Eyeworld Daily News

ASOA NEWS ASCRS ASOA ANNUAL MEETING by Liz Hillman EyeWorld Senior Staff Writer D oes your staffing situa- tion feel like a revolving door? Do you wish you knew how to deal with millennials? This— and more—is what Cara Silletto, MBA, How to improve employee retention BRIEF SUMMARY: Please see the DEXTENZA Package Insert for full prescribing information for DEXTENZA (11/2018) 1 INDICATIONS AND USAGE DEXTENZA ® (dexamethasone ophthalmic insert) is a corticosteroid indicated for the treatment of ocular pain following ophthalmic surgery (1). 4 CONTRAINDICATIONS DEXTENZA is contraindicated in patients with active corneal, conjunctival or canalicular infections, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella; mycobacterial infections; fungal diseases of the eye, and dacryocystitis. 5 WARNINGS AND PRECAUTIONS 5.1 Intraocular Pressure Increase Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. Steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be monitored during the course of the treatment. 5.2 Bacterial Infection Corticosteroids may suppress the host response and thus increase the hazard for secondary ocular infections. In acute purulent conditions, steroids may mask infection and enhance existing infection [see Contraindications (4)]. 5.3 Viral Infections Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex) [see Contraindications (4)]. 5.4 Fungal Infections Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use. Fungal culture should be taken when appropriate [see Contraindications (4)]. 5.5 Delayed Healing The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation. 6 ADVERSE REACTIONS The following serious adverse reactions are described elsewhere in the labeling: • Intraocular Pressure Increase [see Warnings and Precautions (5.1)] • Bacterial Infection [see Warnings and Precautions (5.2)] • Viral Infection [see Warnings and Precautions (5.3)] • Fungal Infection [see Warnings and Precautions (5.4)] • Delayed Healing [see Warnings and Precautions (5.5)] 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Adverse reactions associated with ophthalmic steroids include elevated intraocular pressure, which may be associated with optic nerve damage, visual acuity and field defects, posterior subcapsular cataract formation; delayed wound healing; secondary ocular infection from pathogens including herpes simplex, and perforation of the globe where there is thinning of the cornea or sclera [see Warnings and Precautions (5)]. DEXTENZA was studied in three randomized, vehicle-controlled studies (n = 351). The mean age of the population was 68 years (range 43 to 87 years), 62% were female, and 85% were white. Forty-six percent had brown iris color and 31% had blue iris color. The most common ocular adverse reactions that occurred in patients treated with DEXTENZA were: anterior chamber inflammation including iritis and iridocyclitis (9%); intraocular pressure increased (5%); visual acuity reduced (2%); eye pain (1%); cystoid macular edema (1%); corneal edema (1%); and conjunctival hyperemia (1%). The most common non-ocular adverse reaction that occurred in patients treated with DEXTENZA was headache (1%). 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Risk Summary There are no adequate or well-controlled studies with DEXTENZA in pregnant women to inform a drug-associated risk for major birth defects and miscarriage. In animal reproduction studies, administration of topical ocular dexamethasone to pregnant mice and rabbits during organogenesis produced embryofetal lethality, cleft palate and multiple visceral malformations [see Animal Data]. Data Animal Data Topical ocular administration of 0.15% dexamethasone (0.75 mg/kg/day) on gestational days 10 to 13 produced embryofetal lethality and a high incidence of cleft palate in a mouse study. A daily dose of 0.75 mg/kg/day in the mouse is approximately 5 times the entire dose of dexamethasone in the DEXTENZA product, on a mg/m 2 basis. In a rabbit study, topical ocular administration of 0.1% dexamethasone throughout organogenesis (0.36 mg /day, on gestational day 6 followed by 0.24 mg/day on gestational days 7-18) produced intestinal anomalies, intestinal aplasia, gastroschisis and hypoplastic kidneys. A daily dose of 0.24 mg/day is approximately 6 times the entire dose of dexamethasone in the DEXTENZA product, on a mg/m 2 basis. 8.2 Lactation Systemically administered corticosteroids appear in human milk and could suppress growth and interfere with endogenous corticosteroid production; however the systemic concentration of dexamethasone following administration of DEXTENZA is low [see Clinical Pharmacology (12.3)]. There is no information regarding the presence of DEXTENZA in human milk, the effects of the drug on the breastfed infant or the effects of the drug on milk production to inform risk of DEXTENZA to an infant during lactation. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for DEXTENZA and any potential adverse effects on the breastfed child from DEXTENZA. 8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established. 8.5 Geriatric Use No overall differences in safety or effectiveness have been observed between elderly and younger patients. 17 PATIENT COUNSELING INFORMATION Advise patients to consult their surgeon if pain, redness, or itching develops. MANUFACTURED FOR: Ocular Therapeutix, Inc. Bedford, MA 01730 USA PP-US-DX-0072 discussed at the ASOA Sunday General Session. Ms. Silletto, Crescendo Strate- gies, Louisville, Kentucky, first fo- cused on the current atmosphere of employment and shifting demographics in the workforce. Currently, it's an employee/candi- date/applicants market. "Everyone is hiring these days," Ms. Silletto said. "Today, people are not just job hopping, they are career hopping and indus- try hopping." It's important to understand the mindsets within the current workforce and how that demo- graphic is changing. Ten thousand baby boomers in the U.S. are retiring each day, Ms. Silletto said. Most boomers have a more tradi- tional view of work—the idea that if they work harder, longer hours, etc., they can have more. They did this to provide a better life for their family. Gen Xers are a smaller group, but they learned early in their careers that if they wanted to suc- ceed, they would have to conform to the workforce expectations set by the boomers. The millennials—a group of 80 million—pushed back on these policies. Why? In general, Ms. Silletto said the generational differences are not about birth year. "I don't care what year you were born. What I care about is how you were raised because that gave you a very specific mindset that is different than anyone else in your office," she said. "There are a lot of millennials out there who are what we call old soul mil- lennials. Old soul millennials were raised with a much more tradition- al upbringing. … Old souls are the folks who show up, old souls show up on time—old souls don't wear leggings." Then there are the more stereotypical millennials who have a sense of entitlement and an untraditional sense of loyalty. Practice administrators have to be able to manage and bridge the gaps across this spectrum of mindsets in the office. Traditional loyalty to a company for com- mitment's sake is fading with the boomers leaving the workforce, Ms. Silletto continued. The millen- nial generation was more likely to see their parents get divorced and more likely to see their parents and other family members get laid off after the globalization move- ment. Millennials were told not to be miserable in a job, to find their passion. This drove the millennial mindset that a job needs to be a mutually beneficial relationship. If it's not, Ms. Silletto said, millenni- als are not afraid to leave because the current unemployment rate is low, they will get creative to make ends meet, and their parents are more likely to help them. It's time to recalibrate how long you think a new hire will stay, Ms. Silletto said. She told attend- ees she wants them to prepare for new hires to be in that position for 1–3 years. As such, we need to find ways to maximize the time we have with every single new hire. Ms. Silletto then gave her advice on how to become a M.A.G.N.E.T. employer. Management effectiveness While training and professional development might have been dropped from budgets years ago, these tools are important, Ms. Sil- letto said. Training managers and supervisors to make them better communicators and leaders can lead to better employee retention. Attraction & recruiting Ms. Silletto said the best recruiting tool you have is better retention. Become a place people want to work at, hang on to people you want to keep, and other people will hear about it, she said. "Work internally to be a better place to work first," Ms. Silletto said. Also in this realm is expediting the application-to-hire process. Every

• Cover