PCON Philadelphia: clinical pearls, practice tips

The Sixth Annual Primary Care Optometry News Symposium, to convene in Philadelphia Nov. 17 to 19, will feature an esteemed lineup of speakers from all areas of clinical practice.

Topics such as dry eye, refractive surgery, glaucoma management, coding, contact lenses and more will be discussed during 3 information-packed days of optometric education.

PCON Symposium 2005: Editor Dr. DePaolis will once again moderate at this year’s 3-day meeting.

Rules for coding

For the first time at the PCON Symposium, a grand rounds presentation on coding will be given by PCON “Medicare Coding” columnist and new Editorial Board member Charles B. Brownlow, OD, FAAO. In this presentation, Dr. Brownlow will discuss some of the caveats for providing health care, as well as the National Rules for Medical Records. Among these will be Current Procedural Terminology (CPT) codes for Visit and Procedures, International Classification of Diseases codes, HCPCS Codes for materials and for special procedures not listed in CPT and the documentation guidelines for Evaluation & Management Services.

Dr. Brownlow will discuss the contents of history of present illness, including duration, timing, context, modifying factors and associated signs and symptoms. He will also explain the final seven “gradable” elements of a physical examination, including lenses, bulbar/palpebral conjunctiva, intraocular pressure, dilated view of discs and of peripheral retina, and brief assessment of mental status.

Dry eye, ocular surface disease

Ernest Bowling, OD will discuss the etiologies of dry eye and ocular allergy in his presentation “Is it allergies, dry eye or both?” Dr. Bowling will explain how to identify clinical signs and symptoms to make the differential diagnosis. He will also discuss patient interview techniques that yield valuable diagnostic information, as well as the topical medications used to treat each of these conditions.

Dr. Bowling will go over the “catchwords” from the patient that can point the diagnosis toward one or the other of these conditions. For example, catchwords that point to dry eye are “gritty,” “sandy,” “scratchy,” “dry” or “tired.” In cases of allergy, patients are more likely to use words such as “swollen,” “puffy,” “teary” or “watery.”

He also will discuss how to glean important clues by asking the patient what happens when they rub their eyes. In an allergic reaction, rubbing will cause increased conjunctival vasopermeability, resulting in an increased mast cell migration. Therefore, these patients typically experience a worsening of symptoms.

Conversely, when patients with dry eye rub their eyes, it actually promotes reflex tear secretion and may provide temporary relief.

Lid crusting is another phenomenon that Dr. Bowling will discuss in terms of its significance to dry eye and allergy. Practitioners will also learn clinical pearls regarding associated systemic symptoms.

Glaucoma update

PCON Editorial Board member Bruce E. Onofrey, OD, RPh, will present a glaucoma update, in which he will discuss the goals of IOP-lowering therapy and the available treatments. Dr. Onofrey will explain the advantages and disadvantages of the different classes of drugs, including cholinergic agonists, beta-adrenergic agonists, beta-adrenergic antagonists, alpha-adrenergic agonists, carbonic anhydrase inhibitors and prostaglandin derivatives.

He will discuss prostaglandins and the factors in choosing a prostaglandin, including price, availability in the managed care arena and patient acceptance. Dr. Onofrey will also discuss the future of neuroprotection, as well as future systemic drugs.

Contact lens presentations

PCON Editorial Board member Jennifer L. Smythe, OD, MS, FAAO, will make several presentations on contact lenses.

Dr. Smythe’s first session, titled “Subtleties of silicone hydrogels,” will discuss topics such as treatments, deposits, active vs. passive cleaning and differences in effective power ranges from previous lenses.

She will also discuss incompatibilities between lens materials and solutions, corneal staining with and without symptoms and recommended lens care regimens for silicone hydrogels.

A second presentation by Dr. Smythe, “Clinical pearls for the specialty design contact lens practice,” will explore designs for the irregular cornea such as aspheric gas permeables, mini-sclerals and hybrid designs. For each of these, Dr. Smythe will discuss the fitting goals and initial trial lens selection.

Finally, PCON Editorial Board member Walter L. Choate Jr., OD, FAAO, will join Dr. Smythe on “Non-surgical management of presbyopia.” In this presentation, Drs. Smythe and Choate will discuss multifocals and will outline the fitting goals, front and back add power, lens diameter and material effect.

Oral medications

Nicky R. Holdeman, OD, MD, FAAO, will give a presentation on “Oral medications and ocular sequelae.” Dr. Holdeman will discuss drugs such as hydrocodone/acetaminophen, Lipitor (atorvastatin calcium, Pfizer) amoxicillin, lisinopril, HCTZ/furosemide, atenolol/metoprolol, Zithromax (azithromycin, Pfizer) and alprazolam. He will look at the ocular side effects, drug interactions and contraindications of each of these systemic dugs.

Dr. Holdeman will discuss the optometrist’s role as “internist of the eye,” and the fact that ODs are required to “treat sick people with sick eyes.” He will explain how writing a prescription has become a “cultural phenomenon,” and how prescriptions validate a patient’s complaint and legitimize the patient’s illness.

A second presentation by Dr. Holdeman will address the topic of “The many faces of thyroid disease.”

In this presentation, Dr. Holdeman will talk about the causes of hyperthyroidism, including Graves’ disease, toxic multinodular goiter, toxic adenoma, thyroiditis, iodide-induced hyperthyroidism, toxic-thyroid carcinoma, tactitious thyrotoxicosis and toxic struma ovarii.

Dr. Holdeman will advise practitioners on the signs and symptoms of thyroid eye disease (TED), as well as detail the elements of a baseline TED exam. He will also discuss how to make a diagnosis of Graves’ disease.

In addition, Dr. Holdeman will address the topic of thyroid ophthalmopathy and the various progressive stages.

Refractive surgery update

Thomas W. Samuelson, MD, will provide an update on refractive surgery titled “Which procedure for which patient?”

In this session, Dr. Samuelson will discuss the benefits of LASIK, including patient-friendliness, bilateral-friendliness and the “wow” factor. He will also discuss LASIK limitations, including the range of treatable refractive error and corneal thickness limitations.

Dr. Samuelson will discuss the other refractive surgery options, such as photorefractive keratectomy/advanced surface ablation, epi-LASIK, phakic IOLs and IntraLase (IntraLase Corp., Irvine, Calif.).

Specifically, Dr. Samuelson will address the advantages of IntraLase, such as low IOP, precision, reproducibility, control of surgical parameters, reduced complications and marketability. He will also outline the disadvantages of IntraLase, including expense, size, bulkiness, slowness and a slower return of best-corrected visual acuity.

Dr. Samuelson will then discuss the role of phakic IOLs, comparing them to LASIK in terms of treatment parameters, track record and lasting results.

Also to be discussed in this presentation will be wavefront LASIK and why optometrists should incorporate this technology into their practices. Dr. Samuelson will describe cases for which practitioners should be cautious about custom LASIK, such as those with high prescriptions, those who have had previous refractive surgery and those with dry eye that would prevent good wavefront capture.

Dr. Samuelson’s presentation will explore refractive surgery options for presbyopia, including monovision, laser, conductive keratoplasty (CK), implants and multifocal implants.

He will also discuss the advantages of CK, including its relatively minimal invasiveness compared to LASIK, lack of cutting and flap complications, less dry eye, no suction tissues, no tissue removal and peripheral rather than central treatment.

In another presentation, called “The future of refractive surgery: Is comamagement part of it?” Dr. Samuelson will address the increasing trend toward direct-to-consumer marketing in large laser centers. He will outline the factors in decreasing comanagement, such as shrinking profit margins, less aggressive promoting of LASIK by ODs, malpractice and legal challenges.

He will discuss how to get more refractive surgery patients through aggressive promotion, being an expert, leveraging your clout and truly becoming an expert.

For more information:

• The Sixth Annual Primary Care Optometry News Symposium will be held at the Westin Philadelphia Nov. 17 to 19. Contact Meeting Registration at Vindico Medical Education, (877) 307-5225 or (856) 848-1000; fax: (856) 251-0278; e-mail: meetingregistration@VindicoMedEd.com.