Last Monday we attended the fourth annual Portland Digital Marketing Conference, featuring some of the brightest and most creative thinkers in the industry. It’s important for those of us involved in e-marketing (whether that means working for a large firm or running social media for a small business), to avoid becoming complacent. Something new is happening in online marketing every day, so it’s important that we continue to learn and understand where the industry is going and adjust our marketing efforts accordingly.
If you have a medical practice or any other small business and you’re just getting into the e-marketing game, all the platforms and available tools can be overwhelming. Even if you’ve been at it for a while and feel like you’ve got it under control, it can still get pretty confusing at times.
Regardless of how far along you are in your digital marketing efforts or what problems you have run into, here are a few key tips we took away from the Portland Digital Marketing Conference that will help you maintain a focused online strategy:
Take the time to do it right.
Although many social networks are casual in nature, you shouldn’t take a casual approach to your overall digital strategy. Don’t just assign an intern to send out a few Tweets a day. Make sure whoever is in charge of your social media is someone who is truly invested in the image of your business and can adequately reflect the values and personality you want your business to portray.
Take some time to draft a social media policy that provides guidelines as to how your business should be represented online, both in terms of your marketing efforts and your employees’ personal accounts. Establish rules regarding what should be disclosed online and what shouldn’t, how to respond to negative comments, how your business identifies itself, what legal issues to be aware of, and any other necessary guidelines. Some companies even have separate policies for each social network as well as policies for personal accounts, work accounts, and commenting on social media channels. You can see examples of social media policies from some of the country’s largest companies here.
Don’t spread your online presence too thin.
If you’re a small company just starting to get into social media, do some research and pick one social channel that will benefit your business the most. If you don’t have a lot of manpower to put towards social networking, you don’t want to start out by trying to develop networks on multiple channels at once. Pick one platform and devote the time that it takes to build a strong network. In most cases, network growth will be relatively slow. Test out what works and what doesn’t. Once you’ve begun to develop a significant network on one channel, you can begin branching out and testing the waters of other social media platforms.
Keep in mind that your digital strategy is, in many ways, just another form of customer service.
The most successful marketers are the ones who become a part of the lives of their customers. Your digital strategy shouldn’t just be a way to generate leads, but a way to make sure your customers are receiving the best service you can provide. If someone mentions your company through a social channel, negatively or positively, do your best to respond with a personal message—you do not want to ignore someone or take too long to respond and risk appearing as a faceless company. If you’re a small business without a lot of time to devote to this, any one of these popular tools makes it easy to monitor your online mentions. Set aside 30 minutes to an hour a day to see who is talking about your business and try to respond in a timely manner.
Remember that e-marketing is part science and part art.
While you should always be testing and measuring your Key Performance Indicators (KPI), you can’t lose sight of the human element involved. Every business is unique and there are multiple ways to build your network and engage your audience. A large part of social media marketing is getting a feel for each platform through trial and error and seeing how your audience responds.
We hope this post could provide you with some guidance on your journey into new media, so get creative and keep at it.
Selecting Targeted Treatments for Dry Eye
Research shows that artificial tears, although beneficial, appear to be palliative and there is no evidence that they can treat the inflammation in dry eye disease. Doctors that want to build this part of their medical practice need to employ the use of medications that target the disease.
Articifial tears such as Systane, Optive, Blink, Theratears, Soothe, Refresh, Genteal etc. are a good starting place in the management of mild dry eye but may not be a sound treatment strategy alone for active disease. For example, in the phase III clinical trials for cyclosporine A 0.05% (Restasis) there were two treatment arms: one that recieved cyclosporine and one that received the vehicle, which turned out to be one of the best artificial tears available known as Endura a few years ago. When biopsy’s were performed on patient’s conjunctival tissue after six months of treatment the group treated with cyclosporine had less T-cells measured showing an improvement in the inflammation associated with the disease. However the group treated with the artificial tears alone (Endura BID + Refresh PRN) showed an increase in inflammatory T-Cells of over 39%!
This is probably why doctors that TREAT the dry eye with targeted treatment options seem to grow their medical practices faster as opposed to simply providing an artificial tear samples alone. Gallup pole data shows that most patients had already tried 3-5 artificial tears before seeing an eye doctor and yet over 70% of doctors put that patient on another artificial tear. No wonder they are seeking new practitioners.
Now, as I stated, I do begin all treatments with an artificial tear alone in mild cases, or in addition to targeted treatments. So when should a doctor consider targeted treatments such as Restasis and steroids such as Lotemax, which effectively target the dry eye disease?
There are three times I would consider the need for targeted treatments such as Lotemax and Restasis. If a patient is on a good artificial tear (as opposed to drops with BAK such as Visine or ClearEyes) and you see ANY of the following:
• The patient has dry eye symptoms including dryness, grittiness, burning, stinging, foreign body sensation, transient blurred vision, redness, irritation, epiphora etc.
• The patient shows signs such as corneal or conjunctival staining or an osmolarity reading above 308mOsmol/L
• The patient when using an artificial tear does not feel that the symptoms resolve for more than 4 hours or requires 4 or more drops per day.
All of these indicate that there is likely some degree of underlying inflammation or unprotected areas of the ocular surface and that warrants a more targeted treatment approach.
Visions of Mustang – Bringing Sight to the Forbidden Kingdom
As we have written about in the past regarding the Himalayan Cataract Project, the Himalayan region accounts for the highest prevalence of cataract blindness on earth. It is not fully understood why this is, but studies suggest that it is a combination of high altitude and the associated increased exposure to UV rays. A national survey in Nepal found that “an increase of a few thousand feet in elevation decreased the incidence of cataracts by 2.7 times. At the same time, it was found that exposure to sunlight increased the incidence of cataracts…”
Many people in this part of the world live in remote villages with hardly any access to modern
healthcare. One of the most isolated regions of the Himalayas is the Forbidden Kingdom of Mustang, a Tibetan Buddhist monastery in the ancient walled city of Lo Manthang.
Earlier this year, intrepid documentarian Daniel Byers followed a group of doctors from the US and Nepal on their journey to provide eye care to the people of Lo Manthang. Their trek took them three days on horseback carrying over 850 lbs. of medical gear. The doctors ended up treating 1,650 patients, performing 83 surgeries. Byers’ documentary, Visions of Mustang “will follow the expedition through its trials and triumphs, and share the stories of the people of Mustang on their transformational journey from darkness into light.”
Byers shot over 40 hours of footage and took over 1000 photographs, but the film still needs to be edited and distributed. The filmmaker has taken to Kickstarter to crowdsource funding for the project. The film has earned almost $6,000 of the $12,000 goal with 15 days left. If you want to help Byers share this story with the world and help raise awareness of cataract blindness in the Hamalayas, click here.
A New Type of Video Game for the BlindCreating a video game for the blind sounds like a very difficult task, as nearly every video game in existence involves visual onscreen environments. Rupinder Dhillon, a student at UC Santa Cruz, was up to the challenge with the development of her video game project, Rock Vibe.
As a class project in 2008, Rupinder and two of her colleagues developed a Rock Band-like game for the PC, which allowed blind gamers to participate by responding to vibrations. Unlike other video games for the blind, which mostly employ auditory cues, Rock Vibe can be played by the blind and sighted alike.
The game uses the Rock Band guitar and drum kit coupled with a specially designed device using vibrating motors. In the current version of Rock Vibe, the vibrations are delivered through armbands and wristbands, but the developers plan to improve on these designs. When you feel a vibration on a specific spot on your arm or wrist, you click a corresponding button on the guitar or hit the corresponding part of the drum kit. You have a few hundred milliseconds from when you first feel the vibration to respond. If you respond in time, you will hear the correct note in the song.
If you don’t respond in time, or hit the wrong button, an audible click is heard. When the user finishes a level, the program’s speech synthesizer tells you your score. The game uses the same type of visual interface as Rock Band, so sighted users can follow along onscreen as well.
The game tested well and was presented at two gaming and development conferences, which is why Rupinder is attempting to further her devlopment. She is using Kickstarter to raise funds, which she plans on using for further research and development to improve the software and hardware for Rock Vibe. With 44 days left on her Kickstarter funding project, she already has over $12,000 of the $32,000 she needs. When the game is finished, which it is expected to be in about one year, Rupinder plans on donating several copies of Rock Vibe to schools and centers for the blind.
Endocanalicular Laser-Assisted Dacryocystorhinostomy
Recent advances in endoscopic and fiberoptic technology have led to the development of innovative, minimally invasive approaches for lacrimal surgery. Lacrimal endoscopy, endocanalicular drilling, trephination, electrocauterization and endocanalicular laser dacryocystorhinostomy (DCR) are novel techniques being used to treat nasolacrimal duct obstruction.
In the endocanalicular laser-assisted DCR, a laser fiber optic probe is inserted in the punctum and advanced along the canaliculus to the nasolacrimal sac. Once in the sac, the laser is used to make the osteotomy between the sac and middle meatus. Advantages of the endocanalicular laser-assisted DCR approach include avoidance of an external scar, improved hemostasis, limited intranasal instrumentation and tissue dissection, decreased operative time and presumably faster recovery.
The diode laser, with a 600 micron fiber optic probe, is a portable, semiconductor contact laser of 810 nm wavelength that achieves efficient tissue dissection and instant vaporization. The laser coagulates blood vessels with minimal damage to adjacent structures, giving surgeons an alternative method for DCR surgery.
The endocanalicular approach is ideal for patients who are concerned about external scarring, as well as those with blood dyscrasias or those who cannot be taken off anti-coagulating/anti-platelet agents. Similar to the endonasal DCR, a careful preoperative evaluation with intranasal endoscopy should be performed to assess the intranasal anatomy and exclude nasal pathologies such as polyps or a deviated septum that could make surgery challenging. Relative contraindications to endocanalicular DCR include suspected dacryolith, canalicular or common canalicular obstruction, canaliculitis, lacrimal sac tumor or intranasal mass.
This procedure can be performed under intravenous sedation. 30 minutes prior to arriving inthe operating room, two doses of oxymetazoline 0.05% nasal spray are administered to the ipsilateral nos¬tril. The operative side of the nose is packed with gauze soaked in 4% cocaine solution placed primarily under the middle nasal turbinate. This packing is left in place for five minutes and removed. A 0- or 30-degree rigid 4mm nasal endoscope is then inserted into the nares. The middle turbinate, uncinate pro¬cess and lateral nasal wall anterior to the middle turbinate are injected with a 50/50 mixture of 2% lidocaine with epinephrine 1:100,000 and 0.5% bupivacaine with epinephrine 1:100,000 (fig 1). The area is repacked with gauze soaked in 4% co¬caine solution for an additional five minutes. Laser-protective corneoscleral shields are inserted over both eyes.
After the packing is removed, an infracture of the middle turbinate is performed with a periosteal elevator if necessary. This infracture can improve exposure and protect the turbinate from the laser probe. The superior and inferior punctae are dilated with a punctal dilator. The 600 micron Multidiode™ fiber optic (Multidiode Endo Laser™) is then passed through the inferior punctum and fed through the canalicular system until a “hard stop” is felt at the medial wall of the lacrimal sac. The nasal endoscope, attached to a video monitor, is then placed into the nare. The light on the nasal endoscope is turned down in order to visualize the aiming beam of the laser (fig 2).
Once the light appears to be in adequate position, the laser is placed on a continuous wave/pulse setting at 10 watts of power to create an osteotomy (Fig 3 and 4). The power is
then decreased to 5-8 watts, and the osteotomy is enlarged to prevent sump effect and stenosis of the osteotomy. The laser is then carefully withdrawn after verifying that laser power is deactivated.
Silicone tubes are then passed through the inferior and superior canaliculi and retrieved within the nose. The tubes may be tied as a single square knot and attached to the lateral nasal wall with 6-0 vicryl suture.
A combined solution of topical antibiotic and steroid eyedrops are used four times a day in the operative eye for two weeks. Oral antibiotics may be prescribed at the surgeon’s discretion. If nasal bleeding is present, 0.05% oxymetazoline nasal spray is recommended twice a day during the first 24-48 hours. The patient is examined at routine follow up appointments and the silicone tubes are typically removed in the office after approximately 3 months, again at the surgeon’s discretion.
The success rates of surgical procedures to correct nasolacrimal duct obstruction vary depending on the technique used. The procedure thought to be associated with the highest success remains the external DCR, with success rates in the literature between 80% and 100% (majority around 90%)1-3. The success rates for the endocanalicular laser-assisted DCR are also variable, with efficacy rates in the literature between 60% and 90% 4-10. Current ongoing investigations will further clarify the efficacy of these newer techniques. Studies have suggested that there may be a role for intraoperative use of mitomycin C during endocanalicular laser-assisted DCR; however, there is not enough clinical evidence to support its continued use at this time.
Click here for Dr. Black’s previous posts.
TEDMED 201 – Charles Limb: Building the musical muscle
Yesterday the people at tedmed.com began uploading the first videos from TEDMED 2011. Dr. Charles Limb, a neurotology specialist at Johns Hopkins School of Medicine, gave a fascinating presentation on hearing restoration, or, in a broader view, what our senses mean to us on an emotional level.
Dr. Limb explains how cochlear implantation, one of the most advanced hearing restoration procedures, can successfully restore the ability to hear speech. However, as a musician, Dr. Limb is concerned that the implants do not allow users to fully experience music. While cochlear implants have the ability to electronically process sound, medical scientists have yet to understand the abstract process by which the brain translates the sonic vibrations of music into emotional responses.
Those with cochlear implants have the ability to hear the sound of music, but they cannot process it the same way as people with natural hearing. For example, people with cochlear implants cannot tell the difference between a trumpet and a violin playing the same note.
Dr. Limb hopes that someday, through research and training, the deaf may gain the “ability to perceive beauty” through hearing.
A Tour of ORBIS International’s Flying Eye Hospital
In the 1970s, Dr. David Paton, head of the ophthalmology department at Baylor College of Medicine, wanted to do something about the poor state of vision care and ophthalmic education in the developing world. He came up with the idea of the Flying Eye Hospital—an airplane fully outfitted with ophthalmic equipment, allowing doctors to travel the world teaching the latest techniques in ophthalmic medicine.
Through extensive fundraising and networking, Dr. Paton and his colleagues were able to secure a donated plane from United Airlines. The aircraft was in bad condition, but a generous grant from USAID provided the funds to transform the plane into a fully functional airborne medical center.
In 1982 ORBIS International’s Flying Eye Hospital took off to Panama on its first training mission. Since then, the Flying Eye Hospital has traveled to dozens of countries providing care for those in need and training local doctors in the latest techniques in ophthalmology. The plane is equipped with a 48-seat classroom, an operating room, a laser treatment room, a recovery room, a communications center, and more.
To learn more about ORBIS International and the Flying Eye Center and view an interactive map of the plane, click here.
#5 of 10: Top Reasons for Poor Premium IOL Outcomes and How to Remedy Them: Addressing Cystoid Macular Edema
The etiology of visual loss in cataract surgery can be multifactorial, including but not exclusive to ocular surface disease (dry eye, blepharitis, allergy, EBMD), astigmatism (regular, irregular, keratoconus, FFKC), pre-existing retinal pathology (ERM, AMD, diabetic retinopathy), posterior capsular opacification (PCO), and cystoid macular edema (CME). Any of these problems become even more magnified in a premium patient paying premium prices for premium IOL technology.
Cystoid Macular Edema is the most common cause of significant visual loss in patients without pre-existing disease and is readily under-diagnosed until more frequent use of OCT testing postoperatively has allowed earlier detection. The current definition of CME includes an ophthalmoscopic appearance of cystic yellow foveal appearance, petaloid leakage on fluorescein angiography, any visual deficit including metamorphopsia and decreased contrast sensitivity.
Angiography is the “gold standard,” but Flach has published that macular thickening correlates better with vision loss, and visual acuity does not always correlate with the degree of angiographic leakage.
Angiography is useful, however, to confirm the presence or absence of CME. OCT is a much faster, easier, safer, and even better look at retinal structure and is especially helpful for determining preoperative retinal pathology (ERM, AMD, DR) and postoperative CME diagnosis and monitoring of therapeutic response. 
Onset of CME is typically delayed starting at 4-6 weeks postoperatively. Pathophysiology of CME
includes inflammation, surgical trauma of ocular tissue, retained lens fragments, vitreous traction, photic toxicity, and possibly pharmacologic (epinephrine, tamoxifen). High risk patients include diabetics (even without diabetic retinopathy), previous central/branch retinal vein occlusion, epiretinal membranes, uveitis history, previous CME, CME in fellow eye, previous ocular surgery, and prolonged operative time. The decision to perform premium IOL surgery should be reassessed based on a patient’s risk factors to develop CME.
Treatment of CME can be primarily addressed based on the inflammation etiology model:
Topical steroids and non-steroidals (NSAIDs) work synergistically at the arachidonic acid cascade level to reduce inflammation. NSAIDs primarily act on cyclooxygenase pathway (COX-1 and COX-2) by decreasing prostaglandin formation and steroids act on phospholipase A2 by decreasing arachidonic release.
There are many FDA-approved NSAIDs and steroids for pain and inflammation after cataract surgery including Bromday, Acuvail, Nevanac, and Durezol. A large prospective, randomized, double-masked, multicenter trial by Wittpenn et al showed, statistically, significantly less clinical CME and less mean retinal thickening on OCT in patients taking NSAID+steroid combined versus steroids alone in low-risk patients, those typically receiving premium IOL technology.
In my premium IOL patients (low-risk CME cases), I will start topical NSAID therapy 3 days prior to surgery and continue them 4 weeks postoperatively. OCT is an excellent way to guide withdrawl of NSAID therapy. I always perform an OCT at the 1 month postoperative visit to be sure there are no subtle CME changes prior to NSAID withdrawl. The main precaution with topical NSAID therapy is to avoid usage in patients with severe dryness and/or unstable autoimmune disease so as to avoid corneal melts. These latter patients are not typically candidates for premium IOL technology anyway. With patients who typically develop CME non-responsive to steroid/NSAID combination therapy, referral to a retinal specialist for intravitreal steroid and/or anti-VEGF therapy may be indicated.
Recognizing high-risk CME patients, efficient cataract surgery, and prophylactic topical NSAID usage in premium IOL patients will regularly give a visual outcome free of CME expected from your premium patients.
Stay tuned for managing the ocular surface in your premium IOL patient in my next blog.
Click here for Dr. Jackson’s previous posts.
If you’ve been paying close attention to the world of medical technology, you may already know about Sensimed’s breakthrough product, Triggerfish. The intraocular pressure (IOP) monitoring device has been available in parts of Europe for a couple of years now, and Sensimed announced earlier this month that patient recruitment is underway for Triggerfish’s first clinical trials in the US.
The Triggerfish allows ophthalmologists to monitor IOP profiles continuously for up to 24 hours, helping to diagnose and treat glaucoma and other ocular diseases. The futuristic-looking device is essentially a silicone contact lens with the capability to electronically monitor IOP. The lens is designed with an embeded micro-mechanical sensor that measures fluctuations in diameter of the corneoscleral junction. Patients wear it with an adhesive antenna around the eye connected to a recording device for up to 24 hours performing their normal activities. When they return to their doctor’s office the data is transfered to a computer for analysis via Bluetooth.
If this technology becomes available in the US, ophthalmologists around the country will be able to better manage glaucoma and other diseases, offer more personalized diagnoses, and more effectively adapt treatment to changing conditions.
We know that Thanksgiving is the one time of year when people stop counting calories and indulge in multiple platefuls of delicious home cooked comfort food. We’re sure the last thing you want to read is a recipe for a nutritional Thanksgiving dish. But what if we told that this dish is not only delicious but also a great way to give your eyes the nutrients they need to stay healthy and disease free?
The nutrients said to be most beneficial for eye health are lutein, zeaxanthin, beta carotene, vitamins C and E, zinc, the omega-3 fatty acids DHA and EPA, and anthocyanins. If you want to prepare yourself an eye-healthy meal, you can find these nutrients in items like green leafy vegetables, eggs, cold water fish (sardines, cod, mackerel, tuna), carrots, berries, and nuts.
In honor of the Thanksgiving holiday, we’re giving you a great festive recipe from Real Simple for green beans with roasted nuts and cranberries. It’s a side dish rich in antioxidants, omega 3, zinc, B vitamins, and other nutrients to keep your eyes and body healthy.
Green Beans with Roasted Nuts & Dried Cranberries
What you’ll need:
Kosher salt and pepper
1 1/2 lbs. green beans, trimmed
2 tbs. extra virgin olive oil
1/2 cup roasted, unsalted mixed nuts, roughly chopped
1/4 cup dried cranberries
Directions:
1. Bring a large pot of water to a boil. Add 1 tablespoon salt and the green beans and cook until tender, 4 to 6 minutes.
2. Meanwhile, in a large bowl, combine the oil, nuts, and cranberries.
3. Drain the green beans and transfer them to the bowl. Add 1/2 teaspoon salt and 1/4 teaspoon pepper and toss to coat. Serve warm or at room temperature.
Click here to see more eye-healthy recipes.
