly higher number of academic performance symptoms (e.g., difficulty completing assignments,
inattentiveness and avoidance of reading) when compared to
children with normal binocular vision.31
In 1971, Grosvenor wrote, “Since there is evidence that
hyperopes as a group may be less efficient readers than
emmetropes or myopes, perhaps hyperopia warrants more
study and emphasis than it has been given in the past.”20 Over
40 years later, we are no closer to an evidence-based approach
to the optimal correction of hyperopia as exhibited by the
AOA Clinical Practice Guidelines, Care of the Patient with
Hyperopia (revised 2008): “There is no universal approach to
the treatment of hyperopia.” In 2004, Lyons et al., published
survey results from optometrists and ophthalmologists and
found considerable differences in prescribing patterns among
the professions of optometry and ophthalmology.21 Cotter
theorized that the differences may be due to the level of
emphasis by some practitioners on areas such as accommodation, vergence and stereopsis, as well as symptoms and
academic performance indicators.22
Case series and literature reviews have reported compelling
arguments for the impact that vision therapy has on the
improvement of the signs and symptoms of oculomotor,
accommodative and vergence disorders and its secondary
impact on academic performance. The most definitive study
on the effectiveness of vision therapy, Convergence Insufficiency Treatment Trial (CITT), reported that 12 weeks of
office-based accommodative and vergence therapy with home
reinforcement significantly improved the signs and symptoms
of CI as compared to home-based treatments and placebo
therapy.32 Atzmon et al., randomized a group of reading-disabled children into reading therapy and vision therapy.
Although their study lacked a control group, both interventions
were found to improve reading performance with the additional benefit of less asthenopia in the vision therapy group.33
In the CITT study, Borsting et al., reported that improvement in
signs and symptoms of CI resulted in a reduction of the
frequency of adverse academic behaviors and parental
concern associated with reading and school work.34 Although it
has been hypothesized that the treatment of visual efficiency
disorders reduces the labor of reading, thereby improving
reading performance, this cause and effect has yet to be
proven. Currently, there is a National Eye Institute funded
study, CITT-ART, looking at the relationship of the effect of CI
treatment on reading and attention.
Visual Efficiency and Learning
The ability to see better than 20/40 has often been the
defining criteria to determine adequate vision for school.23
However, visual acuity is not the only aspect of vision that may
affect academic performance; oculomotor, accommodative
and vergence skills can also impact a child’s learning. Poorer
readers have been found to have an increased number of
fixations, higher number of regression saccades, and longer
duration of fixation as compared to normal readers.24 Lefton et
al., observed that these inefficiencies did not naturally improve
over time in students characterized as poor readers.25 Kulp and
Schmidt found that incorporating stereoacuity and accommodative facility testing as a supplement to the Modified Clinical
Technique (MCT) vision screening battery was predictive in
identifying successful or unsuccessful readers in a group of
kindergartners and first graders.26 Quaid and Simpson found a
greater prevalence of hyperopia and reduced vergence facility
www.coavision.org
Visual Information Processing and Learning
Visual information processing skills, also referred to as
visual perceptual skills, are important to consider when
examining children. These skills integrate with higher
cognitive skills and other sensory modalities in order to give
meaning to what is seen and is important for activities like
reading. Visual perceptual skills can be further categorized
as visual spatial, visual analysis and visual-motor skills. Visual
31
CE@Home
spatial skills help us to understand directional concepts like
up, down, left and right and how these directions relate to
our body and other objects in space. These fundamental
skills are essential for navigating the world, understanding
directions and are also important when learning linguistic
symbols (e.g., b, d, p, q). Visual analysis skills are used to
analyze what is seen, remember what is seen, to visualize
what is seen, and to do these things efficiently. Visual-motor skills, also referred to as eye-hand coordination skills,
integrate visual information with motor skills and are
important when writing and copying information.
Studies have shown
evidence of a
relationship between
visual perceptual skills
and learning.
Studies have shown evidence of a relationship between visual
perceptual skills and learning. Solan et al., found correlations
between visual spatial, visual analysis and visual-motor skills
with reading readiness and written and mental arithmetic.35,36
In a meta-analysis by Kavale, visual perception was found to
be related to reading and it was suggested that visual
perceptual skills such as visual discrimination, visual memory,
visual closure, visual figure ground and visual-motor integration be considered along with other factors as predictors for
reading achievement.37 Kavale stated, “visual perceptual
skills, when considered both individually and in combination,
accounted for moderate proportions of the total variance in
reading ability.” Multiple studies have shown the speed of
processing as an important skill that can differentiate good
readers from poor readers.38–42 Visual-motor skills have also
been found to be related to academic achievement.43,44 For
example, Barnhardt et al., found that poor visual-motor
integration contributed to poor spatial organization of
written work as demonstrated by increased errors with
alignment of numbers in math problems and spacing errors
of letters and words.45
Studies have shown the effectiveness of vision therapy in
improving visual perception skills also benefits student’s
receptiveness to academic instruction. Greenspan showed a
statistically significant improvement in visual spatial skills and a
reduction in reversal errors in children who received visual
spatial therapy compared to those in a control group who
received orthoptic (vergence) therapy.46 In a retrospective
study by Tassinari and Eastland, those that received perceptual
therapy showed an improvement in visual-motor test scores
and a reduction in symptoms associated with deficient
visual-motor integration.47 Attention therapy has also been
shown to have a significant impact on reading speed, accuracy
and comprehension.48,49 Seiderman provided perceptual
therapy to learning-disabled children and demonstrated an
improvement on specific subtests of the Stanford Achievement
Test as compared to the control group.50 It is important to
keep in mind that visual perception disorders hamper classroom performance and may contribute to a learning problem,
but it does not cause a learning disability.
Conclusion
It is estimated that as much as 80% of what a child learns is
acquired through vision, hence vision is essential to a child’s
ability to learn and reach their academic potential. As children
progress in school, they encounter higher and higher visual
demands. These visual demands are not only in acuity as size
of print becomes smaller, but also with increased crowding
effects as there are more words on the page and less pictures.
These demands require more precision in saccades as well as
the ability to distinguish the figure from the ground (the trees
from the forest is a common analogy). A child’s accommodative and vergence stamina are challenged with greater
amounts of homework and with a greater presence of technology usage. Some children are able to perform these tasks
without any manifestations of symptoms, whereas others
struggle with symptoms of fatigue, eyestrain, headaches, or
academic performance that does not match their level of
effort. So the next time a child walks into your exam room,
prescribing the correct spectacles may not be the only help
you can provide. Rather, consider all aspects of their vision as
you can play an important role in a child’s academic success.
Need more CE? Then come online!
COA’s continuing education offerings can also be found online! CE@HomeOnline features
six high-quality, one-hour CE articles, in addition to the CE@Home articles in the
magazine. Just visit coavision.org to access them!
The member price for each article is $15.
Articles are posted at the beginning of February, April, June, August, October and
December. For more information and to view articles, visit coavision.org.
32
CE@Home
REFERENCES
1. Basch CE. Vision and the achievement gap among urban
minority youth. J Sch Health 2011;81(10):599-605.
doi:10.1111/j.1746-1561.2011.00633.x.
2. Bowen J. Visual impairment and its impact on self-esteem.
British Journal of Visual Impairment 2010;28(1):47-56.
doi:10.1177/0264619609349429.
3. Khadka J, Ryan B, Margrain TH, Woodhouse JM, Davies
N. Listening to voices of children with a visual impairment: A focus group study. British Journal of Visual
Impairment 2012;30(3):182-196.
doi:10.1177/0264619612453105.
4. Shin HS, Park SC, Park CM. Relationship between accommodative and vergence dysfunctions and academic
achievement for primary school children. Ophthalmic
Physiol Opt 2009;29(6):615-624.
doi:10.1111/j.1475-1313.2009.00684.x.
5. Centers for Disease Control. Visual impairment and use of
eye-care services and protective eyewear among children
— United States, 2002. MMWR 2005;54(17):425-429.
6. U.S. Department of Health and Human Services. Vision
— Healthy People. 2013. Available at: http://www.healthy
people.gov/2020/topicsobjectives2020/objectiveslist.
aspx?topicId=42. Accessed November 7, 2013.
7. Vitale S, Cotch MF, Sperduto RD. Prevalence of Visual
Impairment in the United States. JAMA 2006;295(18):2158.
doi:10.1001/jama.295.18.2158.
8. Kleinstein RN, Jones LA, Hullett S, et al. Refractive error
and ethnicity in children. Arch. Ophthalmol 2003;121(8):11411147. doi:10.1001/archopht.121.8.1141.
9. Williams WR, Latif AHA, Hannington L, Watkins DR.
Hyperopia and educational attainment in a primary school
cohort. Arch. Dis. Child. 2005;90(2):150-153. doi:10.1136/
adc.2003.046755.
10. Hirsch MJ. Relation of visual acuity to myopia. Arch Ophthal
1945;34:418-421.
11. Langford A, Hug T. Visual demands in elementary school. J
Pediatr Ophthalmol Strabismus 2010;47(3):152-156.
doi:10.3928/01913913-20090818-06.
12. Atkinson J, Braddick O, Bobier B, et al. Two infant vision
screening programmes: Prediction and prevention of
strabismus and amblyopia from photo- and videorefractive
screening. Eye 1996;10(2):189-198.
13. Cotter SA, Varma R, Tarczy-Hornoch K, et al. Risk factors
associated with childhood strabismus: the multi-ethnic
pediatric eye disease and Baltimore pediatric eye disease
studies. Ophthalmology 2011;118(11):2251-2261.
doi:10.1016/j.ophtha.2011.06.032.
14. Tarczy-Hornoch K, Varma R, Cotter SA, et al. Risk factors for
decreased visual acuity in preschool children: the multiethnic pediatric eye disease and Baltimore pediatric eye
disease studies. Ophthalmology 2011;118(11):2262-2273.
doi:10.1016/j.ophtha.2011.06.033.
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CE@Home
15. Atkinson J, Anker S, Nardini M, et al. Infant vision screening
predicts failures on motor and cognitive tests up to school
age. Strabismus 2002;10(3):187-198.
16. Rosner J, Rosner J. Some observations of the relationship
between the visual perceptual skills development of young
hyperopes and age of first lens correction. Clinical and
Experimental Optometry 1986;69(5):166-168.
doi:10.1111/j.1444-0938.1986.tb04584.x.
17. Eames TH. Comparison of eye conditions among 1,000
reading failures, 500 ophthalmic patients, and 150 unselected children. Am. J. Ophthalmol. 1948;31(6):713-717.
18. Shankar S, Evans MA, Bobier WR. Hyperopia and emergent
literacy of young children: pilot study. Optom Vis Sci
2007;84(11):1031-1038. doi:10.1097/OPX.0b013e318157a67a.
19. Grisham JD, Simons HD. Refractive error and the reading
process: a literature analysis. J Am Optom Assoc
1986;57(1):44-55.
20. Grosvenor T. The neglected hyperope. Am J Optom Arch
Am Acad Optom 1971;48(5):376-382.
21. Lyons SA, Jones LA, Walline JJ, et al. A survey of clinical
prescribing philosophies for hyperopia. Optom Vis Sci
2004;81(4):233-237.
22. Cotter SA. Management of childhood hyperopia: a
pediatric optometrist’s perspective. Optom Vis Sci
2007;84(2):103-109. doi:10.1097/OPX.0b013e318031b08a.
23. Ong F, Davis-Alldritt L, eds. A Guide for Vision Testing in
California Public Schools. Sacramento, CA: California
Department of Education; 2005.
24. Pirozzolo F. Eye movements and reading disability. In:
Rayner K, ed. Eye Movements in Reading: Perceptual and
Language Processes. New York: Academic Press; 1983:499509.
25. Lefton L, Nagle R, Johnson G, Fisher D. Eye movement
dynamics of good and poor readers: Then and now.
Journal of Literacy Research 1979;11(4):319-328.
doi:10.1080/10862967909547338.
26. Kulp MT, Schmidt PP. Visual predictors of reading performance in kindergarten and first grade children. Optom Vis
Sci 1996;73(4):255-262.
27. Quaid P, Simpson T. Association between reading speed,
cycloplegic refractive error, and oculomotor function in
reading disabled children versus controls. Graefe’s Archive
for Clinical and Experimental Ophthalmology
2013;251(1):169-187. doi:10.1007/s00417-012-2135-0.
28. Daum KM. Convergence insufficiency. Am J Optom Physiol
Opt 1984;61(1):16-22.
29. Rouse MW, Borsting E, Hyman L, et al. Frequency of
convergence insufficiency among fifth and sixth graders.
The Convergence Insufficiency and Reading Study (CIRS)
group. Optom Vis Sci 1999;76(9):643-649.
30. Borsting EJ, Rouse MW, Mitchell GL, et al. Validity and
reliability of the revised convergence insufficiency symptom survey in children aged 9 to 18 years. Optom Vis Sci
2003;80(12):832-838.
31. Rouse M, Borsting E, Mitchell G, et al. Academic Behaviors
in Children with Convergence Insufficiency with and
without Parent-Reported ADHD. Optometry & Vision
Science 2009;86(10):1-9.
32. Convergence Insufficiency Treatment Trial Study Group.
Randomized clinical trial of treatments for symptomatic
34
convergence insufficiency in children. Arch. Ophthalmol
2008;126(10):1336-1349. doi:10.1001/archopht.126.10.1336.
33. Atzmon D, Nemet P, Ishay A, Karni E. A randomized
prospective masked and matched comparative study of
orthoptic treatment versus conventional reading tutoring
treatment for reading disabilities in 62 children. Binocul Vis
Strabismus Q 1993;8(2):91-106.
34. Borsting E, Mitchell GL, Kulp MT, et al. Improvement in
academic behaviors after successful treatment of convergence insufficiency. Optom Vis Sci 2012;89(1):12-18.
doi:10.1097/OPX.0b013e318238ffc3.
35. Solan HA, Mozlin R. The correlations of perceptual-motor
maturation to readiness and reading in kindergarten and
the primary grades. J Am Optom Assoc 1986;57(1):28-35.
36. Solan HA. The effects of visual-spatial and verbal skills on
written and mental arithmetic. J Am Optom Assoc
1987;58(2):88-94.
37. Kavale K. Meta-analysis of the relationship between visual
perceptual skills and reading achievement. J Learn Disabil
1982;15(1):42-51.
38. Spring C. Perceptual speed in poor readers. J Educ Psychol
1971;62(6):492-500.
39. Lyle JG, Goyen JD. Effect of speed of exposure and
difficulty of discrimination on visual recognition of retarded
readers. J Abnorm Psychol 1975;84(6):673-676.
40. Goyen JD, Lyle JG. Short-term memory and visual discrimination in retarded readers. Percept Mot Skills
1973;36(2):403-408. doi:10.2466/pms.1973.36.2.403.
41. Steinhauser R, Guthrie J. Perceptual and linguistic processing of letters and words by normal and disabled readers. J
Reading Behav 1977;9:217-25.
42. Solan HA, Shelley-Tremblay JF, Hansen PC, Larson S. Is
there a common linkage among reading comprehension,
visual attention, and magnocellular processing? J Learn
Disabil 2007;40(3):270-278.
43. Sortor JM, Kulp MT. Are the results of the Beery-Buktenica
Developmental Test of Visual-Motor Integration and its
subtests related to achievement test scores? Optom Vis Sci
2003;80(11):758-763.
44. Taylor Kulp M. Relationship between visual motor integration skill and academic performance in kindergarten
through third grade. Optom Vis Sci 1999;76(3):159-163.
45. Barnhardt C, Borsting E, Deland P, Pham N, Vu T. Relationship between visual-motor integration and spatial organization of written language and math. Optom Vis Sci
2005;82(2):138-143.
46. Greenspan S. Effectiveness of therapy for children’s
reversal confusion. Acad Ther 1976;11:199-78.
47. Tassinari J, Eastland R. Vision therapy for deficient visualmotor integration. J Optom Vis Dev 1997;28:214-16.
48. Solan HA, Shelley-Tremblay J, Ficarra A, Silverman M,
Larson S. Effect of attention therapy on reading comprehension. J Learn Disabil 2003;36(6):556-563.
49. Facoetti A, Lorusso ML, Paganoni P, Umiltà C, Mascetti GG.
The role of visuospatial attention in developmental
dyslexia: evidence from a rehabilitation study. Brain Res
Cogn Brain Res 2003;15(2):154-164.
50. Seiderman AS. Optometric vision therapy — results of a
demonstration project with a learning disabled population.
J Am Optom Assoc 1980;51(5):489-493.
CE@Home
CE Questions
1. According to the Centers for Disease Control and
Prevention (CDC), the prevalence of visual impairment
and blindness among children <18 years is:
a.2.5%
b.5.0%
c.10.0%
d.25.0%
2. High amounts of uncorrected hyperopia can lead to all of
the following EXCEPT:
a.Amblyopia
b.Strabismus
c. Speech delays
d. Visual-motor delays
3. In California, school based vision screening guidelines
indicate that children need to see better than ________
in order to pass?
a.20/20
b.20/40
c.20/60
d.20/100
4. Which one of the following oculomotor anomalies
has been found in poor readers as compared to
normal readers?
a. Decreased number of fixations
b. Increased number of regression saccades
c. Larger span of recognition
d. Shorter duration of fixation
5. The three key signs for convergence insufficiency are:
a. Greater esophoria at near than distance, reduced
near point of convergence, and reduced
compensatory negative fusional vergence
b. Greater esophoria at near than distance, reduced
compensatory positive fusional vergence
c. Greater exophoria at near than distance, reduced
compensatory positive fusional vergence
d. Greater exophoria at near than distance, reduced
compensatory negative fusional vergence
Good news! You can now submit your CE@Home
answers online! Just click on the CE@Home Online logo
at the bottom of our home
page at www.coavision.org.
Name:
License Number:
Email Address:
6. Which of the following statements is true regarding The
Convergence Insufficiency Treatment Trial?
a. Office based therapy showed significant improvement
in signs and symptoms over home based and placebo
based therapy
b. Office based therapy and home based therapy had
similar improvement in signs and symptoms
c. Office based therapy and placebo based therapy had
similar improvement in signs and symptoms
7.
Deficient visual information processing skills can cause a
learning disability.
a.True
b.False
8. Which of the following statements regarding vision therapy
is FALSE?
a. Vision therapy has been shown to improve visual
spatial skills.
b. Vision therapy has been shown to improve visual
analysis skills.
c. Vision therapy has been shown to improve visualmotor skills.
d. Vision therapy has been shown to benefit academic
instruction.
e. All of the above are true
9. According to this article, understanding directional concepts
and being able to navigate the world is heavily dependent on:
a. saccadic skills
b. visual analysis skills
c. visual-motor skills
d. visual spatial skills
10. A child who has messy handwriting, difficulty copying from
the board, and has difficulty lining up number on math
assignments may have a:
a. accommodative disorder
b. visual analysis disorder
c. visual-motor disorder
d. visual spatial disorder
COA Members: No charge
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One hour CE credit. The deadline for receipt of
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CE@Home: November/December 2014 issue
Transcripts will be available online the Saturday after submission.
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35
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Practice Consultants.
Greenbrae, CA:
Sale Pending.
Hayward, CA:
SOLD.
Irvine, CA:
Gross $860k including some
VT.
Merced, CA #1:
Gross $349, lots of upside
opportunity.
Merced, CA #2:
Gross $453k, 3 lanes.
Sacramento, CA:
Gross $287k and growing, on
only 23 OD hours.
San Diego, CA:
Gross $182k on less than 20
OD hours/week.
Santa Barbara, CA:
Gross $374k with half-time
OD; very profitable.
Santa Barbara County, CA:
Gross $295k with halftime OD.
Susanville, CA:
Revenue $310k on 20
OD hours. 2 lanes and a lab.
Tracy, CA:
Gross over $1 million.
We also have practices
available in CT, GA,
LA, ME, MA, NV, NJ,
NY, OK, and TX; see
www.PracticeConsultants.com
for more information.
____________________________
Chico, CA ophthalmology
suite located in Class A
building, high traffic area, south
part of city. Useable space
2924 square feet, $1.11 foot
plus NNN. Medical campus
includes full service surgery
center. Available 11/1/14.
Contact: 916-799-3122
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
Call for a FREE & Confidential Market Evaluation!
8 7 7 •7 7 8 •2 0 2 0
JUST REDUCED! RETAIL OPTICAL STORE FOR SALE: Los Angeles CA
This well-established optical boutique is located in the high end area of Brentwood in Los
Angeles where the tight knit community loves to support local businesses. Annual gross
revenue is over $185K with tons of potential. Seller is motivated. (ID#76501)
NEW! OPTOMETRY PRACTICE FOR SALE: Northern Michigan
This great practice is located in a popular shopping center, surrounded by restaurants and
large retail stores in Northern Michigan. Annual gross revenue is over $245K with high net
profit. Sale includes 2 state-of-the-art exam lanes and a strong referral base. (ID#76535)
OPTOMETRY PRACTICE FOR SALE: Central CA
This busy practice is located in a residential / industrial area in the agriculturally-rich, San
Joaquin Valley. This is a turnkey practice with great cashflow, plus the real estate is also
available for sale. This is a tremendous opportunity. (ID#76505)
NEW! OPTOMETRY PRACTICE W/ 2 LOCATIONS: Southwest Nebraska
This well-established practice has 2 locations in beautiful, Southwest Nebraska. Combined
annual gross revenue is over $1.2 million with over $430K in owner profit! Real estate is
available for sale or lease. (ID#76525)
REDUCED! OPTOMETRY PRACTICE FOR SALE: Coastal LA County, CA
This well-established practice is situated 3 miles from the Pacific Ocean and 3 miles from
LAX on a busy street with excellent visibility and rear parking. Annual gross revenue was
over $630K in 2013, and has great growth potential. (ID#76508)
NEW! OPTOMETRY PRACTICE FOR SALE: Nevada
Here’s a great practice grossing almost $500K on just 3/4 time weekday hours. Priced to
move, this practice has a recent history of doing over $600K in 2011 and 2012. (ID#76532)
NEW! OPTOMETRY PRACTICE FOR SALE: Industrial Area of LA County, CA
This practice is located in an industrial area in LA County, surrounded by other businesses
in a busy retail center. Gross revenue is over $615K on easy doctor hours. (ID#76537)
OPTOMETRY PRACTICE FOR SALE: Upstate NY
This practice was started cold since 1939, and has been family owned since. This office is
situated in a historic area with high visibility and high foot traffic. Over $275K gross in 2013.
Plenty of room for growth. Practice offers easy weekday hours. (ID#71028)
NEW! OPTOMETRY PRACTICE FOR SALE: LA County, CA
Located in Long Beach in a great shopping area. Here’s a practice with a great net of over
$200K before doctor wages. Annual gross revenue is over $820K with plenty of room for
growth. This is a tremendous opportunity. (ID#76529)
OPTOMETRY PRACTICE FOR SALE: Western Ohio
Located just north of Dayton, this well established practice features equipment upgrades, a
spacious 5,000 square foot office and a very strong net profit. Annual gross revenue is over
$850K. The area features quaint coffee shops, restaurants and boutique stores. (ID#76523)
OPTOMETRY PRACTICE FOR SALE: San Gabriel Valley – LA County, CA
This optometric practice is located in a busy, affluent area of Los Angeles County. Annual
gross revenue on part time doctor hours of $333K in 2013. (ID#76533)
OPTOMETRY PRACTICE FOR SALE: Near Houston, TX
This optometric practice is located in a busy retail center in a populated suburb just outside
Houston. Annual gross revenue is over $420K with strong net. Sale includes state-of-the-art
equipment and on-site lab. (ID#76531)
NEW! OPTOMETRY PRACTICE FOR SALE: Gulf Coast Region, FL
This great practice is well established in a nice upscale neighborhood. Grossing $360K
with low rent, this 30+ year old, busy practice is located in a great location in the Gulf Coast
Region of Florida. Tremendous opportunity for growth. (ID#76538)
RETAIL OPTICAL BOUTIQUE FOR SALE: Palm Beach County, FL
This is a high end optical boutique located in a popular outdoor retail center. Annual gross
revenue is over $275K with strong net. Open 7 days per week, this business is turnkey
and ready for a new buyer. (ID#76527)
JUST REDUCED! 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. Annual gross revenue was
almost $540K in 2013, with plenty of room for growth. (ID#76491)
COMING SOON!
OPTOMETRY PRACTICE FOR SALE: Near Palm Springs, CA
Annual gross revenue is $840K and is growing rapidly. (ID#76539)
OPTOMETRY PRACTICE FOR SALE: Near Atlanta, GA
This great, 10-year-old practice is located on the first floor of a new medical building that is
adjacent to the regional hospital. Annual gross revenue jumped to over $750K in 2013, from
just over $500K in 2012. This practice has an excellent referral base. (ID#76500)
OPTOMETRY PRACTICE + OPTIONAL REAL ESTATE FOR SALE: Central Illinois
Annual gross revenue is over $325K on less than 30 doctor hours per week - tons of
potential! Great retail location in downtown area. Office is available for sale or lease Seller owns the building. (ID#76541)
OPTOMETRY PRACTICE FOR SALE: Northern Idaho
This great practice is located in northern Idaho, situated along the Washington/Idaho
border. Annual gross revenue is over $545K on 4 doctor days per week and weekday office
hours only - lots of room for potential growth. Real estate also available. (ID#76512)
For more information go to: PracticeConcepts.com
COA EVENTS
November 7-9, 2014
Monterey Symposium
If you have an event you would
Monterey Marriott, Monterey, CA
www.montereysymposium.com
like to promote, please send
your listing to Kale Elledge at
February 22, 2015
kelledge@coavision.org.
San Jose, CA
www.optowest.com
www.coavision.org.
View more upcoming events at:
Optowest 2015
When & Where
November
15-16
Molina Health Care of California Annual Health Fair (2 Hours CE Credit)
The services rendered are medical, dental, acupuncture and vision. The event is completely FREE to the community.
Volunteer doctors of optometry needed.
Contact: Crystal Durant Advocate, Community Engagement
Crystal.Durant@MolinaHealthCare.com
800-232-9998 ext. 127269
18
SVOS General Meeting (2 Hours CE Credit)
Marriott Courtyard, Cal Expo, Sacramento, CA
916-447-0270
svostamalon@gmail.com
www.svos.info
December
6
SDCOS Holiday Party (Tentative)
Get listed in
California Optometry
If you have events you would like in our When &
Where section, please email Amanda Winans at
awinans@coavision.org with your event, the date
and a contact number, email/website.
38
CVF SPOTLIGHT
Be the help they need today
so they can see tomorrow
Low-income families in your neighborhood are in need!
Sign up today to provide free eye exams to eligible low-income
families by contacting Amanda Winans, California Vision
Foundation Coordinator, at 800-877-5738 and choose option six or
via email at awinans@coavision.org. You can also sponsor the
foundation by contributing financially.
You, too, can be the help our
fellow Californians need.
Doctors needed in Salinas, Los Angeles and surrounding areas.
“Thank you so much for the efforts you make
to provide eye exams.” —Moriah H.
2015
SAN JOSE
Sunday, February 22
2015
ANAHEIM
Sunday, May 3
$AVE MONEY WITH OUR
PREMIUM VENDOR$
Vision West members can save even more money by increasing their purchase
volumes with our Premium Vendors. In addition to our already low discounts,
Vision West has negotiated “Money Saving” deals with our Premium Vendors:
EASTERN
STATES
EYEWEAR
Increase your savings by purchasing from our Premium Vendors today!
Login to the member section at www.vweye.com for details of this program or
call our Customer Service Department at 800.640.9485.

optometry optometry - California Optometric Association

Transcription

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