Ophthalmology Business

MAR 2014

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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6 Ophthalmology Business • March 2014 by Tony Realini, MD Want to examine your own eyes? W e all support and promote the concept of screening eye examinations, but in reality, people without any vision symptoms are relatively unlikely to seek out eyecare. Potentially blinding conditions such as glaucoma and macular degenera- tion are usually asymptomatic until the late and difficult-to-treat stages. Can technology help us identify these people before they experience significant visual dysfunction? Perhaps. A variety of online and smart device app-based services offer both screening and therapeutic opportunities for people with glaucoma, macular degeneration, and diabetic macular edema. Glaucoma Screening for glaucoma is complicat- ed by the lack of a standardized diagnostic definition of the disease. Screening for glaucoma using intraocular pressure (IOP) is of limit- ed value given that many people with glaucoma have normal IOP and most people with elevated IOP do not have glaucoma. Screening by optic nerve appearance often requires dilation for an adequate stereoscopic view. The value of perimetry is limited by its lack of both availability and portability in screening settings. Until now. Tsontcho Ianchulev, MD, University of California, San Francisco, has launched a foundation (KeepYourSight) and spearheaded the development of a web-based perimetry test to identify patients with moderate and advanced glaucoma. Located at www.keepyoursight.org, the test can be self administered by people on their home computer at no cost and tracks reliability indices such as false positive and negative responses as well as fixation losses. The suprathreshold 24-2 testing strategy takes about 5 minutes for both eyes (tested separately), and the results are reviewed by experts and reported back to subjects by email within one to two days. "This test is 90% accurate in detecting moderate or severe glaucoma, which represents more than 70% of undiagnosed glaucoma … and should be the main focus for early screening and timely interven- tion from a public health perspec- tive. While early and preperimetric glaucoma is another important fron- tier, the urgency and need there is less critical," Dr. Ianchulev said. "We recommend periodic rescreen- ing every six to 12 months for peo- ple over 50 so that we can monitor the earliest possible changes before there is any threat to central vision." 02-19_OB March 2104_Layout 1 2/19/14 11:07 AM Page 6

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