Optometric Physician

Vol. 21, #17   •   Monday, May 3, 2021


Off the Cuff: EHR – An Unfulfilled Promise

Although this may sound strange to younger readers, the transition from paper to electronic records was a slow, tedious and painful one for many of us. Paper was quick, extremely customizable and very specific. No redundant boilerplate drivel filling pages, you wrote or drew what you saw and thought. You could measure the growth of your practice and success by the number of charts filling the storage racks. Yes, it was messy, but it worked.

My relationship with electronic health records started before EHR did. In 1977, I purchased a then brand-new Apple II and when a floppy disk drive finally became available, I modified a database program to manage patient recalls. In the early 1980s, I bought a just-introduced IBM PC and taught myself to program in Turbo Pascal. It took a bit over a year, but when I was done, I had created Practice Perfect, a tiny MS-DOS-based office management system that fit on a single 3.5-inch floppy along with 10,000 patient records. I sold a few copies and we used the program in our practice for decades, keeping a DOS computer running long after the world and the rest of the office converted to Windows.

While Practice Perfect managed our billing, recalls and other front office functions, we still used paper for patient records and insurance billing, which was starting to rear its ugly head back then. When I escaped NY and opened Phoenix Eye Care about eight years ago, we didn’t even bother planning for paper record storage. The world had changed and paper records were of historical, not practical, interest. As part of the planning for the office, we looked at virtually every EHR system and finally settled on Compulink, in large part because Shannon was already familiar with it. Based on my experience developing software and user interface design, I thought Compulink was terrible. I still do.

The promise of interoperability with other healthcare providers and access to a patient’s entire health history lessened the pain of learning the system, but that promise was never fulfilled. From the looks of it, it never will be. We still stand alone, an isolated healthcare provider with no access to critical patient health information, yet facing stiff penalties if any of that information somehow escapes our carefully protected environment.

Our overall experience with Compulink can best be described by a single word that rhymes with link. A few years ago, for some reason, our cloud-based system was restored from the wrong backup, putting our system totally out of sync and effectively shutting us down for several weeks. I was able to get it resolved, largely because of my footprint in the profession, but I suspect that this would not have been easily accomplished by the average Compulink user.

Lately, Compulink has been pushing updates without warning or any ability on our end to control their implementation. Because our practice is quite specialized and very busy, we adapted existing forms for specific use. Many of those forms are gone. Errors pop up that we are forced to work around and, in some situations, we have lost the ability to enter and retrieve essential information. Our required patient portal is absolute garbage. When we complained about the bugs and lost forms, we were offered an expensive upgrade or we could wait for the next update push with no timeline for when it will come or assurance that it will fix anything.

I’ve learned several things from my EHR journey. First, paper records weren’t all that bad. Second, if you are considering Compulink for your EHR system, I would suggest you look elsewhere. Finally, if you think that EHR will help integrate healthcare providers and improve patient care through increased access to data, don’t hold your breath.


Arthur B. Epstein, OD, FAAO
Chief Medical Editor

Want to share your perspective?
Write to Dr. Epstein at artepstein@optometricphysician.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.



Rates of RNFL Thinning in Distinct Glaucomatous Optic Disc Phenotypes in Early Glaucoma

This clinical cohort study compared spectral-domain optical coherence tomography (SD-OCT)-measured circumpapillary retinal nerve fiber layer (cpRNFL) among four glaucomatous optic disc phenotypes in early glaucoma. A total of 218 early glaucoma eyes that had at least three years of follow-up, and a minimum of four SD-OCT scans were recruited. The optic discs were classified into four types based on appearance: 76 generalized cup enlargement (GE), 53 focal ischemic (FI), 22 myopic glaucomatous (MY) and 67 senile sclerotic (SS). A linear mixed-effect model was used to compare the rates of global and regional cpRNFL thinning among optic disc phenotypes.

After adjusting for confounders, the SS group (mean: -1.01 µm/year) had the fastest mean rate of global cpRNFL thinning, followed by FI (-0.77 µm/year), MY (0.59 µm/year) and GE (-0.58 µm/year) at p<0.001. The inferior temporal sector had the fastest rate of cpRNFL thinning among the regional measurements except for the MY group (-0.68 µm/year). In the multivariable analysis, GE and MY phenotypes were associated with significantly slower global rates of cpRNFL thinning when compared to the SS phenotype.

Researchers wrote that rates of cpRNFL thinning were different among the four glaucomatous optic disc phenotypes. Those patients with early glaucoma with SS phenotype had the fastest cpRNFL thinning. They added that these patients may benefit from more frequent monitoring and the need to advance therapy if cpRNFL thinning is detected .

SOURCE: David RCC, Moghimi S, Ekici E, et al. Rates of RNFL thinning in distinct glaucomatous optic disc phenotypes in early glaucoma. Am J Ophthalmol. 2021; Apr 25. [Epub ahead of print].




Intraocular Pressure with Mini-scleral Contact Lenses

According to literature data, some experts do not exclude the possibility that scleral lens wear could influence intraocular pressure. The study included 99 volunteers without a history of ocular diseases to evaluate the influence of rigid gas permeable mini-scleral contact lenses on intraocular pressure (IOP), keratometry readings and corneal thickness, and to study the correlation between scleral (IOPs) and corneal (IOPc) intraocular pressure using the Icare ic100 tonometer (model TAO11, Icare Finland Oy). The first group consisted of 66 participants (122 eyes) ages 22.3±2.2 years. IOPc and IOPs were measured by the Icare ic100 tonometer in order to determine the correlation. In the second group (33 participants, aged 22.7±1.7 years), day 1, diurnal IOPc and IOPs fluctuations were measured; on day 2, a mini-scleral lens (diameter 14.9 mm) was placed on the study eye and was worn for six hours, with the paired eye serving as control. IOP was measured before, after lens placement, after two hours of lens wear, and before and after lens removal. Corneal topography was evaluated before and after lens removal.

In the first group, there was a weak but significant correlation between IOPc and IOPs. In the second group, IOPc in the study eye before lens placement (14.8±3.8 mmHg) and IOPc after its removal (13.6±3.9 mmHg) were not different from those in the control eye. There were also no statistically significant changes in IOPs before, during lens wear, and after lens removal. The central corneal thickness increased by 2.9% after six hours of lens wear.

In young individuals without a history of ocular disease, wearing the mini-scleral lens for six hours did not have significant influence on IOP and does not cause clinically significant corneal edema.

SOURCE: Fedotova K, Zhu W, Astakhov SY, et al. Intraocular pressure with miniscleral contact lenses. Vestnik Oftalmologii. 2021;137(2):52-8.



Sleep and Subjective Happiness Between the Ages 40 and 59 in Relation to Presbyopia and Dry Eye

The aim of this study was to explore the status of quality of life between the ages 40 and 59 in relation to presbyopia and dry eye. Near add power and preferred contact lens power were examined in 219 participants at three clinics. A total of 2,000 participants completed a web-based survey on presbyopic symptoms, symptomatic dry eye, sleep quality and subjective happiness.

Mean preferred corrected visual acuity was less than 20/20 in women (vs. men, p<0.01) who were more often prescribed undercorrected contact lenses, whereas men preferred full correction. According to the annual progression rate of near add power in men (0.1468D/year), the estimated difference in presbyopia progression between men and women was 0.75 years in the right eye and 1.69 years in the left eye, implying men might suffer presbyopia earlier than women due to higher myopic power of daily use contact lenses. The web-based survey revealed that men reported lower subjective happiness than women (p<0.001) and earlier onset of presbyopic symptoms by 1.1 to 1.7 years (p<0.05). Men received their first reading glasses 0.8 years earlier than women (p=0.066). Multiple regression analysis demonstrated that awareness of presbyopic symptoms, visual burden, and dry eyes were significantly correlated with poor sleep quality and subjective happiness.

Researchers wrote that presbyopia and dry eye were significantly associated with sleep quality and subjective happiness in middle-adulthood.

SOURCE: Negishi K, Ayaki M, Kawashima M, et al. Sleep and subjective happiness between the ages 40 and 59 in relation to presbyopia and dry eye. PLoS One. 2021; Apr 23;16(4):e0250087.





Industry News

Alcon Launches Systane Hydration Multi-Dose Preservative-Free Lubricant Eye Drops, to Acquire U.S. Commercialization Rights to Simbrinza

Alcon announced the U.S. launch of the newest addition to its portfolio of dry eye products – Systane Hydration Multi-Dose Preservative-Free Lubricant Eye Drops. With its proprietary HydroBoost Technology, this new preservative-free eye drop provides extra moisture for patients with sensitive dry eyes. Learn more.
In addition, the company signed an agreement to acquire exclusive U.S. commercialization rights to Simbrinza (brinzolamide/brimonidine tartrate ophthalmic suspension) 1%/0.2% from Novartis. Read more.



Aerie Completes Enrollment of its Phase IIb Clinical Trial of AR-15512

Aerie Pharmaceuticals completed patient enrollment for COMET-1, a Phase IIb clinical trial of AR-15512 (TRPM8 Agonist) (“AR-15512”) ophthalmic solution for the treatment of patients with dry eye disease. Read more.

Heidelberg and RetInSight to Offer AI-based OCT Fluid Quantification

Heidelberg Engineering GmbH and RetInSight GmbH plan to interface the RetInSight AI-based fluid monitor application with the Heidelberg Engineering product portfolio, using cloud exchange and application marketplace technologies. RetInSight utilizes a novel, proprietary algorithm that supports the detection, localization and quantification of intra- and subretinal fluid in OCT images. The fluid monitor application aims to facilitate early diagnosis and therapeutic guidance in the most common diseases of the retina. Read more.

Prevent Blindness Announces Recipients of Jenny Pomeroy Award, Declares May Ultraviolet Awareness Month

Prevent Blindness announced the recipient of the 2021 Jenny Pomeroy Award for Excellence in Vision and Public Health as R.V. Paul Chan, MD, MSc, MBA, FACS, professor and head, Department of Ophthalmology and Visual Sciences, and The John H. Panton, MD Professor of Ophthalmology, director, Pediatric Retina and ROP Service at the Illinois Eye and Ear Infirmary, University of Illinois at Chicago. Additionally, the group announced the recipient of the second annual Rising Visionary Award as Shervonne Poleon, Vision Science Graduate Program student, University of Alabama at Birmingham. Read more.
In addition, Prevent Blindness declared May Ultraviolet Awareness Month as a way to educate the public on the increased risk of everything from “corneal sunburns” (photokeratitis) to diseases such as cataract and eye cancers. Prevent Blindness offers a variety of free resources on UV protection to keep vision healthy, including fact sheets and a dedicated webpage. Shareable infographics on sun safety are also available. View the resources.

Foundation Fighting Blindness Appoints Dr. Gelfman as Chief Scientific Officer

Foundation Fighting Blindness appointed Claire M. Gelfman, PhD, as chief scientific officer. Dr. Gelfman will be responsible for leading the scientific strategy of the organization, with a focus on research initiatives designed to accelerate new treatments and cures for inherited retinal diseases. Prior to joining the Foundation, Dr. Gelfman served as vice president of pharmaceutical development at Adverum Biotechnologies. Read more.





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