Will Minimally Invasive Glaucoma Procedures Reduce Our

Need for Drops? - page 6

Committed to Infection Control - page 10

published by

A BoozmanHof Quarterly MagazineSpring 2011

Cool Stuff for Eye Doctors - page 11

Eyedea

Doctors

C. William Hof, M.D.Randall E. Cole, M.D., F.A.C.S.

Steven D. Vold, M.D.

Website

www.boozmanhof.com

Eyedea published by

Editor and PublisherMatt Young

Copy EditorHannah Nguyen

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Stephan Max Reinhold, www.liquid-art-gallery.com

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A Helpful EyedeaW elcome to the

inaugural issue of BoozmanHof’s

Eyedea magazine. The purpose

of this maga-zine is two-fold: education and support of local physicians as well as their patients.

At BoozmanHof, we have been serving you for over 30 years. As a relatively recent addition to the Booz-manHof team, I am humbled and honored to be part of both this fine institution and the Northwest Arkansas community.

My decision to leave a university-based practice to join BoozmanHof four years ago was based on my desire to work with Drs. Randy Cole and Bill Hof to help develop a leading ophthalmology center focused on ophthal-mic innovation and clinical research.

Ultimately, our goal is to provide the patients of our area access to high-quality and compassionate eye care.

Currently, our clinical re-search team is involved in a

wide range of Food and Drug Administration-approved clinical trials providing cutting-edge technologies to patients in the areas of cata-ract surgery, glaucoma and anti-inflammatory medica-tion, novel drug delivery sys-tems and minimally invasive glaucoma surgery.

In Eyedea magazine, we will keep you informed of ongoing clinical trials, provide important educa-tional information regarding advances in ophthalmology, assist ophthalmic practices with coding, educate primary care physicians regarding the diagnosis and manage-ment of common ophthalmic problems and update you regarding improvements in ophthalmic ambulatory surgery care.

In this Issue...

04 06 08 11

Vision impairment slows

cognitive performance

Glaucoma surgery gets

minimally invasive

When should you have an

eye exam?

Surgery goes 3D

We desire this publica-tion to be much more than a BoozmanHof advertisement, and also hope to support and provide you information that is genuinely beneficial to you and ultimately your patients. To that end, in fu-ture issues, we will be high-lighting medical practices in our area that partner with us on a regular basis.

Furthermore, we have hired Matt Young, an experi-enced and highly respected editor in the ophthalmic news field to be our editor-in-chief for Eyedea. As pos-sibly the first publication of its kind, we will rely heavily on your feedback as to how we can best serve you.

By working together with the entire Northwest Arkansas medical commu-nity, we hope to develop a win-win relationship with all of you that will benefit all of the patients in our region.

Sincerely,

Steven D. Vold, M.D.President & CEOCataract & Glaucoma SurgeryBoozmanHof Eye Clinic, P.A.

To Our Readers

02 n Eyedea

Eyedea n 03

G rowing up in the small town of

Lamar, Missouri, I developed a special connection to eye care at a young age.

My mother, blinded in one eye with a tennis ball

when she was 16 years old, started seeing an ophthalmologist regularly many years later when I turned 11.

My grandmother also worked for the town optometrist for more than 30 years—the same man who later wrote a letter of recommendation for me for optometry school admissions.

Eye care has always been a central theme in my family, and now, I’d like to take this opportunity to welcome you to my extended family of optometrists and eye care specialists.

In doing so, I’d like to share a little bit of what I’ve learned about the intersection of optometry and ophthalmology.

Some years ago, I was part of an optometry practice that doubled its locations—from two to four—within about a year. Initially, that practice wasn’t doing any kind of medical care or co-management. It was mainly involved in retail, selling glasses and contact lenses. I knew we had to work at something different, and we did. Instead of relying on glasses and contact lens revenue, we made a decision to purchase new diagnostic equipment and bill for those services, increasing our professional services revenue. Co-management is a great way for optometrists to get involved in the medical side of eye care, involving, under Medicare, payment of 20% of the total surgical fee for services related to postoperative care.

Today, sales of glasses and contact lenses are widely available online.

Extending Our Eye Care Familyby Kevin Gardner, O.D.Director of Practice Development

O.D. Corner

O.D. Senator Was at the Beginning of BoozmanHof’s Proud History

John Boozman, O.D., is now a U.S. senator, and this fact reminds

everyone involved at BoozmanHof of the clinic’s proud history.

Sen. Boozman founded Boozman Eye Clinic in 1977 with his older brother, Fay Boozman, M.D., an ophthalmologist. The clinic merged with C. William Hof, M.D., in 1981, thereafter becoming BoozmanHof.

While the Boozman brothers later went onto political life, Dr. Hof’s passion has been in medical missions, and he has operated on patients all over the world. Partnering with the Lighthouse for Christ Mission, he currently volunteers as an ophthalmologist in Mombasa, Kenya several weeks each year. In this setting, he restores sight for many patients and trains doctors in advanced ophthalmic diagnostic and surgical techniques.

Along with the Boozman brothers and Dr. Hof, Jim S. Myers, O.D., also was a founder of BoozmanHof in 1981. Dr. Myers is a frequent lecturer at national optometric meetings on various aspects of ophthalmic disease, and has served as a consultant for numerous leading eye clinics across the country. He performed some of the original research on the material used in some of the first soft contact lenses.

From its internationally recognized prophylaxis regimens to prevent infec-tion to its use of the most advanced glaucoma procedures performed any-where, BoozmanHof continues to set the bar high in ophthalmic care.

Profit margins have been squeezed. Service-oriented medical practices is key to the survival of any optometry office.

With aging baby boomers, it’s the perfect time to get involved with co-management and expand the medical professional services in your practice. Co-management generates additional professional services revenue and we at BoozmanHof want to help this area of your practice grow. We believe that co-management is a great way for ophthalmology and optometry to work together to give the patient the very best care possible.

Co-management enhances your practice and is good for patients. Patients trust you as their primary eye care provider. When you send your patients to BoozmanHof you can be confident your patients will receive the very best of care.

BoozmanHof has been active in co-management with area optom-etrists for 30 years. We look forward to building new relationships to help optometrists and ophthalmologists work together to provide excellence for patients of Northwest Arkansas.

Some optometry practices may be reluctant to take the first step to get involved with co-management. Other optometrists already are involved in co-management. I want every practice to know that I personally am here to help. If you have questions about co-management and how it can benefit your practice, call me at 479-246-1700, or email me at kgardner@boozmanhof.com.

We at BoozmanHof want to assist with new co-management relationships and help other relationships grow. We want you to know that we are co-management friendly, and we really do appreciate our relationship with you.

John Boozman

04 n Eyedea

Clinical Trials

See Better, Think Clearer

V isual impairment can slow cogni-tive performance in older adults.

That’s according to a recent study in Optometry and Vision Science, which investigated simulated visual impairment on cognitive performance in 30 older adults.

“Simulated cataract significantly impaired performance across all cog-nitive test performance measures,” researchers found. “In addition, the impact of simulated cataract was sig-nificantly greater in this older cohort than in a younger cohort previously investigated. Individual differences in contrast sensitivity better predicted cognitive test performance than did visual acuity.”

B oozmanHof is part of the clinical trials of

many new glaucoma devices, according to Steven Vold, M.D.

“We are fortunate to be able to offer the patients of Northwest Arkansas access to the best, new technologies in ophthalmology,” Dr. Vold said.

Here is BoozmanHof’s current clinical trial involvement:

• TheCyPass(TranscendMedical,Menlo Park, Calif.), which Dr. Vold described as a “suprachoroidal microstent,” was implanted in the United States first at BoozmanHof.

• BoozmanHofisinvolvedinclinicaltrialsstudyingtheiStent(Glaukos,Laguna Hills, Calif.), the first ab interno micro-bypass implant for the treatment of glaucoma.

• Theclinicisinvolvedinevaluat-ingNevanac(Alcon,FortWorth,Texas) as a once-a-day drug in the setting of cataract surgery. Currently, the drug usually is used three times daily.

• RandallE.Cole,M.D.,iscurrently

Near, Intermediate and Distance Vision Improvements Pinpointed after IOL Implant

I ntraocularlens(IOL)manufacturersoften tout the benefits of their technologies, but researchers

recently pinpointed improvements inuncorrecteddistance(UDVA),intermediate(UIVA)andnearvisualacuity(UNVA)withtheAcrySofIQReStor IOL +3.0 D.

Among 147 patients, mean UDVA improved from 20/56 preoperatively to 20/22 at six months postoperatively; UIVA improved from 20/73 to 20/30; and UNVA improved from 20/83 to 20/25.

“Commensurate significant post-

operative improvements were observed in the patient-reported uncorrected functional vision, satisfaction with un-

involved with a study evaluating the newest toric IOL design by Ab-bottMedicalOptics(AMO,SantaAna, Calif.).

• BoozmanHofwillevaluateTrueVisionSystems(SantaBarbara, Calif.) to visualize and guide toric IOL surgery.

• TheclinicisinvolvedinclinicalresearchofAqueSys(Irvine,Calif.), which is developing a novel implant for the treatment of glaucoma.

• Ologen(AeonAstronCorporation,Taipei, Taiwan), a collagen matrix for tissue repair, will be compared tomitomycinC(MMC)withtrabeculectomy for the treatment of glaucoma at BoozmanHof. Ologen may help promote normalized wound healing and functional bleb formation.

Patient participants benefit during these trials as well from cutting-edge technologies.

“Patients receive this care at no charge to them,” said Dr. Vold. “These services are only available to patients at top-tier research centers in the United States.”

corrected vision, and social activities,” the researchers noted in the Journal of Cataract & Refractive Surgery.

Clinical Trials at BoozmanHof

Eyedea n 05

A lthough LASIK has become syn-onymous with superior vision over the last decade, ophthal-

mologists are looking at lens-based sur-gery as the way for patients to achieve excellent visual acuity less impacted by the visual deterioration of age.

“There are significant cataracts in an increasing number of people in their 40s and 50s,” said Randall E. Cole, M.D., Medical Director, BoozmanHof Eye Surgery and Laser Center. “When somebody gets to be 50 and they are interested in a solution to where they don’t need glasses much, we’re looking hard at putting a lens in their eye.”

Givenenoughtime,everyonegets cataracts. A corneal treatment will not help the eventual visual loss they cause, but a lens-based one does.

Current “lifestyle” intraocular lenses(IOLs),termedassuchbecausethey enhance the lifestyles of many patients by providing superior quality of vision, often leave patients spectacle independent—something that many have come to expect in the LASIK era.

“Over the last two years, I have put in 400 lenses for presbyopia and astigmatism correction,” Dr. Cole said. “I have been extremely pleased with the results. Patients are functioning amazingly well with very few side effects.”

Dr. Cole appreciates the AcrySof IQReStor(Alcon,FortWorth,Texas)

multifocal lenses. “It has really exceeded my

expectations for what we would ever achieve in terms of spectacle independence for distance, intermediate and reading vision,” Dr. Cole said. Dr. Cole also uses the Tecnis MultifocalIOL(AbbottMedicalOptics,Santa Ana, Calif.) with good results.

The Tecnis Multifocal IOL is less dependant on room illumination than other IOLs such that the ability to read is optimized in lower light conditions, Dr. Vold added. The IOL also has a proven high quality range of vision, and in particular, posterior diffractive steps also contribute to a comfortable reading distance, according to the manufacturer.

The surgeons also know when to avoid these lenses altogether in select patients, or opt for toric IOLs instead.

“I usually don’t use a lifestyle IOL on patients with more than 1 D of cylinder,” said C. William Hof, M.D., Co-founder, BoozmanHof. “With my surgical incision, I can knock off up to 0.75 D of astigmatism.”

Beyond that, Dr. Hof likes to implant a toric lens for astigmatism ranging from 1.25 to 2.5 D.

Dr. Cole also uses toric lens implants to correct astigmatism.

“Astigmatism correcting IOLs are better, safer, more accurate and less invasive than doing

[incision-based astigmatism surgery] with a diamond blade,” Dr. Cole said.

Accommodative IOLs also yield excellent results in patients who are not good candidates for multifocal lenses.

Steven D. Vold, M.D., likes the Crystalens(Bausch&Lomb,Rochester,New York) for patients with mild-to-moderate glaucoma who need maximal quality of vision in terms of light levels and minimal side effects.

“The Crystalens is really a monofocal lens that adds a little bit more in patients that are not good candidates for the multifocal lens,” Dr. Vold said. “I continue to use all three of these presbyobia-correcting IOLs. We are currently the only facility in Northwest Arkansas that offers every lifestyle IOL option to our patients.”

Dr. Hof explained further that while multifocal lenses must split incoming light toward different focal points, the Crystalens focuses 100% of light at the same place, and simply moves in order to focus at different distances.

“By adjusting the prescriptions of each eye, we can maximize the range of vision of these lenses, including near vision,” Dr. Hof said.

Fortunately, all of these surgeons are on the patient’s side when choosing the appropriate lens.

The bottom line, according to Dr. Hof, is that the lifestyle IOL is “a true technological advance.

“This is a real improvement in the technology of delivering eyesight, although it is still not perfect,” Dr. Hof said.

Wowing Lens Patients Just Like LASIK Patients

AcrySof IQ ReStor IOL +3.0 D

Near Far Neutral

The Crystalens moves in order to focus at different distances. Crystalens illustration appears at top right. (Image source: Bausch & Lomb)

AcrySof Toric IOL Tecnis Multifocal IOL

(Image source: AcrySof images provided by Alcon. Tecnis image provided by Abbott Medical Optics)

06 n Eyedea

The days when glaucoma patients are being treated with surgery as a last resort are coming to an end.

Ophthalmologists are keenly aware of the challeng-es of compliance in glaucoma management. It’s a continuous struggle to get patients to take their pressure-lowering eye drops when they don’t notice any immediate visual difference in doing so, despite the fact that drops preserve vision.

Those medications, which to some patients seemingly don’t do anything, are becoming more expensive too.

It’s no wonder that surgeons are looking more at surgical options to treat glaucoma, particularly minimally invasive ones, accord-ing to Steven Vold, M.D., the only fellowship-trained glaucoma subspecialist in Northwest Arkansas. Easier, safer procedures are avail-able now, and they obviously don’t need continuous application.

Laser trabeculoplasty, for one, has be-come more of a first-line treatment, Dr. Vold said. Minimally invasive surgery also is beginning to provide intermediate measures—somewhere between first-line treatment and the gold-but-troublesome standard: trabeculectomy.

“Ultimately, surgeons have waited until patients had bad uncontrolled glaucoma to opt for trabeculectomy or a tube shunt,” added Dr. Vold, but newer, minimally invasive surgical options are allowing for earlier procedures as well, and typically reduce the number of medications that patients rely on.

“There’s a huge interest in minimally invasive glaucoma treatment,” Dr. Vold said. “Recovery is much more rapid and the operation yields far fewer complications.”

Four established minimally invasive procedures are in play at BoozmanHof, as well as numerous potentially signifi-

cant technological advances in surgery, Dr. Vold said.FirstistheTrabectome(NeoMedix,Tustin,Calif.),which

is a technique for ab interno trabeculotomy. The procedure involves using a microcautery technique to remove the inner wall of Schlemm’s canal and the inner wall of the trabecular meshwork.

“You can get patients off of one to two medications after surgery and lower the pressure as well,” Dr. Vold said. “People also recover quickly.”

A second option is canaloplasty, which is a good one for patients on two to three medi-cations and also at high risk for complications from trabeculectomy. The innovative proce-dure opens Schlemm’s canal and reduces pressure without the need for a bleb.

“Patients can go home the same day, and recovery is much shorter, typically two to three weeks” Dr. Vold said. “Combined with cataract

surgery, recovery is a little longer but still faster than with stan-dard filtration surgery. The effect also is a long-lasting one.”

Endoscopic cytophotocoagulation, which ablates the tissue of the ciliary body epithelium, is a third option. This reduces the amount of aqueous production, thereby lower-ing pressure. Typically, it is used in combination with cataract surgery.

“It’s a way to get patients off of one to two medications,” Dr. Vold said.

Goniosynechialysisisafourthprocedure,andforpeoplewho have experienced angle-closure glaucoma. The proce-dure disposes of trabecular meshwork obstruction.

“It’s minimally invasive and gets patients back on their feet quickly,” Dr. Vold said.

BoozmanHof is beginning to use the CyPass device

Glaucoma Surgery

Cover Story

The Trabectome procedure

Canaloplasty, shown in these images, opens Schlemm’s canal via viscodilation with a catheter and reduces pressure without the need for a bleb. The center image shows a red beam of LED light that is at the catheter’s tip, allowing the surgeon to have visual contact with the tip.

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New Horizons in

Eyedea n 07

Glaucoma Surgery R ightfully so, you are probably asking yourself, “Who is this guy, and how

is he qualified to rate a medical facility?”

My name is Tim Buckley, and it is my pleasure to be writing you as part of Eyedea. When I heard from BoozmanHof’s staff of their magazine, I asked if I could please contribute because I felt I can offer an industry insider’s perspective regarding the quality of health care at this institute.

I have worked in the medical device industry since 1997. As first an engineer then marketing executive, I have had the pleasure to develop many new technologies for eye surgery. My career has afforded me the opportunity to work with some of the finest ophthalmologists around the globe. Without hesitation, I can honestly say that BoozmanHof ranks as one of the best.

How do I know? I personally rate quality on numerous factors, including: an overall standard of excellence, patient safety, risk management and continual drive towards improving techniques in therapy.

BoozmanHof has the absolute latest therapeutic technologies in the market. They make tremendous commitments and investments to ensure they have both the latest technology and associated training.

For example, they recently invested in two very premium surgical microscopes, called the OPMI Lumera T from Carl Zeiss. This is high-end premium technology that approximately 20 centers in the United States have. This equipment allows the surgeon to improve surgical outcomes because of far superior visualization.

That is just one example of many of their drive to achieve premium patient outcomes.

In a year of uncertainty when many delayed investment, BoozmanHof kept one thing certain: their commitmenttoqualitycare.Greatjob.

Editor’s note: Timothy D. Buckley is senior marketing manager at

Transcend Medical (Menlo Park, Calif.)

I’m Vouching for World-Class Eye Care at BoozmanHofBy Timothy D. Buckley

(TranscendMedical,MenloPark,Calif.)inconjunctionwithcataract surgery as part of clinical research.

“The CyPass microstent is placed within suprachoroidal space and enhances outflow of aqueous humor,” Dr. Vold said. “The surgery takes only a few minutes to do and patient recovery is remarkably rapid. A patient can achieve excellent vision within only a few days after surgery.”

The procedure works best for patients with mild to mod-erate glaucoma.

Dr. Vold is among the first clinical investigators for thenewiStent(Glaukos,LagunaHills,Calif.),anabinternomicro-bypass implant. The device already has obtained ap-proval for use in select countries in Europe and is currently undergoing review by the Food and Drug Administration.

“We do believe multiple stents will make a difference,” Dr. Vold said. Already, in more advanced cases of glaucoma, theclinicusestheEx-PressGlaucomaFiltrationDevice(Al-con, Fort Worth, Texas) which can help to shorten recovery from trabeculectomy.

In an article Dr. Vold authored in the November/December issue of Advanced Ocular Care that reviewed minimally invasive glaucoma options, he noted: “Trabeculectomy and tube shunts have been the mainstay of glaucoma surgery for several decades. Although these surgeries are highly successful in terms of an absolute reduction of IOP, a significant percentage of patients do not reach their target pressure.”

As a result, Dr. Vold said, “Other procedures are trying to come into the business and extend into that space.”

Dr. Vold noted that BoozmanHof is the only eye surgery center in Northwest Arkansas that uses minimally invasive glaucoma devices and procedures like the Ex-Press, the Trabectome, and canaloplasty.

08 n Eyedea

Seven years into the ophthalmol-ogy writing profession, I was preparing for a medical eye mis-

sion to India and suddenly fascinated by the red reflex.

How was it that I had written hun-dreds of articles on ophthalmology and could still be fascinated by this most basic of tests?

Simple: I didn’t remember ever performing one.

It’s funny how we become spe-cialists in life without sometimes ever really understanding the basics. But it happens, especially as a cop reporter turned eye journalist. Once upon a time, I examined courthouse records for triple murders, and weeks later I was combing the depths of medical literature for mere nuances of innova-tion in ophthalmic surgical technique. Yet knowing that I knew so little about the red reflex seven years later—how humbling.

For clinical professionals, it may be even easier to overrate one’s own ex-pertise. When people rely on you, you really have to know the answer—but how well do you really know it?

In this brief moment in time, I’m here to tell you that you don’t have to know anything—at least not about

when to get an eye exam. Maybe you really do know very little, and that’s perfect, because we’re going to learn together here—believe me. Let’s start….

There are recommended intervals to get regular eye exams, as outlined by the American Academy of Ophthalmol-ogy(AAO).

Before age 3 is the first interval to be aware of. Eyes should be screened during regular pediatric appointments. If a there is a family history of stra-bismus, or amblyopia, or ptosis, or if the child appears to have any of those conditions, an ophthalmologist should be consulted.

From age 3 to 19, eyes should be screened every one to two years during pediatric or family physician visits.

From age 20 to 39, don’t take healthy vision for granted. Have an eye exam at least once between 20 and 29, and at least twice between 30 and 39. Be particularly vigilant about:

• Visualchangesorpain

• Flashesoflight

• Seeingspotsorghost-likeimages

• Linesthatappeardistortedorwavy

• Dryeyeswithitchingandburning.

The AAO actually issued new eye disease screening recommendations in 2007 for aging adults.

Therefore, from age 40 to 64, be aware of the following:

• Adultswithnosignsorriskfactorsfor eye disease should still get their eyes screened at age 40, which is when early signs of disease and changes in vision begin to happen.

• Thisinitialvisiontestwillhelppre-serve vision, and it also helps aid early detection of systemic diseas-es like hypertension and diabetes.

• Regularvisitstotheeyedoctortotreat ongoing disease or injuries, or for vision exams for glasses or contact lenses should continue beyond this initial exam.

For those 65 and over, get com-plete eye exams every one to two years to check for cataracts, glaucoma, age-related macular degeneration, diabetic retinopathy and other eye conditions.

Those that need vision exams more often than recommended above include: 1) people with a family history of eye problems, 2) African Americans over age 40, 3) those with diabetes, and 4) anyone with a history of eye injury.

Anyone at any age with visual symptoms or at risk for eye disease, such as those with high blood pressure, should see an eye care professional to determine how frequently the eyes should be examined.

Now knowing all of this, I think it has been a little too long since I had my eyes seriously checked. What about you, or your patients?

Editor’s note: Matt Young is a contributing

editor for EyeWorld magazine.

The of Vision Screening for Medical Experts By Matt Young

Eyedea editor

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A patient gets her eyes screened.

If you have a problem with your vision, Dr. Hof, pictured here, and all the eye care professionals at BoozmanHof are ready to provide you with excellent care. Call them at 800-428-3937 or 479-246-1700, or email

them at info@boozmanhof.com.

”

“Eyedea n 09

I moved to Rogers, Arkansas from California in the 1970s; there was a great big earthquake and my family

decided that we had had enough. I’ve enjoyed the more peaceful

surroundings of Rogers, but I’ve enjoyed the miracles that happen every day much, much more.

They happen all the time here at BoozmanHof. People who have corneal transplants are often just tickled to death about their experiences. They might not be able to see as well as you or I, but they are the ones that really appreciate vision.

I don’t really enjoy medical coding, but I’ve done it for 23 years. I’m doing it for the patient.

Medical coding is “by the book,” but the book changes daily and you

NowforourfirstQ&A…

Question:

We co-manage cataract surgery care with an area ophthalmologist. Some of the ophthalmologists offer premium intraocular lenses or IOLs. How does co-managing work when these lenses are selected by the patient?

Answer:

The optometrist would file the Cataract CPT code with the 55 modifier as usual, and receives 20% of the Medicare allowable for postoperative care.

Our ophthalmologists offer these lenses but require that the co-managing optometrist attend a presentation that qualify and educate them on the

Quick Facts about Janis Geary, ACS-OH

• JoinedBoozmanHofEyeClinicinNovember 1987

• CertificationfromtheBoardof Medical Specialty Coding (BMSC)in2004

• Helpedintheestablishmentofthe Corporate Compliance Plan for BoozmanHof Eye Clinic

• CoordinatorfortheannualBoozmanHof Coding and Billing Conference

• BoozmanHofbusinessofficedirector

Admittedly, I have a fair amount of medical coding experience, and I’d like to

help you in any way that I can to ensure your patients

are getting the best care. – Janis Geary

Ask JanisVeteran medical coder provides answers to your ophthalmology management questions

have to keep on top of it. You have to read a lot, explore a lot, and not believe everything you hear. It’s very trying.

Admittedly, I have a fair amount of medical coding experience, and I’d like to help you in any way that I can to ensure your patients are getting the best care.

I can’t imagine not being able to see. A lot of people take that for granted until they don’t have it anymore.

I’m going to help you in the issues of Eyedea magazine, so that you can help patients. If you have questions related to medical coding, call me at 479-246-1700, or email me at jgeary@boozmanhof.com. I’ll personally respond to you, and we’ll also answer the best questions in the pages of Eyedea.

postoperative care and benefits of lifestyle lenses. When the optometrist completes his course he is qualified to co-manage and receive an additional fee(usually$200pereye)forhisextratime and postoperative care of the lifestyle lens patient.

This fee is not billed to the insurance company; it is collected from the patient or financed. The patient is made aware of the extra fee before surgery, in writing. We give the patient a copy and send a copy to the co-managing optometrist. All optometrists are welcome to attend this training presentation at their convenience. YoumaycontactKevinGardner,O.D.,for more information or scheduling. Call 479-246-1700, or email him at kgardner@boozmanhof.com to reach him for details.

Why Janis Wants to Help

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10 n Eyedea

Surgery Center Update

E ndophthalmitis, a terrible blinding infection, typically occurs around 1 of every 1,000 cases.

At BoozmanHof, the rate stands at 1 in 28,000 after cataract surgery—a remarkable achievement.

“From the first day we opened, we have used a comprehensive prophylaxis system,” said Randall E. Cole, M.D., medical director, BoozmanHof Eye Surgery and Laser Center. “We create as many barriers as we can to reduce infection.”

Statistically, BoozmanHof’s ambulatorysurgerycenter(ASC)ranksas among the best anywhere in keeping patients infection-free.

Here’s part of what they do:

• BoozmanHofgetseveryoneinvolvedin prophylaxis—from physicians to employees to patients;

• Patientsuseantibacterialsoapforthree days before surgery;

• Theyalsousetopicalantibioticsforthree days preoperatively;

• TheASCusesvancomycinandgen-tamicin—two strong antibiotics—in the irrigating solution;

• TheASCdeferssurgeryifthepatienthas an active or untreated systemic infection.

“We have been fortunate that our system is very effective,” Dr. Cole said. “We continue to do things most practices just don’t do in terms of having an extremely clean environment.”

Steven D. Vold, M.D., joined BoozmanHof after previously serving as

vicechairmanattheScott&WhiteEyeInstitute,TexasA&MHealthScienceCenter College of Medicine, Temple, Texas, and also after working at the prestigious Wheaton Eye Clinic in the Chicago area. He was immensely impressed at how well the BoozmanHof system worked.

“In addition to being a busy cataract surgeon, Dr. Vold operates on extremely sick eyes using procedures like trabeculectomy and glaucoma drainage devices,” Dr. Cole said. “He performs some of the most complex and high risk surgeries in all of ophthalmology where the risk of infection would be much higher. In the 3.5 years that he has been here he has been extremely pleased with the postoperative outcomes.”

It is critical that patients use antibiotic drops as instructed to be infection-free, Dr. Cole said.

TheASChasusedVigamox(Alcon,FortWorth,Texas)andZymar(Allergan,Irvine, Calif.)—two powerful fourth-generation fluoroquinolones—“since the day they came out,” said Dr. Cole.

These are used three days before the surgery, four times per day.

“Some surgeons will argue that, ‘Hey, we just need to use them an hour before surgery to achieve good aqueous concentration,’” Dr. Cole said. “The point is not aqueous concentration. The point is killing bacteria in the flora around the eye. You can’t do that in an hour.”

Dr. Cole noted that 80% of postsurgical eye infections are caused by bacterial flora from the patient. It is therefore important to use antibacterial soap and topical antibiotic drops well before surgery to control bacteria that are around the eye, he said.

The other 20% of infections come from the surgical environment.

“That’s where most epidemics come from,” saidDr.Cole(picturedhere). “Poor sterilization, dirty instruments, autoclaves that aren’t working, and lack of adherence to asep-tic technique are critical factors here.”

By Matt YoungEyedea Editor

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Journey to the Center of the Eye

Who knew 3D could be helpful as well as entertaining? TheguysatTrueVisionSystems(SantaBarbara,Calif.)did.

Journey to the Center of the Earth is nothing compared to 3D surgery. Ok, you don’t get Brendan Fraser coming out at you. But you do get to watch surgery in a particularly meaningful way.

Patients and their family members can witness their surgical options preoperatively in 3D. Then, LIVE, surgeons can operate more comfortably by witnessing surgery on a projector or monitor in 3D, surrounded by better informed colleagues.

“TrueVision provides a vastly improved 3D view of a surgical procedure in high-definition,” said Steven D. Vold, M.D. “I can operate more comfortably and my operating room staff can see what I see, which gives them an advantage to anticipate my needs during surgery. With these benefits patients are ultimately the winners.”

You’ve heard of Botox; how about Juvederm?

For a while, the only talk about town seemed to be Botox(Allergan,Irvine,Calif.),thatminimallyinvasive,

injectable, cosmetic option to reduce facial wrinkles.It’s a great option—no doubt—but a relatively ephem-

eral one, lasting for several months. Surgeons report Juvederm(Allergan)potentiallylastinglonger—monthstoyears, also depending on the location of treatment.

The mechanisms of action are different too. Botox: muscle relaxant. Juvederm: dermal filler. Technically, Juvederm is an injectable gel made from naturally-occurring hyaluronic acid.

As for the best news: you’ve got TWO true beauty optionsnow!ANDthey’reaneasyphonecallaway:(800)428-3937. BoozmanHof performs these injections on Wednesday afternoons.

A Macular Degeneration Option from Left Field

Genentech must be apoplectic over the competition—itself. Genentech(SouthSan

Francisco, Calif.) makes Lucentis, a treatment for age-related macular degeneration(AMD)reportedtocost a couple thousand dollars per dose.

GenentechalsomakesAvastin,originally sold for the treatment of metastatic cancers, and reports subsequently surfaced that it’s good

attreatingAMDtoo—atonlyabout$50perdoseforamountsneeded for the eye!

True, Lucentis is Food and Drug Administration-approved for treating AMD, while Avastin is not. And the availability of Medicare in the United States means that Lucentis injections are covered, although co-payment required still makes Lucentis significantly more expensive than Avastin in many instances. Of course when at all possible, financial considerations should be secondary to ensuring patients receive the best medicines.

That said, it has yet to be seen which medication truly is the best; both already are reported to be safe and effective, with the ability to improve vision in AMD patients. A large study comparing the two is underway and backed by the U.S. government. We should hear more about which is best later this year.

Until then, suffice to say that it’s cool to have cheap treatment options, but cooler still to have two potentially great choices for AMD treatment.

Cool Stuff

Before Juvederm

After Juvederm

Eyedea n 11

Before Botox

After Botox

(Image source: TrueVision Systems)

(Image source: Allergan)

W hen you send patients to BoozmanHof Eye Clinic, you can be confident that your patients will receive the very best care, with the latest technology, from experienced skilled physicians. We will work closely

with you and your staff to ensure that your patients obtain the best possible results. Once a treatment plan is formulated, our surgical counselors will work with your office in arranging the return to your care.

Since its beginnings as Boozman Eye Clinic in 1977 and later as BoozmanHof, our practice has endeavored to offer the latest innovations in ophthalmic surgery. We offer the precision of wavefront-guided LASEK and a full range of new lens optionsforcataractpatients,includingapodizeddiffractiveopticstechnology(theAcrySofIQReStor)andaccommodatingIOLtechnologies(Crystalens).

Our fully accredited, Medicare-approved surgery center accommodates every outpatient procedure we perform, including cataract surgery, LASEK, glaucoma and retinal surgeries. Staffed with experienced eye care professionals, our facility offers the very best in ophthalmic surgical technology in a comfortable, patient-focused environment.

We look forward to working with you and your staff!

We Value Our

Relationship with You

12 n Eyedea

BoozmanHof Eye Clinic offers:• Experiencedsurgeonsandstaff• State-of-the-artoperatingroomand

laser suite

Procedures include:• AdvancedSurfaceAblation(LASEK)• Astigmatickeratotomy• Aqueousshunttoextraocularreservoir

(AhmedFP7orBaerveldtshunt)• Avastin/Lucentisintravitrealinjections• Blepharoplasty• Botox/Juvederm• Canaloplasty(transluminaldilationof

aqueous outflow canal with suture)• Cataractextractionwithintraocular

lensimplantation(lifestyle,toricandaspheric lenses available)

• Ciliarybodydestruction(endoscopiccyclophotocoagulation)

• CornealtransplantsincludingDSEK• Ectropion/Entropionrepair• Endothelialkeratoplasty• Excisionofpterygiumwithconjunctival

graft• Ex-PressGlaucomaFiltrationDevice• FocalGridLaser• Irisrepair• iStentglaucomaprocedure• Laserperipheraliridotomy• Nd:YAGcapsulotomy• Panretinalphotocoagulation(PRP)• Removalofskinlesions

If you have any question or if there is anything that we can do for you, please

don’t hesitate to give us a call at 800-428-3937 or 479-246-1700, or email us

at info@boozmanhof.com.Visit our website at www.boozmanhof.com

• Aninviting,spaciousclinic• Comfortablereceptionandrecovery

areas

Our Doctors

• Repairoflacerationofcorneaorsclera• Repositioningoftheintraocularlens• Scleralreinforcementwithgraft• Strabismussurgery• Temporalarterybiopsy• Trabeculectomy(withMitomycinCor

Ologen)• Trabeculotomy(withtheTrabectome)• TranscendCyPassglaucomaimplant• VisianICL(ImplantableCollamerLens)

implantation• Vitrectomy

(From Left) Dr. Randall E. Cole, M.D., F.A.C.S., Dr. Steven D. Vold, M.D., Dr. C. William Hof, M.D.