With rapid changes in healthcare technology and telemedicine, there's perhaps never been a more important time for optometrists to get involved in local and federal legislative initiatives. Deciding you want to make a difference in changing the course and direction of the profession is a vital first step, but the truth is that getting involved with legislative action can be daunting.  How do you develop a relationship with your local or state representatives?  How do you get your opinions and passion for eyecare and patient advocacy heard?

In 1901 when Minnesota became the first state to recognize and legislate the scope of practice for optometrists, ocular healthcare was quite different than today.  As technology has changed and improved to provide safer, faster, and more efficient healthcare solutions, medical providers have had to learn and adopt this new technology to best serve their patient's needs. That's the basis of continuing education hours to maintain  a medical license after all.  But by 1921 when all states in the US had passed legislation recognizing and defining optometric care, the technology that now exists to treat patients could not have been dreamed of or planned for to be written into those original defining laws.  That is the situation that optometry faces now in 2018 where the legislation written in each state that defines the practice of ocular healthcare is now also limiting how the profession can best serve patients. 

Dr. Joanna Bomkamp Gerhardt training on the YAG Laser at the Southern College of Optometry.  Training for minor surgical and laser procedures is a standard part of optometry school curriculum, but the ability to perform these procedures that were taught in school is legislated state by state.  via

The optometric work force is changing!  Women in Optometry reported last year that 66% of optometry school graduates in 2021 will be female.  Dr. Stephanie Aguilar (above) is one of this new generation of optometrists that will be the first to see the profession switch from male dominated to female dominated.

Dr. Aguilar at her residency graduation

The decision to pursue residency training after completing optometry school can be a difficult one.  Dr. Aguilar knew by her third year in school that it was the right decision for her. "All of the coolest speakers (whether AOA representatives, private practice doctors, etc.) that came to school had done residencies and spoke so highly of the experience. My professors in school also recommended a residency to improve my clinical skills, as well as gain knowledge and experience before going into the workplace. At that time, I was also considering a career in a hospital setting and knew if I wanted to ever do that, a residency was a must."

She has great advice for student ODs that are interested in pursuing a residency of their own. "The best way to prepare for residency applications is to start early. The easiest ways to stand out are to be involved in your school and excel in the areas that your residency is in."  During the interview, be prepared to discuss specifics about your clinical experiences so far, and be personable and conversational throughout the process. "Think of a few clinical scenarios that were significant to you, as this was a common topic of conversation during interviews. As always, be yourself because it’s likely that during your interview you are not only being evaluated on your credentials, but also whether or not your preceptors can stand working with you for a year!"  

Finding the right job out of school or residency is a huge milestone (or hurdle!) in a young optometry career. While Dr. Aguilar had entered her residency considering working in a hospital setting, it was a private practice back in her home town of San Antonio, Texas that became the right fit for her.  Like many great opportunities, networking was the key.  "In my case, who I knew was critical. I found my job through a previous volunteer experience. Every time I came home from optometry school, I would volunteer at the Haven for Hope I Care Clinic that provides eye care for the homeless population in San Antonio. I had a good relationship with the manager at the office. While in Boston, I called her and asked if she knew any doctors hiring in the area. She put me in contact with two doctors, one of them being my place of work now. My advice is to treat everyone with respect because you never know who will help you down the road. Keep your options open, interview with many different offices and always ask for what you deserve in compensation."  With our pay gap as it stands currently in optometry, her words of advice can't be more of a call to action!




Patient care is Dr. Aguilar's true passion, and it hasn't taken long in her young career to see her love for optometry touching lives.  Even after a residency focused on treating and managing ocular disease, it's the simple day to day mission of being an optometrist - helping patients see their best - that has left the biggest impression on her so far.  "The patient encounters that impact me the most are those in which I feel I’ve made an improvement in the patients’ lives. Whether it’s a patient that is successfully fit into multifocal contacts, a child seeing their parents clearly for the first time thanks to new glasses, or a corneal ulcer patient that is healed after two weeks of pain and blurred vision."

The future for young optometrists hold exciting promise, but plenty of challenges as well. "In my opinion the biggest immediate risk to our profession is telemedicine or optometry offices that offer a “comprehensive eye exam”, when in reality it’s someone remotely performing refraction and then reviewing anterior and posterior segment photos."  

"Another risk to our profession is the group mentality that someone else will take care of this problem. In my opinion, all optometrists should support the American Optomteric Association because they work tirelessly to support and improve our profession. Without them, there is no telling where optometry would be and I hope I never to find out. So being a member of the AOA, joining their team or lobbying on optometry’s behalf is advantageous to all of us."



Want to learn more from Dr. Aguilar?  Stay tuned for more articles written by her appearing on the blog, and you can reach out to her for advice or mentorship by email!

Deep, boring pain behind your eyes. Throbbing, pulsating pain in your temples. Vision changes, zig zags, flashing lights, or tunnel vision.  Nothing seems to help except lying down or just closing your eyes.  For the 13% of Americans living with chronic headaches and recurrent migraines, these symptoms are all too familiar.   In fact, those diagnosed with chronic migraines spend 15 or more days each month with a migraine headache, and each episode could last 72 hours or more at a time (a condition known as status migrainosus). Photophobia or light sensitivity is one of the most common vision complaints of someone living with migraines, so seeking help from an optometrist can be a great resource for finding relief.  There are numerous eyewear tints, coatings, and lens designs that could be a major source of comfort, and even a low powered prescription could greatly reduce eyestrain or tired eyes that could be a trigger for a migraine event.

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It's that time of year again! As new technology in the world of contact lenses continues to enter the marketplace and get FDA approval, older and less breathable contact lenses are being taken off the market.  Effective as of 11/1/2017 you can no longer get trial or diagnostic lenses of any contact lens listed below.  Here's a list of the recent discontinuations and their last dates for available box purchases by CooperVision:

• Biomedics XC
• Discontinued 11/1/2017
• Biomedics 38 and Biomedics 55 were discontinued in 2016
• Biomedics Premier (aspheric) is still available at this time
• Clearsight 1 Day Toric
• Discontinued 11/1/2017
• Vertex Toric XR
• Discontinued 1/1/2018
• Vertex Sphere was discontinued in 2016
• Avaira Sphere
• Discontinued 5/1/2018
• This lens is being replaced by Avaira Vitality
• Avaira Toric
• Discontinued 1/1/2018
• This lens is being replaced by Avaira Vitality Toric
• Frequency 55 Toric
• Discontinued 11/1/2018
• Frequency 55 sphere was discontinued in 2016, Frequency 55 Aspheric is still available at this time 
• Frequency 55 Toric XR
• Discontinued 11/1/2018

If you need extended range (XR) toric lenses,  Proclear Toric XR and Biofinity Toric XR are both still available through CooperVision!

If you wear one of these CooperVision products, you are in the most current contact lens technology! These are the brands that will continue to be available and best priced by the company going forward.

With Friday's announcement that the FDA has approved Vyzulta, Valeant and Nicox's novel new glaucoma therapy, the eyecare world gets its first new treatment for glaucoma since prostaglandins entered the market in 2001!  Numerous efficacy studies point towards Vyzulta being the most effective intraocular pressure (IOP) lowering medication to date.  Vyzulta combines tried and true prostaglandin analogue latanprostene with nitric oxide to target aqueous outflow through multiple channels, including uveoscleral, trabecular meshwork, and through Schlemm's canal to reduce IOP.

From the poster Integrated Safety and Efficacy of Latanoprostene Bunod for Lowering of Intraocular Pressure in Open Angle Glaucoma and Ocular Hypertension by Murray Fingeret, OD and Jason Vittitow, PhD

The Basics
Vyzulta (Bausch and Lomb) 0.024% latanoprostene bunod
Dosage: 1 x a day in the evening
Approved for age 16 and older; not tested for safety with pregnancy or nursing mothers
Do not insert over contact lenses; wait 15 minutes after drop instillation to put in contact lenses
Approved for: Primary Open Angle Glaucoma and Ocular Hypertension

Side Effects
Like all prostaglandin analogues, there are possible side effects that include:

• Redness  (occurred in 6% of clinical study participants)
• Irritation or Pain with Insertion (occurred in 4% and 3% respectively)
• Increased Pigmentation of the Iris and Eyelid Skin
• Lash Growth
• Increased Inflammation  - active ocular inflammation is a contraindication for use
• Macular Edema 

From the poster Integrated Safety and Efficacy of Latanoprostene Bunod for Lowering of Intraocular Pressure in Open Angle Glaucoma and Ocular Hypertension by Murray Fingeret, OD and Jason Vittitow, PhD

The Study Data
Multiple clinical studies have show promising results! Vyzulta showed better efficacy versus the current standard treatments on the market, including prostaglandin analogues alone and timolol dosed twice daily.

The JUPITER study showed longterm efficacy in a population of 130 patients with open angle glaucoma or ocular hypertension over a 52 week period. The average starting IOP of all patients enrolled was 19.6 mmHg.  At week 4 there was a 22% reduction from baseline IOP in the treated group. At week 52 the average IOP of the treatment group was 14.4 mmHg, a reduction of 26% from baseline. 

Against Prostaglandin Analogues Alone: 
The VOYAGER study looked at Vyzulta's efficacy against Xalatan (latanoprost 0.05%) dosed once daily in 413 patients with open angle glaucoma or ocular hypertension. Over the 28 day study, Vyzulta showed statistically better IOP lowering effect versus Xalatan, with a mean difference in IOP lowering effect of 1.23 mmHg between the two medications.  Additionally, 68.7% of Vyzulta treated patients achieved average dirunal control of IOP of < 18 mmHg, versus only 47.5% of Xalatan treated patients.

Against Timolol:
The APOLLO study looked at the effectiveness of IOP lowering in Vyzulta dosed once a day in the evening against timolol maleate 0.5% dosed twice daily. Vyzulta showed statistically significant greater IOP reduction than timolol at all time points studied over the 3 month trial period. The percentage of subjects with an average IOP of 18 mmHg or less, and the percentage with IOP reduction of >25% were significantly higher in the Vyzulta group versus the timolol group.  22.9% of patients treated with Vyzulta had an average IOP 18 mmHg or less versus only 11.3% of timolol treated patients. IOP reduction by >25% occurred in 34.9% of Vyzultra treated patients versus only 19.5% on timolol.

The CONSTELLATION study tested Vyzyulta dosed once a day in the evening against 0.5% timolol maleate dosed twice daily on its effects on nocturnal IOP increases. Nocturnal IOP using Vyzulta was statistically significantly lower than using timolol. Patients on Vyzulta treatment had 2.5 ± 3.1 mm Hg lower IOP overnight than baseline versus  2.3 ± 3.0 mm Hg lower IOP on timolol treatment.  Vyzulta also showed greater ocular perfusion pressure overnight compared with timolol treatment.

There is no word yet on cost or when eye doctors can start prescribing Vyzulta, but company representatives have said the medication will hit the market "by the end of 2017."

Stem cell treatments have promised regenerative cures for many untreatable conditions since the first successful stem cell transplant back in 1956. In the world of eyecare, where damaged retinal tissue results in permanent and uncorrectable vision loss, the prospect of recovering vision with a stem cell therapy is an understandably exciting one. Much excitement surrounded the successful Phase I/II clinical study of injecting stem cells into the eye to treat conditions like Stargardt macular dystrophy and macular degeneration in February 2015.  Of the 18 patients treated with stem cell injections in that study, there were no significant adverse events and 47% of eyes showed either improvement or no worsening in vision over a 2 year period.  But unfortunately these early successes in the field of ocular stem cell injections have led some to take risky approaches to gain financially from the excitement around stem cell treatments and the desperation of patients that are faced with living with permanent vision loss.

Pluripotent stem cells from the California Institute for Regenerative Medicine which is currently doing FDA approved stem cell research for retinitis pigmentosa.