Fall 2014 - Profitable Practice

Transcription

GROUNDBREAKING
GENETIC TEST FOR AMD?
EYE FOODS - THE PLAN
PUBLICATION MANAGEMENT AGREEMENT #42113014
A HELPFUL RESOURCE FOR YOU AND YOUR PRACTICE
BACK ISSUES AVAILABLE ONLINE AT PROFITABLE-PRACTICE.COM/MAGAZINE/EYECARE
FALL 2014
EYE CARE PROFESSIONAL
HR LAW AND
“UNIQUE HARDSHIP”
SUMMER 2014
1 | EDITOR’S PAGES
Let There Be Light, Feedback,
Food and Other Content Notes
12 |RESEARCH
Eye Movement When Reading Could
Be Early Indicator Of Alzheimer’s
KAREN HENDERSON
3 |FEATURE INTERVIEW
Dr. Laurie Capogna
Dr. Paul Chris
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PUBLISHER
ROI Corporation Brokerage
is Licensed under
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Business Brokers Act,
2002 (REBBA).
James Ruddy
EDITOR-IN-CHIEF
MANAGING ASSOCIATE EDITOR
Natalia Decius
PROJECT MANAGER
FULLCONTACTMARKETING.CA
6 |PATIENT EDUCATION
Research Suggest Older Adults May
See Better In Their Eye Doctors’s Office
7 |HR LAW
Don’t Take The Bait
MARIANA BRACIC
9 |SCIENCE
Groundbreaking Genetic Tests For
Age Related Macular Degeneration
Now Available Through Canadian
Eye Care Professionals
Janice Awde
11 |EDUCATION
Damaging Light: Educate Yourself
And Your Patients!
Back Issues of Profitable Practice
Magazine are available at:
profitable-practice.com/
magazine/eyecare
16 |PRACTICE MANAGEMENT
Compromising Patient Care
MELISSA GMUSA
17 |HUMAN INTEREST
I Can See Clearly Now
HOW TO REACH US
LETTERS TO THE EDITOR
editor@profitablepracticemagazine.com
1155 Indian Road,
Mississauga, ON L5H 1R8
DICK MOODY
SUBSCRIBER SERVICES
18 |PRACTICE MANAGEMENT
Why I Hired A Professional
TIMOTHY A. BROWN
19 |NUTRITION
Foods Rich In Antioxidants May Lower
The Risk Of Cataracts In Women
20 |RESEARCH
Is He The Impatient Type? Promising
Results On Gene Therapy
21 |OPTICAL ODDS AND ENDS
Notes On Pavement Optical
Illusion, Prescription Labels
by Karen Henderson
Karen Henderson
5 |BOOK REVIEW
Eyefoods: A Food Plan
For Healthy Eyes
Let There Be Light, Feedback,
Food and Other Content Notes
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Profitable Practice: Eye Care Professional
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profitablepracticemagazine.com
Food and light—two things we all need
to survive and thrive—are the main
themes for this issue of Profitable Practice.
I did a quick straw pole among friends
and colleagues; the question: How big a
factor is eye health when choosing what
to eat? The answer was not a surprise;
very few said they equated eye health
with good nutrition. Fortunately this
attitude is changing, in great part to the
work of some of this issue’s contributors.
After I had seen a copy of Eyefoods: A
PLAN FOR HEALTHY EYES, I was
delighted to meet the author herself,
Dr. Laurie Capogna, at the recent
OAO conference in Niagara Falls. She
absolutely spills over with a love for her
work involving eyes and nutrition, and I
know you will enjoy meeting her here and
learning more about her book.
I was so pleased to have discovered the
Vision Institute of Canada, a unique
hybrid not-for-profit organization that
combines clinical services, local community
outreach services, educational activities,
research activities, nutrition education and
Aboriginal vision health awareness.You
will learn more about their nutrition work
through our interview with their Executive
Director Dr. Paul Chris–a guitar player
and true Beatles lover.
I also want to highlight a few other Vision
Institute professionals including Dr.
Catherine Chiarelli, the Chief of Clinical
Services. She has been with the Institute
since 1989 and her specialty is children’s
vision. She has extensive experience in the
examination and management of children
with special needs, including strabismus,
amblyopia, low vision, learning difficulties,
deafness/hearing loss and developmental
disabilities. She works with organizations
like the Early Years foundation, schools
where she goes out and does eye exams
for infants. She also actively participates on
many committees to develop better eye care
services for children and adults.
Dr. Lois Calder is particularly interested
in the eye care needs of seniors. She is the
Director of Low Vision Services, assisting
the growing population of those with partial
sight. She also directs the Community
Outreach Programs, providing mobile
primary eye care services to over 20 longterm care facilities and shelters. Her interest
extends internationally, including regular
participation on volunteer eye care projects
in the developing world.
Our second theme revolves around both
different types of light and how they affect
our eyes.You may have noticed from past
issues that I am an aging and long term care
expert, and so was especially interested in an
article featured on WebMD that talks about
the need for good home lighting for older
adults. The article’s premise is that older
adults may actually see better in their eye
doctor’s office that they do at home… all
because of poor lighting. Older eyes need
more light to see. At the same time, they also
become more sensitive to glare.
Here are some lighting tips to help seniors
function safely at home:
• Increase light levels in task areas such
as kitchen counters, bathrooms and
sitting rooms where reading or visually
demanding work is done.
• Indirect lighting rather than downlights
or accent lights soften shadows and make
room lighting more uniform. Match
indirect lighting with light-colored wall
and ceiling surfaces to improve lighting
uniformity.
• Reduce glare by using diffusing shades
instead of bare, bright bulbs for decorative
lighting.
• Use adjustable task lights to easily add
more light for hard-to-see print and small
objects or details.
• Use dimmers so lighting levels can be
adjusted for optimal seeing.
PROFITABLE PRACTICE
PROFITABLE PRACTICE
EDITOR’S PAGES
1
FEATURE INTERVIEW
• Install automatic motion sensor controls to turn on hallway
or bathroom lights for easier orientation and safer walking
at night.
A final caution here:Vision problems can lead to falls, and falls
too often are the reason seniors need to move to a care facility.
We continue the light theme with an article on page 11 about
“blue light”, where we encounter it and how damaging it
can be to all ages. Out of curiosity, I visited the site called
f.lux (https://justgetflux.com) referred to in the article, and
downloaded the program. The home page states:
Ever notice how people texting at night have that eerie
blue glow?
Or wake up ready to write down the Next Great Idea, and get
blinded by your computer screen?
During the day, computer screens look good—they’re designed to
look like the sun. But, at 9PM, 10PM, or 3AM, you probably
shouldn’t be looking at the sun.
f.lux fixes this: it makes the color of your computer’s display adapt
to the time of day, warm at night and like sunlight during the day.
It’s even possible that you’re staying up too late because of your
computer.You could use f.lux because it makes you sleep better, or
you could just use it just because it makes your computer look better.
Having had eye surgery last year and now facing cataract
surgery, I decided to read the entire publication. I found it very
informative. However, I was surprised that so many articles
referred to new research and practices in countries other than
Canada. I would hope there are many areas that are successfully
being researched in our country. Although this is perhaps a
small point of criticism, I would think eye care professionals, or
people like myself who find themselves reading these articles,
want to hear what we are achieving in Canada. I wish you continued success in your publications.
Yours truly,
Janice Awde
We meet Janice on page ten and gain valuable insight into
seniors’ eye care challenges–and solutions.
We are always delighted when an article by Dick Moody
comes our way; his humour and reflective writing style are
always welcome at Profitable Practice.
Timothy A. Brown brings his many years of decisionmaking experience when he describes why he prefers to hire
a professional to do something he ‘may’ be able to do himself.
Sound words of advice!
Macular degeneration is becoming more prevalent as the
population ages; we present AMD Insight, a privately owned
Canadian company which has developed a genetic test for
AMD, a development worth following.
f.lux makes your computer screen look like the room you’re in, all
the time. When the sun sets, it makes your computer look like
your indoor lights. In the morning, it makes things look like
sunlight again.
Finally, research figures prominently in this issue. Our
Research Review on page 12 touches on Alzheimer’s disease,
cornea renewal, Smartphones and “Smart Lens” technology.
We hope these pique your interest. Optical Odds and Ends
and some fascinating Eye Facts round out the issue.
Tell f.lux what kind of lighting you have, and where you live. Then
forget about it. f.lux will do the rest, automatically.
ROI news
I have downloaded f.lux and it works as promised. Give it a try.
More content notes
Mariana Bracic is one of our most prolific and valued
contributors; I know you will enjoy yet another of her well
written, on-target articles starting on page seven.
Patient care is a new topic for us in this issue; Melissa Gmusa
describes how easy it can be to let client communication slip
to the back burner… and how dangerous this can be to a
profitable practice.
We are delighted to announce the launch of ROI’s new web
site that features the back issues of Profitable Practice Eye Care
Professional Edition; if you have missed any issues or wish to
print off articles for patients or colleagues, we have made it
easy for you to do. Just visit:
profitable-practice.com/magazine/eyecare.
We always want to hear from you! What news, experience or
story would you like to share with your colleagues? Contact
us at: editor@profitablepracticemagazine.com.
We are here to inform and serve you. Enjoy the issue!
We share another perspective on patient awareness through
an email we recently received from an eye care patient, Janice
Awde–a critical perspective for Profitable Practice and one I
plan to continue. Her letter reads:
James Ruddy
Editor-in-Chief
Profitable Practice
I recently had the opportunity to read the Eye Care
Professional Edition of Profitable Practice Spring 2014. I
wanted to specifically read the feature interview written by
your Managing Associate Editor, Karen Henderson, because
I have been a patient of the Brampton Optometry Clinic
almost since the inception of the clinic, although under the
care of Dr. Marion Cotnam. 2
Feature Interview: Dr. Laurie Capogna
With Managing Associate Editor
Dr. Laurie Capogna is the co-founder of
Penninsula Vision Associates, an eye care practice
in Niagara Falls, Ontario. I wanted to interview
her because of her beautiful book, Eyefoods: A Food
Plan For Healthy Eyes, a book which I came across
in the offices of The Vision Institute of Canada.
Karen Henderson is the Managing Associate
Editor of Profitable Practice Magazines
and can be reached at
karen@profitablepractciemagazine.com
What are the major
challenges that
optometrists face
today?
May I call you Dr. Laurie?
As I see it:
Of course!
1.Competition from
online, big box stores
and other retail operations
Where did you go to school?
I graduated from the University of Waterloo in 1998.
Can you give us a brief summary of
your career?
2.The retail climate is changing and as a result so must
optometry. Patients have so much choice when it
comes to their eyewear needs; optometry can no
longer be complacent and assume that patients will
stay with them for their eyewear. However, with
change comes opportunity–optometry has so much
more to offer than just refractions and eyewear; we
must use this to our advantage. Personally, I am excited about the opportunities that exist in optometry
today, such as wellness and nutrition, preventative
eye care, sports eye wear and binocular vision as well
as low vision and vision rehabilitation. All of these
areas are underserviced and in their infancy; we need
to educate the public and when we do, our niche
practices will grow.
I started practicing in 1998 in a medical model practice
which includes both an ophthalmologist and optometrists. We also have an optical boutique–so we are able
to offer our patients every aspect of eye care.
Since you graduated, how has the perception
of optometrists changed with the public in
general and other professionals in particular?
What are your professional affiliations?
I am a member of the Ontario Association of Optometrists, the Canadian Association of Optometrists and
the Ocular Nutrition Society.
Why were you drawn to optometry?
It is a great health care profession that also offers a
business and retail side… and a professional career that
offers many different options on how to practice.
For many years, I also practiced at a Lasik clinic in
Niagara Falls one day per week. In 2010, I opened a
low vision clinic, so I changed gears and stopped
practicing at the Lasik clinic to focus on this. At the
same time, I was writing and publishing my first book
with Dr. Barbara Pelletier.
What does a typical day look like for you?
Karen Henderson
efficient process allows
me to spend more time
with the patient.
During a typical day I will do approximately 15-20
full eye exams and 15-20 follow-ups. The follow-up
patients range from post-operative patients to glaucoma or red eye patients. An excellent support staff is
key for me to see such a high volume of patients; our
team at Peninsula Eye Associates is highly trained and
efficient. Technicians take a case history and work up
the patients. I can then practice out of two exam rooms
where the patient is always ready and waiting. This
The biggest change is the passing of the TPA law a
couple of years ago. When I graduated in 1998, we
were expecting the law to be passed shortly thereafter.
However, it took many, many years.
During my career I see optometrists and ophthalmologists working together more, especially in refractive eye
care and Laser centres. Also, because optometrists are
working hard to keep the lines of communication open
with GPs and reaching out to local MDs, these types of
relationships are growing. However, we cannot become
complacent; we must keep up these efforts.
What still excites you about being an
optometrist?
There is so much opportunity for growth in many
different areas. I am driven by the preventative aspect
PROFITABLE PRACTICE
• Install low-level, well-shielded stair, entrance and hallway
lights to make steps visible and to illuminate potential
hazards.
3
BOOK REVIEW
What has changed the most for you over
your career?
Technology is changing so fast–both with treatment options
and ophthalmic and contact lenses. Also, with the instant availability of information on the Internet, patients are often aware
of new products and studies even before you are. This has made
it so essential to stay on top of everything. Everyday I read
reviews and journals to be sure I am up to date. You need to
be aware of all treatments, even alternative treatments, because
if you can’t educate your patients about them, they will find
someone else who will.
Your secret to relaxing?
A workout–followed by a nice dinner with good red wine!
What are your hobbies or interests; do you have a
bucket list?
I love to travel and my husband and I love to learn the cultures
and try the foods of different countries. I don’t have a bucket
list because new things come up all the time that I’d like to try
and see.
If I weren’t an optometrist I’d be:
An accountant! I know it seems very different but after some
long weeks caring for patients I crave a bit of quiet time and
think that working with numbers all day could be calming!
What advice do you have for graduates just
starting out?
Seize every opportunity possible. Don’t limit yourself and learn
as much as you can. There is still so much to learn and those
first few years will open your eyes to different ways of practicing and shape the optometrist you will become.
of nutrition in preventing diseases such as AMD and cataracts.
However, there were always more questions and we realized
that people didn’t just need general knowledge, they needed a
plan. So this led us to start researching and our journey led us
to writing and publishing Eyefoods–written for the public to
educate them about the power of nutrition and lifestyle in ocular health and function. It is designed to make it simple for all
eye care professionals to make nutrition a part of their practice
and educate their patients about disease prevention through
nutrition.
How influential was your upbringing in farm
country here in Ontario regarding your views on
the importance of nutrition?
This shaped the type of person I am today. I never loved working on the farm; however, my parents used this attitude as an
opportunity to motivate me to become educated so I would
have a choice and be able to control my own future. Farm life
definitely taught me the importance of hard work and shaped
my work ethic.
There has been increasing press given to the relationship between over-the-counter drugs and
eye health; what kind of science exists to prove
that drugs like zinc picolinate are beneficial to eye
health?
There are times when it is recommended that a patient take a
specific nutritional supplement, such as patients with age-related macular degeneration, or ocular surface disease. However,
for prevention, we can’t say exactly if supplements decrease
the risk of developing ocular disease. What we do know is
that a diet high in antioxidants, carotenoids and omega–3 fatty
acids is essential to proper ocular health and function. In cases
where a person’s diet is lacking then a supplement targeted
for eye health may be a good idea. Every person has different
needs so this is something that should be discussed with
their optometrist.
Bottom Line: Nutrition and eye health go together; have fun choosing
brightly coloured and textured foods that will add variety to your diet!
Do you have any final thoughts about the status
and well–being of optometry in Canada today?
I think that optometry is in a great position; if you are motivated and willing to seize the opportunity there is so much room
for growth.
Let’s talk about your book. I must say it could
easily be titled: Eyecandy: A FOOD PLAN FOR
HEALTHY EYES. The cover, the layout and the
graphics are so enticing that I wanted to run out
and buy every fish, fruit, vegetable, grain, bean and
nut available! What led you to write Eyefoods: A
FOOD PLAN FOR HEALTHY EYES?
I have always been passionate about food and nutrition. Together with my colleague and friend Dr. Barbara Pelletier, we
would spend hours discussing both of these. In practice I would
have many conversations with my patients about the power
4
Dr. Laurie Capogna
Dr. Laurie Capogna graduated from the
University of Waterloo with her Doctor of
Optometry degree and is an active par tner
in Peninsula Vision Associates, where she
provides full spectrum optometric care in
a surgical eye care centre. Dr. Capogna
has co-authored the best selling book Eyefoods: A Food Plan for Healthy Eyes as well
as the ground-breaking children’s book,
Eyefoods for Kids: A Tasty Guide to Nutrition and Eye Health. She regularly lectures
and has written many ar ticles on the topics
of nutrition and eye health. You can reach
Dr. Capogna at laurie@eyefoods.com or
through her web sites www.eyefoods.com
and www.peninsulavision.ca.
Eyefoods: A Food Plan
For Healthy Eyes
As reviewed by Managing Associate Editor
This book should be called eyecandy: A FOOD
PLAN FOR HEALTHY EYES. When I first saw
the cover, I wanted to take a bite out of it. This is
one of the most beautifully designed, laid out and
photographed ‘self-help’ books I have ever read.
However, it’s not just another pretty piece of print
material; it contains first rate, valuable information and
guidance for those who see the importance of caring
for their eyes.
The book is divided into three parts: The Basics, The
Details and The Plan. Let’s explore.
Part One – The Basics
The first chapter talks about eye health and disease;
topics include disease description, risk factors, diagnosing and treatment. A wonderfully clear graphic of the
eye opens the chapter, followed by a discussion of the
most common eye disease–AMD in both its forms,
cataracts, dry eye syndrome and eyelid disorders.
Next follows a look at eye nutrients; after careful study
the authors have determined the most important
nutrients for the prevention of eye disease and the promotion of eye health. An FAQ section answers questions like: How much of each nutrient do I need? The
chapter then describes the recommended nutrients and
their most common food sources.
ber one modifiable risk
factor in AMD prevention. Body mass index
(BMI) is also discussed
and the authors include
sound advice on physical activity. Something
else I learned: Scientists
believe that exercising at
least three times a week
can slow the progression
of age-related macular
degeneration.
Part Three –
The Plan
The last section of the
book is perhaps the most
valuable because it covers the all-important plan—how
to integrate eyefoods easily into your life.
The plan outlines daily and weekly targets for eyefoods,
along with serving sizes and a chart that tells you how
many units of each food category you need per week.
The Eyefoods Nutrition Lifestyle Plan:
1. Wear good-quality sunglasses
2. Take control of your health
3. Get moving
Part Two – The Details
4. Quit smoking
Chapter three lists the most critical eyefoods, starting
with leafy green vegetables, followed by cold water
fish, orange vegetables, green vegetables, eggs, fruits and
juice, lean protein, nuts and seeds, whole grains, beans
and lentils, seeds and oil. For each category of food you
learn about:
5.Take an eye vitamin if you are at risk or have
eye disease
• Their eye nutrients
• A weekly consumption target
• Meal ideas
Chapter four covers the all-important aspect of lifestyle
and general health. UV exposure is covered in considerable detail, as is the importance of choosing the
proper lenses for sunglasses. The inevitable subject of
smoking is next; I learned that smoking is the num-
6. Maintain a healthy weight
The book ends with Eyefood For Thought which
discusses emerging research and reveals the authors’
plans for the future of Eyefoods; they are committed to
building on the eyefoods foundation as the results of
more research emerge. They will also include new and
exciting ways to help integrate eyefoods into your life,
including fresh recipes and meals plans. A very helpful
glossary concludes your journey through the world of
incredibly beautiful eyefoods.
I think I will go and enjoy a huge, colourful salad now.
I can’t resist any longer.
PROFITABLE PRACTICE
of optometry and get excited about educating and helping my
patients realize the options they have for prevention and wellness, which include proper nutrition, exercise and leading edge
lens choices such as polarized sun wear and blue filters.
5
PATIENT EDUCATION
HR LAW
Research Suggests Older Adults
May See Better In Their Eye
Doctor’s Office
The principal culprit: poor home lighting.
“The results from our study suggest that older adults
are not seeing as well in their homes compared to their
vision when tested in the clinic,” said study author Dr.
Anjali Bhorade, an associate professor of ophthalmology
at the Washington University School of Medicine, in St.
Louis.
PROFITABLE PRACTICE
“For example, a patient may see 20/20 in the clinic.
However, [they can] have 20/40 or worse vision in
their home,” she said. “This decreased vision in the
home can negatively affect their function in their home,
and thus their quality of life.”
6
“We found that poor lighting in the home was the
most significant factor contributing to decreased vision,” Bhorade said. “More than 85 per cent of older
adults had lighting in their homes below that of the
recommended level. Our results suggest that simply
increasing lighting may improve the vision of older
adults in their homes.”
The researchers focused on 175 eye patients between
the ages of 55 and 90.
Most of the patients had been diagnosed with glaucoma
before attending a regularly scheduled appointment
with their ophthalmologist at some point between
2005 and 2009. The remainder had no eye health issues.
All of the patients had their vision tested both in their
doctor’s office and at home. Both exams were scheduled within a one-month span, and took place during
the daytime. Home exams included testing that assessed
near-vision abilities, such as paying bills or reading.
Digital light meters also were used to determine lighting levels in both settings.
Vision test results were significantly better in the doctor’s office than in a home setting, regardless of whether
a patient had glaucoma.
For example, nearly 30 per cent of glaucoma patients
were able to read two or more lines more easily on an
eye chart when tested in the doctor’s office than when
by Mariana Bracic
at home. Among those with more severe glaucoma,
nearly four in ten read three or more lines better when
tested in the office than when tested at home.
The same dynamic was observed with near vision, the
researchers said. More than one-fifth of patients experienced better results at the doctor’s office when trying
to read two or more lines of text.
Bhorade and her associates determined that lighting
was the key factor behind the difference. Home lighting
was three to four times less bright than in a clinical setting, on average.
“Not all older adults, however, may benefit from increased lighting,” Bhorade said. “Therefore, to optimize
lighting conditions in the home, we recommend an
individualized in-home assessment by an occupational
therapist, or a referral to a low-vision rehabilitation
specialist.”
Dr. Alfred Sommer, a professor of ophthalmology at the
Bloomberg School of Public Health at Johns Hopkins
University, said the study highlights the broader issue of
understanding the real-world limitations of people with
vision issues.
“This is a real issue,” he said. “The ophthalmologist’s
office is not the world we live in. It’s a very artificial
situation, in which vision is tested in a very dark room
but with very high contrast letters. And even that’s only
looking at one measure of vision, without regard to
other possible [eye] issues.”
“It’s no surprise that when people are in their home
setting, under ambient conditions, everything is a little
bit grayer and not so intense,” Sommer said. “The question is whether that difference has a functional impact.
Can people easily navigate through their world and
function in society?”
“This is a whole new science that is now coming into
play–the effort to develop ways to test for real-life conditions so we can improve vision in a way that’s really
meaningful to patients,” Sommer said.
Bottom Line: Too many seniors assume their home lighting meets their vision needs; more education together with
individualized in-home assessments are needed to ensure that
these people have enough light to function safely in their home
environment.
Source: webmd.com
Dr. Gupta has a receptionist, Nadine, who has
been with Dr. Gupta’s practice for almost three
years. Unfortunately, for much of that time Nadine
has been a very poorly performing employee. She
is often both late and absent culpably (meaning
the law would not consider her lateness and
absences as having had sufficiently good reasons).
She often fails to follow proper procedures when booking patient appointments and confirming them with
patients. She is doing a poor job at keeping the schedule
full. She has a bad attitude and is, not infrequently, insolent to the office manager and occasionally even to Dr.
Gupta herself. Unfortunately, neither Dr. Gupta nor her
office manager (who is also Dr. Gupta’s husband, Dean)
have ever documented any of these problems.
Recently, Nadine was involved in a very serious vehicular accident. She called the office to advise that she
had been admitted to the emergency department of the
local hospital and did not know when she would be
released. Several weeks later, Nadine was finally released
from the hospital. However, she still had extensive
problems and was engaged in a fairly intensive program
of physiotherapy. She sent in a note from her treating physician indicating that she would not be able to
return to work for three months. Near the end of the
three-month period, she sent the office another note
from her doctor indicating that she would be unable to
return to work for another two months. Near the end
of that two-month period, she contacted the office and
told Dean that she would like to return to work but on
a graduated basis. She felt that she could begin working
four hours per day, for two days per week. (Prior to the
accident, she was regularly working eight hours per day,
four days per week.)
Dr. Gupta and Dean both felt that Nadine was gaming
the system. They called our office to express their
frustration and tell us they would like to fire her. Not
only had her performance been terrible for almost
the entire length of her employment, but now she was
using her accident as an excuse to play around with
the schedule. They were really tired of dealing with
this employee and just wanted her out of their office
permanently. They wanted to know if they had any
obligation to alter work hours for her according to her
PROFITABLE PRACTICE
Researchers warn that patients who see perfectly
well in their eye doctor’s office often end up seeing considerably less well in the comfort of their
own home.
Don’t Take The Bait
7
SCIENCE
From our perspective as highly specialized HR-lawyers who
advise healthcare professionals across the country, we saw
several warning signs. The most alarming red-flag was that
Nadine had brought a complaint before the Ontario Human
Rights Tribunal a few years ago against a former employer
who had employed her. It seemed clear to us that Nadine
was trying to bait Dr. Gupta into terminating her so that she
could launch another human-rights claim. We explained to
Dean and Dr. Gupta that, because there was no documentary
evidence of the history of Nadine’s poor performance, such
a complaint would be both difficult and expensive to defend
successfully. From our perspective as highly specialized HR-lawyers who
advise doctors and dentists across the country, we saw several
warning signs.
...
As the reader may well imagine, there is an enormous
amount of case law on what exactly constitutes “undue
hardship.”
With respect to Nadine’s request to work half-time, we had
to explain to Dr. Gupta, and it is important for readers to
understand, that where an employee has a disability, that
triggers an obligation on the part of the employer under
provincial human rights legislation to accommodate the
employee to the point of “undue”. As is obvious from the
wording of the standard itself (i.e. undue hardship) the law
expects that the employer will undergo some hardship; it
is only when the level of hardship becomes undue that
we are off the hook, so to speak. So the key question in a
human rights complaint would be whether Dr. Gupta could
accommodate Nadine’s request to have a graduated return to
work without incurring “undue” hardship to the practice. As
the reader may well imagine, there is an enormous amount
of case law on what exactly constitutes “undue hardship”.
The damning evidence in this case that would be difficult
for Dr. Gupta to overcome is the fact that the office did not
replace Nadine with any temporary help; the other staff had
been able to take over her work during her absence of five
months. It would be difficult to persuade a tribunal that
re-introducing Nadine half-time would constitute undue
hardship in these circumstances.
Note: Profitable Practice was unable to reach Macula
Risk® PGx for comment.
AMD Insight, a privately owned Canadian company
headquartered in Toronto, Ontario focuses on genetic
testing for AMD and making it available within Canada.
The company also concentrates their efforts on attaining novel technologies that help detect, diagnose, and
manage AMD patients. AMD has obtained the exclusive
rights to Macula Risk® PGx, a combined prognostic
and pharmacogenetic DNA test designed to determine
a patient’s risk of progression to advanced age-related
macular degeneration and aid in the selection of appropriate eye vitamin formulations for AMD based on
his or her individual genetic risk profile.
Approximately one in ten Caucasians will lose vision
from AMD. Progression to vision loss can be prevented if the disease is diagnosed and treated early.
Unfortunately, up to 80 per cent of advanced cases are
diagnosed and referred to a specialist only in the later
stages of the disease where permanent vision loss is
likely. Furthermore, recent scientific literature suggests
that patients taking high-dose eye supplements for
AMD may be taking a formula that is consequently
accelerating the onset of vision loss due to their
unique genetic profile.
Perhaps most importantly, it was important for Dr. Gupta, as it
is for readers, to understand that situations involving employee
claims of disability are one of the biggest, most expensive,
potential pitfalls for Canadian employers. It is understandable
that an employer would feel frustrated dealing with a poorperforming employee who is taking advantage of Canada’s
pro-employee bias to game the system. However, the best
way to deal with this problem is to beat such undesirable
employees at their own game. Do not take the bait, fire them
and then be saddled with an extremely expensive human
rights complaint. Fortunately, Dr. Gupta and Dean called us
before they acted on their desire to fire Nadine. Now, they
understand that if they took Nadine’s bait and fired her, their
position would immediately worsen. Their problem would
not actually go away, it would very likely get disastrous.
We sincerely hope that readers can benefit from Dr. Gupta’s
experience, and avoid a similar costly pitfall.
Bottom Line: An interesting case study involving undue hardship
and how an employer can best deal with this potentially costly
situation.
8
Groundbreaking Genetic Tests For
Age Related Macular Degeneration
Now Available Through Canadian
Eye Care Professionals
Macula Risk® PGx has two components:
Mariana Bracic
BA(Hons) JD | Founder, MBCLegal.ca
905.825.2268 | mbracic@mbclegal.ca
Mariana is proud of the dramatic benefits her
completely unique, niche specialization
(HR law + doctors) provides to her
clients’ wealth and happiness.
1.Macula Risk® PGx prognostic testing–approximately
20 per cent of patients diagnosed with the dry form
of AMD will progress to advanced AMD with vision loss. This progression may be prevented if the
high-risk AMD patient is identified early, treated appropriately, and referred to a retina specialist earlier.
Macula Risk® PGx is up to 89.5 per cent accurate at
identifying those at high-risk
2.Vita Risk™ pharmacogenetic testing–according to
the U.S. National Eye Institute, high-dose eye vitamins with zinc are the standard treatment for patients
with moderate dry AMD. However, a recent article
published in the Journal of the American Academy of
Ophthalmology demonstrated that these treatments
may be either helpful or harmful depending on the
genetic profile of the patient. Macula Risk® PGx determines the safest and most effective formulation for
AMD patients based on their genotype.Vita Risk™ may
also be ordered as a component of Macula Risk® PGx
or as a separate test.
The web site www.macularisk.com describes the test
components, the therapy and how to become a Macula
Risk® PGx provider.
In addition the site provides:
1.A tool which is designed to guide practitioners
through the development of a specific care protocol
for an individual AMD patient based on their disease
stage and Macula Risk® score.
2.Another tool, the Macula Risk® CPT Practice
Advisor, will help professionals realize the aggregate
economic potential of managing AMD within their
practice based on location, practice size, the incidence and prevalence of AMD in the U.S. population, and patient management based on the Primary
Eye Care Protocol.
Source: digitaljournal.com
Bottom Line: The Internet provides access to a growing
amount of eye research and new diagnostic products which
should be explored.
PROFITABLE PRACTICE
request. They much preferred to terminate her employment
on the basis of her history of poor performance.
9
FEATURE INTERVIEW
EDUCATION
We love to receive feedback from our readers;
Janice Awde recently took the time to share some
comments (see Editor’s Pages). When I learned that
Janice has undergone and continues to undergo
extensive eye surgery and treatment, I asked her to
share her patient experience.
Janice; it’s lovely to meet you. Thank you so
much for your time today! Please tell us a
little about yourself.
I am married and have two children and four grandchildren. My background and interests have revolved around
music since the age of five; I attended York University in
Toronto where I obtained a music degree. I am a retired
teacher–I taught for 36 years and very early on realized
how important good eyesight is for reading music, along
with reading report cards and all the other visual activities that teachers engage in.
PROFITABLE PRACTICE
How were your eyes as a child?
10
I started wearing glasses in grade eight and have always
been very angry about what happened to me then. I
moved from a farm community to Hamilton in 1956;
when I started school there I had some catching up to
do, so they made me copy the notes from every class and
course I had missed going to a country school; all of a
sudden I started to have problems with my eyes. They
said it might have been eye-strain but in any case I had
to start wearing glasses at the age of 14.
How have your eyes changed, now that you
are a senior?
In 1989 I started to see Dr. Marion Cotnam, a wonderful optometrist. Everything was fine until I reached the
magic age of 65 and my eyes started to deteriorate. In
2013 Dr. Cotnam was concerned about my eyes and
sent me to a specialist named Dr. Somani who agreed
there was something there; I assumed it was cataracts. He
in turn sent me to Dr. Efrem Mandelcorn who told me I
had a macular pucker and had to have surgery. I successfully recovered in four weeks–a fascinating experience as
I gradually saw the air bubbles in my eye disappear!
develop in a few years. But in February 2014 my vision
started to blur; back to Dr. Somani who confirmed that I
had developed a cataract in the same eye.Yes, I had been
prepared for this possibility but was not prepared to have
to wait until this July to have the measurements done
in preparation for August surgery. I guess I am lucky; I
have had to wait eight months for surgery… others have
waited a year or longer due to the growing number of
aging Canadians who need eye care from a limited number of specialists available.
Were you surprised at the costs involved in
your care?
OHIP covers some of the costs of the lenses and necessary drops but not the upgrade to a more accurate
measurement, which I think is so critical. I hope the
government rethinks the coverage it provides to seniors.
Overall, how have you found your treatment
in Ontario?
I have been very pleased with the care I have received
but am disappointed about the wait. I am fortunate to
have an excellent optometrist who has sent me to other
skilled doctors I have needed. The role of the optometrist is key to getting the surgical treatment you need.
What advice do you have for other seniors
who face eye surgery?
Make sure you have a family member or friend who will
go to appointments with you; there is a lot of information to absorb and paperwork to do. I always carry a
notebook and pen so I can write things down. My husband and I deliver books from the library to homebound
seniors; a lot of them need audio books because they can
no longer see, so I ask everyone who can to advocate for
more prompt, affordable treatment for seniors.
Do you have anything else you would like
to share?
I would sooner lose my hearing than lose my eye–sight,
so I really hope that Ontario continues to develop first
class optometrists and eye surgeons who can meet the
growing needs of an aging population.
What happened next?
You can reach this very active, independent 71-year old
via email: janice.awde@rogers.com
They told me that I would probably develop a cataract
as a side effect of the macular pucker; I assumed it would
Bottom Line: A good optometrist should be a key member of
every senior’s care team.
Damaging Light: Educate
Yourself And Your Patients!
By Alyssa Keating
It’s relatively common knowledge that “blue light” is
harmful to your eyes. If you didn’t know, now you do.
It doesn’t necessarily have to be “blue” to be harmful.
Imagine the difference between an old-school incandescent bulb and a high powered fluorescent light bulb.
Which is easier to look at? Chances are you’ll prefer the
warm glow of the incandescent. While the EPA may
prefer (and even mandate) we phase out these sources
of light in favor of more energy-efficient compact
fluorescent bulbs (also known as CFL’s), these lights can
cause eyestrain and insomnia among other conditions.
Computer Vision Syndrome
It turns out that women in the 70s had the right idea
when they started wearing rose-tinted lenses in the office. Rose-tinted lenses decrease the absorption of the
blue-tinted light from the fluorescent overhead light and
they claimed it eased their eyes. When computers came
onto the scene, sitting in front of one for hours on end
was made easier by these lenses –but they have somewhat
fallen out of fashion. Now millions of us suffer from
eyestrain at the office–also known as Computer Vision
Syndrome (CVS). CVS is a collection of symptoms many
people experience during the day; these symptoms may
include eyestrain, dry eye, diplopia and headaches.
Where the problem lies is that very few people turn
off their computers when they leave the office. More
and more people are not only working longer hours,
they also aren’t unplugging after hours. iPads and cell
phones are glued eight inches from our faces for longer
and longer stretches of time, and younger and younger
people are becoming increasingly exposed to the false
blue-white wavelengths emitted from all the electronics we cannot live without. It’s not uncommon to see a
two–year old on an iPad or a ten-year old texting away
for hours. Electronics in children can increase binocular
vision problems on an already fragile developing system,
so it’s even more vital to limit usage of devices depending on the child’s age.
Insomnia
Insomnia is a sleep disorder which plagues millions of
adults. Acute insomnia is usually a short-term inability
to sleep which can last for a few days to a few weeks.
It can involve inability to fall asleep, stay asleep or wake
feeling rested. Chronic insomnia usually lasts for longer
periods of time and fatigues the person chronically. The
theory is that blue-white light stimulates the brain to
stay awake and alert, since blue-white light is what is
emitted at the peak of noon when the sun is high in
the sky and the sky is blue.
When we stare at our devices late into the night, we
trick our brain into thinking it’s still midday. Melatonin
(a hormone signaling it’s time for sleep) isn’t released,
and we find it difficult to fall asleep. Even having the
TV on or a blue light alarm clock in the background
can be stimulating for some individuals. On the other
side of the coin, yellow-white light (similar to incandescent light) mimics what light we would see as the
sun is naturally setting. It’s reddish in hue and soft. It
lets our brain know it’s time to relax and sleep. This is
why we often feel calmer with this “hue of white”.
Using candles has a similar effect.
To counter the effects of the blue-white light, unplug as
many electronics as possible one hour before bedtime.
This will help tell the brain that it’s time to shut off and
sleep. In addition, if a computer must be used in the
later hours of the evening, a free program called f.lux
can be downloaded which helps decrease the blue light
emitted from the monitor. It contains a timetable of the
sunsets and rises and dims the screen upon sunset.
In addition, a pair of blue-blocker glasses (amber in color)
absorb the blue light so that little to none can reach the
cornea.The combination of decreasing usage, f.lux, and
blue-blockers can be effective in decreasing eyestrain at
night and can serve as non-medicinal insomnia remedies.
AMD Risk
Even more harmful than insomnia or eyestrain is the potential for retinal disease later on. Research has shown that
increased exposure to blue light over extended periods of
time can increase the risk for AMD. Not much research
exists yet, since technology really took off 20-25 years
ago, and the target population has not had enough time
to age into the target range. However, blue light has the
shortest wavelength over any visible wavelength and is the
most potentially damaging light to the retina (second to
UV, which is invisible).When the retina absorbs excessive
blue light over a lifetime, the retinal cells lose the ability
handle the high-energy waves and the retina begins to
deteriorate.
Source: optometreystudents.com
Bottom Line: Improved energy efficiency is always welcome
but more energy-efficient compact fluorescent bulbs can cause
eyestrain and insomnia among other conditions.
PROFITABLE PRACTICE
Feature Interview: Janice Awde
11
RESEARCH REVIEW
Researchers from Montreal and the New York-based company Corning have created the first laser-written light-guiding
systems that will be developed for commercial use. This means
that by embedding the phone’s glass with layer upon layer of
sensors, the phone could take your temperature, assess your
blood sugar levels of you’re diabetic or even analyze DNA.
In addition to biomedical sensors, the technology could also
eventually allow computing devices to be embedded into any
glass surface, such as windows or tabletops, creating the transparent touchscreens seen in movies like Avatar and Iron Man,
the researchers say.
“We’re opening the Pandora’s box at the moment,” says paper
co-author Raman Kashyap, a professor of electrical engineering and engineering physics at Polytechnique Montreal in
Canada. Now that the technique is viable, “It’s up to people to
invent new uses” for it, he says.
For more information: “Making Smart Phones Smarter with
Photonics,” J. Lapointe et al., Optics Express, vol. 22, Issue 13
Source: Sciencedaily.com
Novartis To License Google
“Smart Lens” Technology
Novartis announced that its eye care division Alcon has entered
into an agreement with a division of Google Inc. to in-license
its “smart lens” technology for all ocular medical uses.
Under the agreement, Google[x] and Alcon will collaborate to
develop a “smart lens” that has the potential to address ocular
conditions. The smart lens technology involves non-invasive
sensors, microchips and other miniaturized electronics which
are embedded within contact lenses. Novartis’ interest in this
technology is currently focused in two areas:
Firstly, helping diabetic patients manage their disease by providing a continuous, minimally invasive measurement of the
body’s glucose levels via a “smart contact lens” which is designed to measure tear fluid in the eye and connects wirelessly
with a mobile device; secondly, for people living with presbyopia who can no longer read without glasses, the “smart lens”
has the potential to provide accommodative vision correction
to help restore the eye’s natural autofocus on near objects in
the form of an accommodative contact lens or intraocular lens
as part of the refractive cataract treatment.
Source: Opticalprism.ca
Eye Movement When Reading
Could Be Early Indicator Of
Alzheimer’s
Feature Interview: Dr. Paul Chris
Researchers have suggested that alterations in eye movements
when reading could be linked to impairments in working
memory and an early indication of Alzheimer’s disease, according to a new study published in the Journal of Clinical and Experimental Neuropsychology. Researchers found that the patients with a diagnosis of probable Alzheimer’s disease showed a
decreased ability to predict the next words in a sentence based
on contextual information, including sentence meaning and
grammatical structure, when compared to the control group.
Dr. Paul Chris is the Executive Director of the
Vision Institute of Canada in Toronto and maintains a private practice in Downsview, Ontario. Dr.
Chris has had a long and distinguished career as
outlined in the interview below.
The study focused on a group of 18 patients with a diagnosis
of probable Alzheimer’s disease. Eye movements were recorded
at the Universidad Nacional del Sur (UNS), Bahía Blanca,
Argentina. The patients also showed signs of less focussed visual
exploration, including slower eye movements when reading,
and longer fixations both when processing new information
and when reading sentences for the second time.
Dr. Chris, where did you go to school?
No surprise! I went to the University of Waterloo, and
graduated in 1976 with my OD degree.
May we have a brief summary of your
career?
Journal Reference:
Gerardo Fernández, Jochen Laubrock, Pablo Mandolesi,
Oscar Colombo, Osvaldo Agamennoni. Registering eye
movements during reading in Alzheimer’s disease: Difficulties in predicting upcoming words. Journal of Clinical and
Experimental Neuropsychology, 2014; 36 (3): 302 DOI:
10.1080/13803395.2014.892060
Source: www.sciencedaily.com
Lab-Grown Corneas Could
Prevent Blindness
Researchers in the U.S. have found a way to identify the stem
cells that renew the cornea (the clear layer that covers the front
of the eye), and have used them to grow normal corneas in mice.
These stem cells–called limbal stem cells (LSCs)–are known to
be the basis of cornea renewal, but there has not been a way to
harvest them before now.
Through a number of laboratory experiments, the researchers
found that a protein called Abcb5 is located on the surface of
the LSCs.
The protein can now be used as a marker to identify and separate them from other cells.
They also showed that transplanting the isolated human LSCs
into mice lacking these cells caused them to develop normal
corneas after five weeks, and then maintain them for over a year.
The hope now is that these cells could be used in human
corneal transplants to enrich them with lots of these LSCs and
improve the chances of success. However, this would depend on
the condition being treated, with the long-term success rate of
corneal transplants ranging between 60 and 90 per cent.
Vision Institute of Canada’s First Nations Guide To Nutrition
For Vision And Eye Health
After graduating I spent four years working as an associate with another practitioner in Toronto. In 1980
I went into private practice sharing office space with
another optometrist. I have been in this same practice
location in Downsview since then. In 1994 I was encouraged by some colleagues to get involved with the
College of Optometrists by running for Council which
I did; as a result I was on the Council for ten years and
spent two years as President of the College. When my
role on Council finished in 2004, I was approached to
be on the board of directors of the Vision Institute of
Canada; I accepted and joined the board. At about the
same time the previous Executive Director, Dr. Mitch
Samek, was retiring and the board asked me to take on
the job and I accepted.
The Institute is a charitable not-for-profit
organization; is there anything similar to it?
No, from my understanding it is the only non-profit
charitable optometry eye clinic in North America.
When it was set up in 1981, it was supported with
funding from the Ontario Association of Optometrists,
the University of Waterloo School of Optometry and
the College of Optometrists of Ontario. The purpose
was to provide specialized vision care services not generally found in a typical optometrist’s office, outreach
programs to nursing homes and chronic care facilities,
and educational programs for optometrists and optometry students. It’s grown over the years and has evolved
into a multi-disciplinary clinic. We see about 4000
patients a year and our mandate is eye health education,
research and specialized clinical services. Our major
areas of care are pediatrics, low vision and specialized
contact lens treatments.
PROFITABLE PRACTICE
Making Smartphones With
See-through Sensors
FEATURE INTERVIEW
Source: Nursingtimes.net
12
13
situated between Sudbury and Sault Ste. Marie. We took four
optometrists and state-of-the-art eye examination equipment
and completed eye exams on over 150 kids in the elementary
school. We provided free glasses to nearly one in three students
we examined; that is nearly a third of all First Nations children
in elementary school needing glasses. If these children can’t see
clearly and comfortably, it makes learning to read more difficult; and if they can’t read they end up with low literacy scores
leading to poor levels of graduation from high school which is
happening.
Working with the Canadian Association of Optometrists, the
National Collaborating Centre for Aboriginal Health and the
Southern Ontario Aboriginal Diabetes Initiative, the Institute
developed a series of posters and brochures to promote yearly
comprehensive eye examinations for people living with diabetes and for children. We made these available across the country
to Aboriginal communities, Friendship Centres and on-reserve
health clinics to raise awareness about the importance of good
vision and eye health and to promote improved access to vision care services. We have also just created a booklet on what
parents and teachers need to know about children’s vision.
Who funds all this work, the Ontario Government?
Diabetes And Your Eyes In Inukitut
How does someone come to you?
Usually by referral from other optometrists, ophthalmologists
or family physicians but we also accept patients who call us directly. A special low vision service began in the fall of 1982 and
services were extended to include house calls to seniors, nursing homes, senior’s residences and hospitals. At the main clinic,
our services have steadily grown to include care for children
and adults with learning, cognitive or physical disabilities, for
individuals with neurological impairments and for those with
other special vision needs. A small portion of our practice also
provides regular eye care services to the public. We have developed charitable programs for various organizations such as the
YWCA, who provide free eye exams and glasses to those in
the family shelters that they operate. Other charitable services
are provided to people who need such care, but they must be
referred through a social service agency or social worker.
Your business model is both impressive and
unique; why aren’t there other organizations like
yours in North America?
Naturally I got thinking: What’s missing in our diet? As a
result of my developing interest in nutrition and its impact on
the eye, I came across a statistic that revealed that First Nations
citizens have five times more diabetes than non-aboriginal
populations; a great deal of it is caused by poor diet. That in
turn led me to think that there should be more attention paid
to Aboriginal vision health related to diabetes, specifically
preventable vision loss from diabetic retinopathy. No one at the
time was really talking about this in First Nations communities;
attention was being paid to foot care and other diabetes related
issues but vision care wasn’t getting a lot of attention.
You are very involved in an Aboriginal eye care
program; please elaborate.
So the Institute made Aboriginal vision health an area of focus.
In 2010 we put on an Aboriginal Vision Health Conference
that brought together First Nations organizations, optometrists,
the Canadian Diabetes Association and the CNIB to raise
awareness about diabetes and eye health in Aboriginal peoples.
The conference featured some of the top minds in nutrition
and eye health.
We are trying to raise awareness in various health circles and in
the Aboriginal community about the importance of eye exams
for children and for adults living with diabetes. I have always
We also focused on the vision care needs of children in onreserve elementary schools and developed an outreach project
to the Sagamok First Nation community in 2012, a reserve
I honestly do not know but I think it is a model that other
provinces could easily adopt.
14
been interested in Aboriginal health and history and have spent
many summers on Manitoulin Island. In 2001, The Age
Related Eye Disease Study (AREDS) was published which
looked at taking a vitamin and antioxidant supplement for
macular degeneration; the study concluded that if you took a
specific formula of vitamins, zinc and other antioxidants, this
could lower the progression of dry macular degeneration into
wet macular degeneration.
No. Service delivery programs do generate funds through
OHIP and direct patient billings. However, due to the nature
of the care provided to patients, these funds are inadequate
to meet total budget requirements. Furthermore, as a charitable organization, the Institute’s fees are reduced from those
recommended by other professional organizations to make
our services more accessible to those in need. In response to
the Institute’s request for assistance, the ophthalmic industry
provides loans of instrumentation, which are valued in excess
of $300,000 in addition to generous, yearly financial contributions. We are very grateful for support we receive from corporate sponsors, supporting optometrists and the public.
We are also funded from revenue generated from a three-day
continuing education conference we put on every November
for optometrists. Our annual conference is well-worth attending. We feature the best speakers on topics of the most interest
and a great trade show; the cost is reasonable, the venue and
the food are excellent and attendees can earn 20 hours of CE
credits. The next conference will be concentrating on retinal
diseases and contact lenses; the dates are November 7-9, 2014
at the Markham Hilton Suites Hotel.
What part of your Downsview practice do you
enjoy most?
I am a community optometrist for the Canadian Forces Base
Downsview so I see a lot of the returning Afghan vets as well
as military personnel who work at or pass through the base.
When you examine returning vets, what types of
injuries or special problems are you encountering
as a result of fighting overseas?
I have examined the eyes of a number of vets who lost feet and
legs to roadside bombs and those visits are always an emotional
experience. I see a lot of corneal problems resulting from the
dry and often windy Afghan desert environment but fortunately not a lot of eye injuries.
Lets turn the conversation to you! What do you
do to relax?
I am a musician and a real Beatles fan. I got my first guitar
in 1964 and I love playing music; I have a small band… we
play in our basements and garages. There is nothing like a real
garage band even at my age! I also love being out in nature and
getting up north as much as I can.
What are three things on your bucket list?
I’d like to be a much better guitar player; I’m good after 50 years
of playing but I would like to be a lot better! That and my continued work with Aboriginal vision health are on my bucket list.
Only about 16 per cent of children under the age of six have
an eye exam before they start school. Eye exams in Ontario are
covered by OHIP for children 19 and under so this eliminates
one financial barrier to arranging for one. Pediatricians and
family doctors need to be more aware about the need for early
childhood eye exams along with the kindergarten teachers who
meet these little ones for the first time. School boards should be
involved to ensure that the question is asked: Has this child had
an eye exam?
One last thing to mention: There are “vision screenings” and
then there is the gold standard of eye care–the comprehensive
eye exam. Just because a child can read 20/20 on the eye chart
during a vision screening does not mean they don’t need glasses.
A lot of kids fall through the cracks because of vision screenings.
My bucket list includes the wish that every Aboriginal child has
a comprehensive eye exam before the age of five, before they
start school. That would be a huge achievement.
Do you have any final thoughts about the status
and well-being of optometry in Canada today?
There is a big movement in our profession towards something
called managed care, a business model that already exists in the
U.S. and is growing in Canada. This may take away some of the
independence that optometrists have enjoyed in the past. They
risk losing how they run their practices–by setting their own
fees, working how they like, where they like, when they like.
Bottom Line: Both Dr. Paul Chris and the Vision Institute of
Canada show it is possible to make inroads into the rather complicated
situation of First Nations children who suffer from diabetes, a poor diet
and need vision correction.
Dr. Paul Chris
Dr. Paul Chris has been practicing
optometry since 1976. He is Executive
Director of the Vision Institute
of Canada and also runs his own
practice in Downsview, Ontario. He is
passionate about improving eye care
for Aboriginal children and about the
role nutrition plays in eye health. You
can reach Dr. Chris at (416) 224-2273
or through the Vision Institute’s web
site www.visioninstitute.optometry.net.
15
PATIENT CARE
HUMAN INTEREST
Compromising Patient Care
by Melissa Grmusa
customer service warrior (aka receptionist) can answer
calls even if they cannot make it into the office. The
patient does not see any difference on their end, and
for your office it is business as usual. If you see your
practice becoming the next Canada wide conglomerate, you can also network the Mitel’s four up to 99 sites.
It does not limit you. The key: Communication.
If you do not see your practice growing much but you
need an upgrade, Toshiba has a phone system that is
quite basic. This phone system still has the necessary
features like voicemail and auto-attendant, and the
digital sets they offer are more ‘economical’ if that is
what you are looking for. This is older technology but
it will do what you need it to do, and since they are
still in production it will not be difficult to find a new
functioning handset if one breaks.
Are you easily accessible? What can they do in case of emergency?
PROFITABLE PRACTICE
In today’s technologically driven society, we are constantly encouraged to be in contact with one another. There are so many social media platforms and outlets
like blogs, Twitter, Facebook, and LinkedIn that force us
to always be available. If joining the digital age and all
of its platforms seems like a major endeavour or a fruitless one, consider something simpler–a phone system.
16
by Dick Moody
You are running a modest sized eye care office, and
budgeting may be tight. It is a safe assumption that a lot
of expenditures will be going to equipment upgrades
and technology. These are obviously crucial elements
to give your patients the best care while they are in the
office. How do you create this same excellent service
for your patients while they are out of the office? How do your patients reach you? I recently moved to Toronto, and searching for a new
eye care professional and doctor was a nightmare. There
are so many in the Greater Toronto Area, and a girl can
only read so many reviews. I began calling around to
some recommended ones—to my surprise I could not
get a hold of anyone. I got busy signals and also just
constant ring tones. It was inconceivable to me that a
modern day business does not have voicemail. I could
not even leave my information and let them know I am
shopping. How can you expect me to become a new
patient, if I cannot even get a hold of you in the most
traditional way possible?
Some offices may say, “We just do not have the budget
for a new system,” or “We do not have a need, our
ten–year-old phones are still working.” Although your
ten-year-old phones are sufficient, are they really working for you? Some phone systems only provide you
with a connection, and are not helping you enhance
your patient care. It is possible to upgrade and not
compromise your budget.
Budgeting is a relative term.You can always finance a
new phone system if you do not have the initial capital
for it, and build it based on your needs. The basic Mitel
MiVoice Office is designed with “enterprise functionality for small and medium businesses”. This means a lot
of the bells and whistles are built in, and you just need
someone to turn them on if you need them.You can
work off the bare bones system that comes with an
auto-attendant, after hours answer and voicemail. If you
want to enhance your patient care even more, you can
‘twin’ your cell phone to your office set so that your
I Can See Clearly Now
One of today’s favourite new buzzwords, the cloud,
can also host your phone system. All you do is pay
a monthly fee to a provider, and they will host the
phone system for you on their premises. Here again,
you can still get the basic features and functionality, all
you pay for are the handsets and maybe some initial
set up costs. This can be compared to buying or leasing
a home, and the cloud is like leasing. If you expect to
rent for ten years, you may just want to buy. However,
if you want no responsibility for the equipment, do not
care if you own it and if you have a strong and sufficient Internet connection, then the cloud may be the
right move for you.
Whichever solution you choose, it is important to think
about what makes the most sense for your practice,
and how it can elevate your patient care. You can buy
a system with a solid foundation and room to grow,
one that is an updated version of what you are familiar
with or simply rent the features from the cloud phone
system. Whatever you do though, get voicemail!
Bottom Line: This article points out the need for an eye care
practice to have a phone system that meets it’s needs; the
author also thoughtfully offers suggestions regarding available
phone technology today.
Melissa Grmusa
Melissa Grmusa is a sales executive for
Introtel, a telecommunications company. She
can be reached at 905.625.8700 ext. 311 or at
mgrmusa@introtel.com.
It wasn’t cool to wear glasses in the 1930’s when I
was going to Thornton School in Saskatoon. Kids
who wore glasses then were called “four-eyes” or
“specs.” If the glasses had thick lenses they were
said to be made from the bottom of Coca-Cola
bottles. And everyone knew that when Clark
Kent slipped into a phone booth to put on his
Superman outfit, the first thing he did was take
off his glasses! Superman absolutely did not wear
glasses when leaping over tall buildings.
Some parents couldn’t afford glasses in those hard
times and if their kids could find their way to school
and back home again without getting lost, it was assumed they had 20/20 vision. For those who didn’t
see all that well, it helped in the early grades that the
teachers wrote “CAT” on the blackboard in big letters.
And because the class chanted the multiplication tables
every day, one didn’t need to look at the blackboard
to know that “2 x 2 makes 4”. So although I needed
glasses, I slipped comfortably through elementary
school without wearing them.
But life got more interesting when I went to Nutana
Collegiate where teachers wrote the entire history
of the universe in tiny cursory script on faded grey
“blackboards”, and occasionally complex formulae
written for a previous chemistry class appeared beside
notes being scribbled on the blackboard by a teacher
explaining dangling participles to a bewildered composition class. From my classroom seat I didn’t clearly
see any of these hieroglyphics and without the help of
notes copied from my classmate Lionel Gaunt’s binder,
I would still be attending classes at Nutana!
I seem to remember now that the kids who wore
glasses when I was in high school usually read books
about how to build a space rocket… or how to
remove an appendix… or how to double a million
dollars in five years. There was a message for me there
that I didn’t see.
Eventually, my need to see what I was missing finally
overruled my vanity and I started to wear glasses after
leaving school. Amazing! Where signs at a distance
were formerly just a blur, I could now see what movies were playing at the Capital Theatre from a block
away, and I could even see sparrows in the treetops.
It has been said that for all its developmental changes
over the years, the spectacle frame is one of technolo-
gy’s best examples of poor
engineering. But there
have been alternatives;
monocles were favoured
by the British and German aristocracy and gave
the wearer a one-eyed
glowering stare that was
intimidating.
Fancy and gilded lorgnettes were worn by
ladies of means who used
them to cast a disdainful
glance at café menus and
calling cards. And “pincenez” glasses didn’t need
sidebars to hook over the
ears because they were
held in place by fiercely
gripping the nose which
must have made breathing a chore.
Now, glasses are being used as a fashion statement.
Hollywood stars wear non-prescription lenses with
expensive frames when they go to lunch–or they
change the colour of their eyes with contact lenses.
Television newsreaders aren’t afraid to wear glasses to
read their tele-prompters. And it’s now fashionable
to perch your sunglasses on top of your head even
though it makes a person look like they have just left a
welding class.
In my old age I have had cataract surgery in both eyes
and I can now see reasonably well without wearing
glasses. Even so, when I make the trip to the Pearly
Gates I’m going to take my prescription glasses with
me. I don’t want to make any mistakes when reading
the road signs which lead to Paradise and Purgatory!
Bottom Line: There will be no place for vanity when Dick
Moody travels to the Pearly Gates!
Dick Moody
Dick Moody is a retired broadcast advertising salesman who now writes for his
local newspaper as well as Profitable
Practice. He can be reached through the
editor of this magazine.
17
PRACTICE MANAGEMENT
NUTRITION AND EYE HEALTH
Why I Hired A Professional
by Timothy A. Brown
Foods Rich In Antioxidants May Lower
The Risk Of Cataracts In Women
I can only imagine what my clients go through
when they hire me to sell their practice. I know
that some of my clients have spied on me when I’m
bringing buyers into their practice. This is a very
challenging moment for a proud owner, for an emotional seller, for somebody who has time and money
invested.
I completed a course in Consumer Behaviour this
week. It was part of a designation I am seeking, a
Fellowship in the Real Estate Institute of Canada
(FRI). In this course we talked about personality types, behavioural issues and how to deal with
people in certain business situations; in particular,
the course was designed for business brokers and real
estate agents to help them deal with people when
they are buying or selling their homes.
18
As I write this column, I am gazing out the window of the second story of my office watching the
agent and the buyers as they are walking around the
property. I’m so curious and I want to be there and
I want to know what’s going on. I am feeling frustration because I am a broker who sells for a living and
I have no control over the situation. I want to go
over and I want to help the agent to sell the property,
but it’s not my job. I have to stand down and stay
away. It is very difficult for me...
It is also painful for me to watch as I see her talking
to them and motioning with her hands, pointing out
the features of the lot–it is a fabulous property! She
is no doubt addressing the possibilities for this young
couple to raise their future family. The house is situated in a highly desirable location and it has considerable potential… but I can’t hear what anyone is
saying. I speculate that the potential buyers are complaining about this feature or that feature or some
perceived deficiency. I know there are deficiencies
and things to be done. The house is a little bit older.
It needs some repairs and renovations. It occurs to
me that I am a vendor who has hired a broker and
now I am spying on her, desperately trying not to
interfere. It is very difficult for me…
The lesson is that while I am an accomplished individual in the real estate and the business brokerage marketplace, I do have to know when to allow a professional
to complete her assigned task without any attachments,
emotional or otherwise. It is a very difficult lesson to
learn but well worth the results.
To close, as I look down on the house outside my
office, many fond, happy family-related memories return and will continue to do so as time passes.
Bottom Line: A personal account of why to delegate some
things to the appropriate professionals, even if you feel you can
do the job yourself!
Timothy A. Brown
Timothy A Brown is the CEO of ROI Corporation Brokerage. His company offers
extensive ser vices including appraisals
and sales of professional practices.
He can be reached at 905.278.4145 or
timothy@roicorp.com
www.roicorp.com
Swedish researchers found that women with the
highest intake of antioxidants had a lower risk of
developing cataracts as they age.
“Oxidative damage of the eye lens caused by
free radicals has been suggested to be crucial in
development of cataract,” said Susanne Rautiainen
of the Institute of Environmental Medicine at the
Karolinska Institute in Sweden who led the study.
Researchers looked at the diets of more than 30,000
women over the age of 49 for about seven years
for signs of developing cataracts. Based on total
antioxidant consumption, the researchers divided the
women into five groups, ranging from the greatest
antioxidant intake to the least.
They found that those who consumed the highest
total intake of antioxidants had about a 13 per cent
lower risk of developing cataracts than those who
consumed the least, MSN reported. Among those
who ate the most antioxidants, 745 cases of cataract
were recorded, compared to 953 cases among women
with the lowest antioxidant consumption
“Previous studies have focused on individual
antioxidants obtained from the diet or supplements
and they have reported inconsistent results,”
Rautiainen said. “However, in diet much wider
ranges of antioxidants are present than those studied
previously.”
Instead of looking at single antioxidants, such as
vitamins C and E, and plant flavonoids such as
lycopene, the researchers used a measure of total
antioxidant values in foods, which takes into account
how the nutrients work together.
Foods high in antioxidants include coffee, tea,
red wine and colourful fruits and vegetables. To
learn about the best antioxidant foods, apply the
“Antioxidant Color Wheel”. The purple-blue-redorange spectrum contains most antioxidant-rich fruits,
as described here: www.everythingantioxidants.com/
what-is-the-best-antioxidant-food.
“The results are not that surprising,” William Christen
of Brigham and Women’s Hospital and Harvard
Medical School in Boston told MSN.
Christen, who was not involved with the study,
said the findings are in line with previous research
suggesting antioxidants may help protect against
cataracts, but the study has limitations, he stated.
“The women participants simply reported on a
questionnaire the food choices they made over the
past year,” Christen said. “As an observational study,
there is always concern that women who choose
healthier diets may also differ in other important ways,
like body weight, smoking habits and aspects of the
diet other than antioxidants, that may be more directly
related to cataract risk.”
Rautiainen said she suspects the results would be
similar among men and in other countries.
SOURCE: JAMA Opthalmology, online December 26,2013
PROFITABLE PRACTICE
PROFITABLE PRACTICE
Let me tell you a little about an experience I
just went through. I own a rental property that is
adjacent to my office; the two properties merged
on title when I bought them a few years ago. I
wanted to sell the rental so I hired a local real estate professional with whom I had worked in the
past for the sale of a previous home.
Part of the course was also designed to help us better
understand our own behaviour patterns. I have taken
similar courses on numerous occasions in the past, but
it is always good to be reminded of how we behave,
how others perceive us and how in turn we perceive
them. With regard to the house next to my office that
we have owned for six years (and rented to numerous family members), it was very difficult for me to
stand back and allow a professional real estate agent
to do her job. I recognized that my desire to express
my emotional interest in this property had to be suppressed to facilitate the work of a professional.
19
RESEARCH
OPTICAL ODDS AND ENDS
Promising Results On
Gene Therapy
People with fast eye movements tend to be less patient and
more likely to make impulsive decisions, a new study contends.
A clinical trial of gene therapy has shown promising initial
results that could have implications for the future treatment of
macular conditions.
Assessing body movement, including the speed of the eyes as
they focus on one thing and then another, helps reveal how
a person’s brain evaluates the passage of time in relation to
the value of a potential reward, the Johns Hopkins University
researchers said.
“When I go to the pharmacy and see a long line, how do I decide how long I’m willing to stand there?” principal investigator Reza Shadmehr, a professor of biomedical engineering and
neuroscience, said in a university news release. “Are those who
walk away and never enter the line also the ones who tend to
talk fast and walk fast, perhaps because of the way they value
time in relation to rewards?”
Having a better understanding of how people evaluate time
when making decisions might help explain why malfunctions
in certain areas of the brain make decision-making harder
for people with brain injuries or neurological disorders like
schizophrenia, the researchers said.
Patients affected by choroideremia were injected with a small,
safe virus which carried the missing CHM gene into the lightsensing cells in the retina. In an operation similar to cataract
surgery, the patient’s retina is first detached and then the virus
is injected underneath using a very fine needle.
The aim is for the CHM gene, once delivered into the cells of
the retina, to start producing protein and stop the cells dying
off. The results suggest that the approach has promise for treating people early on before too many cells in the retina have
been lost.
Results of the trial have been reported in The Lancet medical journal. Based on the success of the first six patients, three
more have recently been tested at a higher dose.
Professor Robert MacLaren of the Nuffield Laboratory of
Ophthalmology led the development of the retinal gene
therapy and this first clinical trial.
For the study, published in the Journal of Neuroscience, researchers conducted a series of experiments with volunteers
and found a strong correlation between eye-movement speed
and patience or impulsivity.
He said: “It is still too early to know if the gene therapy treatment will last indefinitely, but we can say that the vision improvements have been maintained for as long as we have been
following up the patients, which is two years in one case.”
“It seems that people who make quick movements–at least eye
movements–tend to be less willing to wait,” Shadmehr said.
“The results showing improvement in vision in the first six
patients confirm that the virus can deliver its DNA payload
without causing significant damage to the retina. This has huge
implications for anyone with a genetic retinal disease such
as age-related macular degeneration or retinitis pigmentosa,
because it has for the first time shown that gene therapy can be
applied safely before the onset of vision loss.”
“Our hypothesis is that there may be a fundamental link between the way the nervous system evaluates time and reward
in controlling movements and in making decisions,” Shadmehr
said. “After all, the decision to move is motivated by a desire to
improve one’s situation, which is a strong motivating factor in
more complex decision-making too.”
Source: medicinenet.com
Sources: Macular Society, The Lancet
Prescription Labels Fail To
Meet Guidelines
More than 20 shoppers were taken to hospital after tripping over
“crazy paving” in a town centre in Wales–because it creates an
optical illusion hiding a kerb. The new paving stones have been
blamed for a spate of falls by people who can’t see the kerb because of the mixed-up pattern.
Small print and poor printing on prescription labels handed out
by pharmacists may be misread and may lead to errors in taking
medication, according to new research by the University of
Waterloo and CNIB (Canadian National Institute for the Blind).
The treacherous stones, part of a £10.5m town centre makeover,
create a hidden trip trap–with many unable to spot the edge of
the kerb.
The study, published recently in the Canadian Pharmacists
Journal, found that labels on prescription medications dispensed
by pharmacies do not consistently follow professionally recommended guidelines for legibility.
The new paving design was introduced as part of a town centre
revamp in Pontypridd, South Wales. But the pattern at street level
is very similar to the loading bay -four inches below- and many
are unable to see the drop.
By simply following recommended guidelines for font size, use of
bolding, justification, sentence case and spacing, researchers expect pharmacies can improve the legibility of their labels without
the need for new technologies or larger labels.
Source: The Telegraph
“Surprisingly, there are few guidelines and no regulations for the
print on prescription labels in Canada,” said Dr. Sue Leat from
Waterloo’s School of Optometry and Vision Science. “In Ontario,
regulations specify only the content of prescription labels, not
how they appear.
Source: sciencedaily.com
MORE EYE FACTS YOUR PATIENTS
MAY NOT KNOW
• While it takes some time for most parts of your
body to warm up to their full potential, your eyes
are on their “A game” 24/7.
• Eyes heal quickly. With proper care, it only takes
about 48 hours for the eye to repair a corneal
scratch.
Do you enjoy receiving
PROFITABLE PRACTICE
Eye Care Professional Magazine?
As an eye care professional your subscription is FREE. To continue a
new year of issues, please request a subscription by mail, fax or email.
Or subscribe at: WWW.PROFITABLE-PRACTICE.COM
SUBSCRIPTION FORM
• Seeing is such a big part of everyday life that it
requires about half of the brain to get involved.
Send to: Profitable Practice
1155 Indian Road
Mississauga, ON L5H 1R8
Fax: (905) 278-4705
Email: subscription@
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• Doctors have yet to find a way to transplant an
eyeball. The optic nerve that connects the eye to the
brain is too sensitive to reconstruct successfully.
• The cells in your eye come in different shapes.
Rod-shaped cells allow you to see shapes, and coneshaped cells allow you to see color.
• Your eyes are about 1 inch across and weigh about
0.25 ounce.
• Some people are born with two differently colored
eyes. This condition is heterochromia.
Check One:
1 YEAR
2 YEARS
NAME:
• Out of all the muscles in your body, the muscles
that control your eyes are the most active.
ADDRESS:
• 80 per cent of vision problems worldwide are
avoidable or even curable.
CITY:
PROV.:
POSTAL CODE:
Source: https://www.vsp.com/eyes.html
PROFITABLE PRACTICE
Is He The Impatient Type?
Check His Eyes
Pavement Optical Illusion
Injures 20 People
EMAIL:
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Fall 2014 - Profitable Practice

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