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ASCRS•ASOA SYMPOSIUM & CONGRESS, SAN FRANCISCO 2013 ASCRS SYMPOSIUM, SAN DIEGO 2011 EW SHOW DAILY 13 Inaugural IOMED symposium discusses synergies needed by Michelle Dalton EyeWorld Contributing Writer T he first symposium on the Integrated OphthalmicManaged Eyecare Delivery (IOMED) track covered new technologies that can help improve practice efficiencies, business strategies necessary to improve patient outcomes and practice efficiencies, and how to manage challenging cases in integrated eyecare settings. Among the numerous advances in technology, a digital phoropter has shown clinical reliability at 95% or better compared to a doctor's refraction. Almost 86% of patients with dry eye have meibomian gland dysfunction, said Elizabeth A. Davis, MD, Bloomington, Minn. The key to using the newer devices to assess the tear film includes discontinuing lens use four hours before, eliminating gel-based eye drops 24 hours before, and no eye drops at all four hours before the assessment. "This procedure is billable and in Minnesota, it's reimbursed between $23 and $62," Dr. Davis said. Paul M. Karpecki, OD, Lexington, Ky., has established a dry eye clinic in his integrated practice, and recommends other practices follow suit. "We're one of the only practices with this business model," he said. "On my dry eye clinic day, I'm easily seeing 40 patients a day." He recommends practices use patient education materials for "each and every disease state." His goal, he said, is to see patients once at the point of care, not to have to bring them back two or three times to run different tests. "Integrating an ocular surface disease component into your optometric practice will enhance your referrals," he said, noting ophthalmologists may not want to be burdened with the diagnostic aspect, and optometrists may not have any interest. Femtosecond laser cataract surgery is coming to your area, if it's not already here, said J. Christopher Freeman, OD, Oklahoma City, Okla. Optometrists want to know what the ophthalmologists in their practice think about the technology. "We need to work together to have a cohesive plan—when should the topic be broached, what do patients need to know, and what message does the surgeon want patients to know?" he said. Richard C. Edlow, OD, Baltimore, Md., said the demographics of the country are changing, and "we're coming up on a 20-year plateau in the 65+ year old population," he said. "That will change dramatically in this decade—we'll see a 360% increase in demand for our services." The Affordable Care Act will add 40 million previously uninsured people who need care, age-related care will grow with the aging population, and there will be an increase in treatment modalities. In 2020, "there will be a 10.8% increase in eyecare visits," he said. And the types of diseases commonly seen in eyecare practices are likely to change as well, he added. "In 2000, 82.5% of the population was Caucasian, which will drop to 69.2% by 2030," he said. "The black population will increase to 10.2% from 5.5%, and the Hispanic population will increase to 13.2% from 8.4%." MarketScope data predicts there will be about 3.8 million cataract procedures in 2015, increasing to 4.5 millions in 2020, and to 4.8 million in 2030. Worse, in 2020 there will be 36,700 full time employee ODs and 14,820 full time employee MDs. "The Bureau of Labor Statistics predicts that we'll need 45,500 ODs an 15,000 MDs in 2020 to keep up with demand. We are woefully short," he said. Derek A. Preece, MBA, Incline Village, Nev., said ophthalmic techs need about 17 minutes to conduct an exam, reducing the MD's time to 8 minutes. "At that rate, though, a practice needs to have three techs and five open lanes so no one is standing around waiting to see a patient," he said. "Ophthalmologists need to learn to delegate more routine tasks to their staff in order to improve efficiency." Some other time saving techniques: using kiosks or tablets to have patients self-check in, using time tracking software to evaluate the lulls and resolve bottlenecks. "The less time a patient spends in the exam area, the more time they will spend in the optical area," he said. Finally, in MD-owned clinics, those with an optometrist on staff averaged $461,535 yearly (n=532); those without an optometrist averaged $378,368 (n=432). EW Editor's note: Mr. Preece owns a fee-based consulting business. The remaining participants consult for industry. Best Paper of Session winners Session: 1-A CORNEA—Surgical Techniques and Technology Infectious Keratitis After Boston Type I Keratoprosthesis Implantation: Incidence, Organisms, Risk Factors, and Outcomes Michelle J. Kim Coauthors: Fei Yu, PhD, Anthony J. Aldave, MD* Session: 1-B INTRAOCULAR SURGERY— Femtosecond Laser Femtosecond Laser–Assisted Technique for Bag-in-the-Lens IOL Implantation Ana Paula Fraga Santini Canto, MD Coauthors: Tim Schultz, MD,* William W. Culbertson IV, MD,* H. Burkhard Dick, MD* Session: 1-C INTRAOCULAR SURGERY— Presbyopia-Correcting IOLs Prospective Comparison of 1 Accommodating and 2 Multifocal IOLs: Visual Acuity, Refractive Outcome, and Contrast Sensitivity at Postoperative Year 1 Robert Edward T. Ang, MD* Session: 1-D INTRAOCULAR SURGERY— Power Calculations Measurement and Utilization of Postoperative Anterior Chamber Depth of Fellow Eye in Cataract Surgery Valliammai Muthappan, MD Coauthors: Irene C. Kuo, MD, Daniel M. Paskowitz, MD, PhD, Albert S. Jun, MD, PhD, John G. Ladas, MD, PhD Session: 1-E KERATOREFRACTIVE—LASIK, Femtosecond Laser Postoperative Biomechanical Changes After Femtosecond LASIK and Myopic Ablation Marcony R. Santhiago, MD, PhD Coauthors: Katie M. Hallahan, MD, Steven E. Wilson, MD,* David Smadja, MD, Renato Ambrósio Jr, MD, PhD,* William J. Dupps Jr, MD, PhD* Session: 1-F INTRAOCULAR SURGERY— Complications Capsulorrhexis in Hypermature Cataract With Raised Intralenticular Pressure Lakshmipathy R. Srinivasan, MBBS, DO Session: 1-G INTRAOCULAR SURGERY— Femtosecond Laser Early Visual Outcomes of First 100 Cases of Femtosecond Laser–Assisted Cataract Surgery in Ophthalmic Institution in Singapore Soon-Phaik Chee, FRCSE* Coauthor: Seng-Ei Ti, FRCSE continued on page 14