A recent study by the
Of the surveyed practices 12 percent had EMR systems in place, 7 percent were in the implementation process, and 10 percent had plans to do so within 12 months. Among practices with EMR: 69 percent were satisfied or extremely satisfied; 64 percent reported increased or stable productivity; 51 percent reported decreased or stable overall costs; and 76 percent would recommend the use of EMR to fellow ophthalmologists. EMR features rated as most valuable were similar among users and included improved patient care and billing/charge collection. The EMR adoption rate among ophthalmologists is similar to that of other 
Given these positive findings, why is EMR use still limited among
Studies Report Progress in Predicting AMD
Two reports in September's Ophthalmology highlight recent studies on macular degeneration.
The Complications of Age-Related Macular Degeneration Prevention Trial was a multicenter, randomized clinical trial (conducted from 1999 to 2005) that investigated whether low-intensity laser treatment could prevent vision loss in patients with early stage age-related macular degeneration. This clinical trial, sponsored by the National Eye Institute, did not show that the laser treatment was effective in preventing loss of vision, but the results did provide valuable information on factors that predict progression to advanced AMD.
Patients with early AMD whose eyes have many large drusen are known to be at higher risk for developing choroidal neovascularization and/or geographic atrophy. CAPT is the first study large enough to look separately at risk factors for the development of CNV and of advanced GA in AMD patients with extensive drusen in both eyes. The 1,052 CAPT participants each had 10 or more large drusen and visual acuity of 20/40 or better in each eye at the study outset. Each patient received low-intensity laser treatment in one eye only; the other eye was observed. Follow-up exams took place yearly for five or six years. CAPT concluded that laser treatment did not change the risk of developing
Analysis of the CAPT results allowed researchers to identify factors that predicted the risk of progression from early to advanced AMD. They found that some factors were associated with both forms of advanced AMD and others with only one form. Increased age and pigment clumps in the retina were associated with the development of both CNV and GA. Current, but not past, smoking was linked to a higher risk of CNV, indicating that smoking is likely an active stimulus to CNV. The size of the retinal area covered by drusen and the presence of lightly pigmented areas in the retina were associated only with progression to GA. "These findings increase the understanding of how CNV and GA develop and aid ophthalmologists in discussing prognosis with patients who have many large drusen," said Maureen G. Maguire, PhD, professor of ophthalmology at the University of Pennsylvania Health System, and corresponding author on the risk factors study.
In the second study, Janet S. Sunness, MD, director of the Hoover Low Vision Services at the Greater Baltimore Medical Center, and her fellow researchers report a simple and inexpensive way to predict the rapid loss of visual acuity the ability to see detail in dry AMD patients. Of patients with GA who have visual acuity of 20/50 or better, about one-quarter become legally blind within four years. Other GA patients never progress to severe vision loss. The ability to identify GA patients at highest risk is important to patient care as well as future AMD research. Dr. Sunness' study evaluated GA patients who began the study with 20/50 or better vision; their performance under low luminance conditions strongly predicted whether they would suffer significant loss of visual acuity within two years. This study was the first to quantify predictive values for "low luminance visual acuity deficit" and describe the importance of this predictive tool for GA patient screening.
It is known that the visual function of GA patients is significantly worse in low-light conditions. In annual exams over the two-year study period, Dr. Sunness' team measured the patient's standard visual acuity, the ability to read lines on a chart under regular testing conditions, and then repeated this measurement with the patient wearing moderate gray sunglasses (2 log unit neutral density filter). On average, elderly patients without GA were able to see two fewer lines with the filter in place, while GA patients with 20/50 vision or better at baseline saw five fewer lines. The 91 study participants were a cohort of a larger 1992 to 2000 NIH-funded study, directed by Dr. Sunness, of the natural history of GA progression at the Wilmer Eye Institute at Johns Hopkins School of Medicine.
The participants with the worst "low-luminance deficit" at baseline were significantly more likely to have lost visual acuity by the end of the study than the better LLD group. Contrast sensitivity and reading speed were also measured for participants; the retinas were photographed; the eyes were examined for AMD progression; and the total area of GA in each eye was determined. Another predictor of visual acuity loss was a significantly reduced reading rate at baseline. Factors that did not predict visual acuity loss in these patients include: age, gender, the GA total area at baseline, or the rate of GA enlargement during the study period.
GA is a public health issue that deserves heightened attention and research, Dr. Sunness says, as the disorder causes more severe vision loss than diabetic macular edema, a well-recognized public health problem, and as treatment or prevention of GA is not currently available. Also, GA affects both eyes for most patients, resulting in vision loss that is more devastating than when eye disorders affect one eye only.
Eli Lilly Registry Will Disclose Physician Payments
Drug manufacturer Eli Lilly announced that it will become the first pharmaceutical research company to disclose its payments to physicians in the
"With each of our industry firsts, from launching our clinical trials registry to the public reporting of educational grants, Lilly is striving to be a leader in improving transparency across our industry," said Lechleiter. "As Lilly continues to look for more ways to be open and transparent about our business, we've learned that letting people see for themselves what we're doing is the best way to build trust."
Earlier this year, Lilly was the first pharmaceutical research company to endorse bipartisan federal legislation—the Physician Payments Sunshine Act—that would establish a national registry of payments to physicians by medical device, medical supply and pharmaceutical companies. The legislation, introduced last September, has not been passed yet by Congress.
Dr. Lechleiter added, "Though we remain hopeful that the Sunshine Act will be passed by Congress at some point, Lilly is taking action independently. Being more transparent by opening up our business to the public is an important step to building trust and confidence."
Under the Lilly registry plan, the public will have access to an Internet database listing its payments to physicians. Lilly will launch this registry as early as the second half of 2009. When launched, its contents will include 2009 payments to physicians who serve the company as speakers and advisors. By 2011, Lilly plans to expand the reporting capabilities of the registry to resemble the Sunshine Act legislation. The registry will be updated annually to reflect the previous year's payment information.
"Many physicians perform valuable services for the biopharmaceutical industry by advising us on the development of new medicines and giving lectures to other medical professionals to educate them about new treatment options," said Dr. Lechleiter. "For these services, they are compensated at market rates. These services help to advance the science related to medicines and are important to both current and future patients who rely on pharmaceuticals as an integral part of their therapy."
