AB 890, (Wood) passed the legislature at 10 pm on the last night of this year's session and has since been signed by the governor. It grants independent practice authority to nurse practitioners (NPs).

CAEPS continues to share the views of the American Academy of Ophthalmology, the American Medical Association, and the California Medical Association that the law lacks sufficient training requirements and safeguards for independent practice, and will do little or nothing to expand access to care-- a primary focus of the bill's supporters. It will likely also create a lower "tier" of care for low-income patients.

Furthermore, the bill will likely raise the costs of care, given redible studies indicate that NPs will order more imaging services, tests, and pharmaceuticals, further burdening the Medi-Cal program, and therefore the state's already tenuous budget given the COVID-19 pandemic.

As AB 890 will require the development of significant regulations in order to be implemented, CAEPS will work closely with the other groups to ensure this is done with the greatest degree of patient safety and actual improved access.

The number of older Americans with low vision is expected to double in the coming years, as more people live longer. Low vision describes poor vision that can't be fixed or improved with glasses, contacts or surgery. People with low vision have blind spots that can make it difficult or impossible to drive, read or see faces. But the tragedy isn’t that people have lost vision, it’s that most believe nothing can be done to improve their quality of life. CAEPS and the American Academy of Ophthalmology (AAO) are taking the opportunity of September’s Healthy Aging Month to let people know they can retain their independence and stay safe, despite declining vision.

Age-related macular degeneration is one of the leading causes of low vision. Other common contributors include diabetic eye disease, glaucoma and inherited retinal diseases. Whatever the cause, vision rehabilitation helps people make the most of the vision they have left so they can live as independently as possible.

The field of vision rehabilitation has advanced significantly over the years, offering more effective technologies and strategies. Today, ophthalmologists can offer solutions that range from a simple, portable video magnifier that can enlarge text and objects to high-tech glasses with cameras that allow people to read text and see faces.

But there are many simple changes people can make on their own to help them live better:

• Improve contrast. Put dark place mats under white place settings, buy rugs that are a contrasting color with the floor, and kitchen towels and cutting boards that contrast with the countertop. Use contrasting colored tape along the edges of rugs, stairsteps and lamp shades.
• Improve lighting. Every year, about 3 million older Americans are treated for injuries from falls, according to the Centers for Disease Control and Prevention. Many of these falls are caused by low vision. Add lighting to staircases and dark hallways. Remove rugs from hallways to prevent tripping. Task lighting in the kitchen can also make food preparation safer and easier.
• Reduce clutter and organize. A cluttered house is more difficult to navigate and can contribute to falls and frustration. When each item has a specific place and is identified with a high-contrast label, it’s easier to locate items needed for everyday living.
• Embrace technology. Books on tape and personal voice-activated assistants, like Google Home or Amazon's Alexa, can be enormously helpful for people who can no longer see well enough to read, dial a phone or set a thermostat.

Most importantly, see an ophthalmologist and a low vision specialist. An ophthalmologist can determine the full extent of vision loss and exact location of blind spots. Either the ophthalmologist or a low vision specialist can then determine the best techniques and devices that can help patients get around their individual challenges.

Unfortunately, many patients are referred for vision rehabilitation as a last resort, once their disease has advanced to a late stage. But it's most effective when introduced early in a patient's visual loss, so they can involve themselves in the process as they learn how to move around in their new world.

"Many patients are just not aware of resources that can make their lives richer and more fulfilling. All it takes is to ask your ophthalmologist if he or she doesn't volunteer the information to get a conversation going," said Amin Ashrafzadeh, MD, CAEPS President. “The prospect of being unable to drive, read or see loved one’s faces is frightening and can lead some people to withdraw from life,” said John D. Shepherd, MD, a clinical spokesperson for the AAO. “While there isn’t one strategy or tool that works for every person, vision rehabilitation offers hope. It can help people stay in their homes and keep doing the things they love to do.”

Think you have the facts on your child’s eye care? When is the right time to have their eyes checked? Is too much screen time damaging their eyes? Do they need to wear sunglasses?

There are a lot of myths and misinformation out there about children’s eye health. Don’t turn to Dr. Google for answers, ask your ophthalmologist — a physician who specializes in medical and surgical eye care — if you want to set your child up for a lifetime of good vision. Here, CAEPS and the American Academy of Ophthalmology (AAO) debunk seven common myths about children’s eye health:

1. Pink eye only happens in young children. While young kids are known for getting pink eye, due to close contact in day care centers, so can teenagers, college students, and adults — especially those who don’t clean their contacts properly. The best way to keep pink eye from spreading is to practice good hygiene, including washing your hands, not touching your eyes, and using clean towels and other products around the face.
2. Antibiotics are necessary to cure your child’s pink eye. Antibiotics are rarely necessary to treat pink eye. There are three types of pink eye: viral, bacterial, and allergic conjunctivitis. Most cases are caused by viral infections or allergies and do not respond to antibiotics. Antibiotics may be prescribed for bacterial conjunctivitis depending on severity. Mild cases of bacterial conjunctivitis usually resolve on their own within 7 to 14 days without treatment.
3. Sun is bad for your eyes. While it’s true that long-term exposure to the sun without proper protection can increase the risk of eye disease, some studies suggest sun exposure is necessary for normal visual development. Children who have less sun exposure seem to be at higher risk for developing myopia or nearsightedness. Just make sure they’re protected with UV-blocking sunglasses and sunscreen.
4. Blue light from screens is damaging children’s vision. Contrary to what you may be reading on the Internet, blue light is not blinding you or your screen-obsessed kids. While it is true that nearsightedness is becoming more common, blue light isn’t the culprit. In fact, we are exposed to much more blue light naturally from the sun than we are from our screens. The important thing to remember is to take frequent breaks. The Academy recommends a 20-20-20 rule: look at an object at least 20 feet away every 20 minutes for at least 20 seconds.
5. Vision loss only happens to adults. The eyes of a child with amblyopia (lazy eye) may look normal, but this eye condition can steal sight if not treated. Amblyopia is when vision in one of the child’s eyes is reduced because the eye and brain are not working together properly. Strabismus (crossed eyes) is another eye condition that can cause vision loss in a child. Strabismus is when the eyes do not line up in the same direction when focusing on an object.
6. All farsighted children need glasses. Most children are farsighted early in life. It’s actually normal. It doesn’t necessarily mean your child needs glasses because they use their focusing muscles to provide clear vision for both distance and near vision. Children do need glasses when their farsightedness blurs their vision or leads to strabismus. They will also need glasses if they are significantly more farsighted in one eye compared with the other, a condition that puts them at risk of developing amblyopia.
7. There is no difference between a vision screening and a vision exam. While it’s true that your child’s eyes should be checked regularly, a less invasive vision screening by a pediatrician, family doctor, ophthalmologist, optometrist, orthoptist or person trained in vision assessment of preschool children, is adequate for most children. If the screening detects a problem, the child may need to see an ophthalmologist or other eye care professional. A comprehensive exam involves the use of eye drops to dilate the pupil, enabling a more thorough investigation of the overall health of the eye and visual system.

"Sometimes what you read on the internet or hear from friends can do more harm than good," said Amin Ashrafzadeh, MD, CAEPS President. “As the kids head back to school, show them that you’ve done your homework,” said Dianna Seldomridge, MD, clinical spokesperson for the AAO. “Educate yourself so they will have the best chance to preserve their vision for a lifetime.” 

Sunglasses really aren't an optional summertime accessory, they're an essential prescription for eye health. Long-term exposure to the sun without proper protection can increase the risk of eye disease, including cataract, growths on the eye, and eye cancer. As summer gets underway, the California Academy of Eye Physicians and Surgeons (CAEPS) and the American Academy of Ophthalmology (AAO) share seven essential tips for buying the best sunglasses to protect your eyes.

• Choose sunglasses that block 99 to 100 percent of both UVA and UVB radiation. Labels can sometimes be confusing. Some indicate sunglasses offer "100 percent protection from UVA/UVB radiation", others offer "100 percent UV 400 protection." Rest assured, both will block 100 percent of the sun's harmful radiation.

• Doubt the UV protection label? Take your sunglasses to an optical shop. Most have a UV light meter that can test the UV-blocking ability of sunglasses.

• Buy oversized. The more coverage (in area) from sunglasses, the less sun damage inflicted on the eyes. Consider buying oversized glasses or wraparound-style glasses, which help cut down on UV entering the eye from the side.

• Don't be fooled by color. While dark lenses may look cool, they do not necessarily block more UV rays.

• You don't need to pass on cheap sunglasses. Sunglasses don't have to cost a lot of money to provide adequate eye protection. Less expensive pairs marked as 100 percent UV-blocking can be just as effective as pricier options.

• Don't forget the kids. Children are just as susceptible to the sun's harmful rays as adults. Start them on healthy habits early.

• Consider polarized lenses. Polarization reduces glare coming off reflective surfaces like water or pavement. This does not offer more protection from the sun but can make activities like driving or being on the water safer or more enjoyable.

Even short-term exposure can damage the eyes. Sun reflecting off water (like from the surface of a pool or lake) can cause a painful sunburn called photokeratitis on the front part of the eye. It causes redness, blurry vision, sensitivity to bright light, and, in rare cases, even temporary vision loss.

"Think of sunglasses as sunscreen for your eyes," said Dianna Seldomridge, MD, clinical spokesperson for the American Academy of Ophthalmology. "Your eyes need protection from the sun's damaging ultraviolet rays just like your skin. Make sure your eyes are protected year-round. Harmful UV rays are present even on cloudy days."

"Protecting yourself from potential eye damage is as easy as donning a cool pair of shades, said Amin Afshrafzadeh, MD, CAEPS President and a Cornea and External Disease specialist practicing in Modesto. "You shouldn't ignore this simple way to limit your risk for eye damage."

What to Expect When You Return to your Ophthalmologist’s Office

We can’t tell you when it will be safe to go back to the hair salon, when the kids will return to school or when you can hug your grandparents again. But we can say that your next trip to the ophthalmologist will be different. That’s because ophthalmologists are devising new office procedures to prevent the spread of COVID-19.

As California "reopens," the California Academy of Eye Physicians and Surgeons in partnership with our national counterpart the American Academy of Ophthalmology (AAO) want to share how ophthalmologists are working to protect their patients and staff.

In March, CAEPS and the AAO urged ophthalmologists to immediately stop routine surgical and in-office visits to preserve protective equipment such as masks and to mitigate the risk of spreading COVID-19, the illness caused by the novel coronavirus. Although both groups made recommendations to curtail routine care — in turn based on recommendations from the Centers for Disease Control and Prevention and public health officials — the decisions to reopen more normal practice are being handled locally and regionally.

Ophthalmologists are ready with new procedures. Here is what you should expect to see:

• The clinic may ask you to wait outside or in your car instead of in the normal waiting room. This is to protect you, the other patients and the office staff from possible virus exposure in crowded waiting areas and until you can be screened.
  
• The clinic is likely restricting the number of people who enter. If you do not need someone to be there with you, do not bring anyone to your appointment.
• Expect to see hand sanitizer when you enter the building and in the waiting room and exam rooms.
• Expect to be asked to wear a mask. Here’s a video on how to properly put on and take off your mask. You won’t be alone. The staff as well as all visitors should wear a mask.
• Waiting room chairs -- when used -- will be spaced out to accommodate social distancing. The office may also have made arrangements or adjustments for additional waiting areas to prevent crowding.
• You will not see magazines, clip boards, or other high-touch materials that could help spread the virus.
• Cleaning will occur more frequently throughout the clinic.
• As usual, exam rooms and equipment will be thoroughly cleaned before every patient.
• Expect to be asked a series of questions to determine your risk profile.
• Expect everyone to have their temperature taken, whether they are at high risk of being infected or not.
• Your eye doctor may use a special plastic breath shield on the slit lamp machine they use to look into your eyes. They may also wear a plastic shield over their eyes in addition to a mask.
• Your doctor may ask you to wait to speak until after your eye exam is complete. He or she can then talk with you and answer questions when they can be a safe distance from you.

As you can imagine, there may be a backlog of patients who postponed care, so you may have to wait for an appointment. Also, the additional precautions required in operating rooms will likely result in fewer surgeries performed each day.

"Ophthalmologists are doing everything possible to ensure patients are comfortable with the updated processes and techniques. We recognize these are challenging times, but those challenges must be balanced with your needs as a patient," said Amin Ashrafzadeh, MD, CAEPS President and a  Cornea and Refractive Surgery specialist practicing in Modesto.

“Our primary responsibility as physicians is to our patients’ safety and health,” said Dianna Seldomridge, MD, clinical spokesperson for the AAO. “It’s the core of the medical profession. If you have questions or concerns about coming into the office, give your ophthalmologist's office a call. As always whatever is done will be guided by what’s best for you.”

In this time of national pandemic, experts say guarding your eyes — as well as your hands and mouth — can slow the spread of coronavirus. Read an article from the American Academy of Ophthalmology's EyeSmart site that describes why it's important to protect your eyes during the coronavirus disease 2019 (COVID-19) pandemic, and five ways you can help yourself and others.

Age-related Macular Degeneration (AMD) is one of the leading causes of blindness over age 50, affecting about 2.1 million people nationwide. Early diagnosis and treatment are the keys to preventing vision loss.CAEPS and the American Academy of Ophthalmology (AAO) are therefore educating the public about the facts on AMD. 

AMD is a degenerative disease that happens when part of the retina called the macula is damaged. It’s the part of the eye that delivers sharp, central vision needed to see objects straight ahead. Over time, the loss of central vision can interfere with everyday activities, such as the ability to drive, read, and see faces clearly.

Ophthalmologists – physicians who specialize in medical and surgical eye care – have more tools than ever before to diagnose the disease earlier, and to treat it better. But these advances cannot help patients whose disease is undiagnosed, or patients who are unaware of the seriousness of their disease. People’s lack of understanding about AMD is a real danger to public health. A recent study showed that most people with AMD don’t realize it’s a chronic health issue that requires regular attention for the rest of their lives. 

Both Academies offer these seven steps to help people take control of their eye health:

• Get regular comprehensive medical eye exams. AMD often has no early warning signs, so getting regular comprehensive eye exams from an ophthalmologistis critical to diagnosing and treating the eye disease in its early stages. Both CAEPS and the AAO recommend that adults with no signs or risk factors for eye disease get a baseline eye disease screening at age 40 — the time when early signs of disease and changes in vision may start to occur. By age 65, the recommended exam frequency is every one to two years, even in the absence of symptoms or eye problems.
  
• Quit smoking. Numerous studies show smoking increases the risk of developing AMD, and the speed at which it progresses. Smokers are twice as likely to develop macular degeneration compared with a nonsmoker.
  
• Eat a well-balanced diet. Many studies demonstrate that eating a diet rich in fruits, vegetables, and nutrient-packed foods, such as salmon and nuts, may reduce the risk of AMD. Researchalso suggests that patients who ate fresh fish, an important source of omega-3s, were at lower risk of developing AMD.
  
• Take the right kind of vitamins. Vitamins can delay progression of advanced AMD and help people keep their vision longer if they have intermediate AMD or advanced AMD in one eye. But make sure it’s the right combination of vitamins. A recent study found that some of the top-selling products do not contain identical ingredient dosages to eye vitamin formulas proven effective in clinical trials.
  
• Exercise regularly. Exercising three times a week can reduce the risk of developing wet AMD by 70 percent. Studies also show that physical activity may lower the odds of both early and late-stages of AMD.
  
• Monitor your sight with an Amsler Grid. This simple, daily routine takes less than one minute and can help people with AMD save more of their vision. Using this grid is essential to finding any vision changes that are not obvious, so you can report them to your ophthalmologist.
  
• Know your family’s eye health history. If you have a close relative with AMD, you have a 50 percent greater chance of developing the condition. Before your next eye exam, speak with your family about their eye health history. You may need more frequent eye exams based on your family history.
  

“Most people understand the importance of annual medical examinations," said Rahul N. Khurana, MD, Immediate Past President of CAEPS, and a clinical spokesperson for both CAEPS and the AAO. “However, we often forget that our eyes also need regular evaluation by a medical doctor. Degenerative diseases, such AMD, can now be successfully treated, but early detection is imperative to avoid lasting consequences."

To learn more ways to keep your eyes healthy, visit the American Academy of Ophthalmology’s EyeSmart^® website.

Learn the risk factors

Approximately 2.7 million Americans have the potentially blinding eye disease glaucoma, but only half are aware of it. Meanwhile, glaucoma incidence is on the rise. Researchers predict that glaucoma will affect as many as 6.3 million Americas by 2050. 

The California Academy of Eye Physicians and Surgeons (CAEPS) and the American Academy of Ophthalmology (AAO) are sharing a list of disease risk factors in recognition of January as "National Glaucoma Awareness Month."

“It is imperative that people understand the precursors to this debilitating disease,” said Amin Ashrafzadeh, MD, CAEPS President. “If you are at risk, then getting an exam from an ophthalmologist as soon as possible can help protect you from vision loss.”

Glaucoma is a group of eye diseases that damage the optic nerve, which links the eyes to the brain. It is most commonly associated with elevated pressure inside the eye, known as intraocular pressure, or IOP. Without treatment, glaucoma can cause irreversible vision loss in a person’s side vision, then in his or her central vision. With early diagnosis and treatment, sight can be preserved. However, glaucoma has no noticeable symptoms in its early stages, so it is imperative that people know the risk factors.

Certain factors can increase an individual’s risk of developing glaucoma, including:

• Family History: Individuals with a parent or sibling with glaucoma have a nine times higher risk of developing the disease, according to one study.

• Older Age: As people age, their risk for glaucoma increases. Because this is the case for several eye diseases, both Academies recommend that adults start getting regular comprehensive eye exams at age 40. This is the age when early signs of eye disease and changes in vision may first occur, even if you have seemingly perfect vision. So, it is important to get a comprehensive eye exam from an ophthalmologist, a physician specializing in medical and surgical eye care.

• African, Hispanic or Asian Heritage: People of African and Hispanic heritage are three times more likely to have the most common form of glaucoma than Caucasians. Glaucoma-related blindness is at least six times more prevalent in African Americans than in Caucasian Americans. Additionally, people of Asian heritage are at an increased risk of a sudden and acute form of glaucoma known as angle-closure glaucoma.

• Nearsightedness: People who are nearsighted are more likely to have glaucoma. One study even found that the more severe the nearsightedness, the higher the risk of glaucoma.

• Type 2 Diabetes: Having type 2 diabetes increases the risk of glaucoma. The longer a person has lived with diabetes, the greater their risk for glaucoma becomes.

Additionally, when the cornea – the clear, round dome on the front of the eye that covers the iris and pupil – is abnormally thin, IOP readings may be falsely low. This puts patients at increased risk for undiagnosed glaucoma. This is common among those who have had refractive surgery, such as LASIK or photorefractive keratectomy. Another risk factor associated with glaucoma is a history of eye trauma.

“Many of my patients are surprised to learn that one or more of these factors put them at an increased risk,” said CAEPS member Andrew Iwach, M.D., a clinical spokesperson for the AAO and a glaucoma specialist. “Being aware of your personal risk of glaucoma is the first step to saving your sight.”

Glaucoma treatment ranges from medicated eye drops to a variety of surgeries that can help reduce high IOP. This may involve procedures that make small changes in the eye to help fluid drain more easily. In some cases, small devices known as shunts or stents are inserted in the eye to increase the flow of the eye’s fluid out of the eye.

People age 65 or older and concerned about their eye disease risk may be eligible for a medical eye exam at no out-of-pocket cost through EyeCare America™, a program of the Foundation of the AAO. In addition, those who are at an increased risk for glaucoma may also qualify for a glaucoma exam through EyeCare America. This public service program matches volunteer ophthalmologists with eligible patients in need across the United States. To see if you, your friends or family members are eligible, visit www.eyecareamerica.org.

To learn more about glaucoma, its risk factors and its treatment, visit www.geteyesmart.org.

According to a national survey released by the American Academy of Ophthalmology (AAO), nearly two out of three American adults report having eye or vision problems. A significant percentage of them, however, fail to seek medical attention in the form of regular, sight-saving eye exams. In observance of Healthy Aging Month in September, The California Academy of Eye Physicians and Surgeons joins the AAO in emphasizing the importance of having regular eye exams to maintain healthy eyes and vision.

Some of the more common age-related eye diseases include age-related macular degeneration, cataract, diabetic retinopathy and glaucoma. Early detection and treatment of these conditions can help to save sight before vision loss occurs. Ophthalmologists – the physicians that specialize in medical and surgical eye care – recommend a dilated comprehensive eye exam as the best way to prevent these conditions from becoming debilitating.

U.S. Adults Do Not Get Eye Exams as Often as Recommended
The survey results emphasize a need for more education about the importance of medical eye exams. Findings showed that 64 percent of adults had at least one or more of the following issues with their eyes or vision:

• difficulty seeing at night;
• blurry vision;
• reading up close;
• flashes of light;
• red, watery eyes; and,
• double vision.

Despite experiencing some level of impairment, only 13 percent admitted they had been seen by an ophthalmologist.

How Often Do Adults Need Eye Exams?
Both Academies recommend that a healthy adult get a baseline eye exam at age 40, even if they have no history of eye problems or eye disease. Those who have chronic conditions, such as diabetes or high blood pressure, may require more frequent exams.

"Sight is precious, and catching problems early can make a big difference in maintaining vision for the long term, says Rahul N. Khurana, MD, a retina specialist and CAEPS President.

Those over age 65 who may be concerned about cost or lack of health insurance, the AAO’s EyeCare America program offers eligible seniors a comprehensive eye exam and up to one year of treatment at no out-of-pocket cost.

To learn more ways to keep your eyes healthy, visit the AAO's  EyeSmart^® website.

One in four Americans age 65 or older has diabetes, putting them at increased risk for vision loss and blindness. Fortunately, diabetes-related vision loss is largely preventable with regular care. Yet studies have found a majority of Medicare beneficiaries with diabetes do not get the necessary eye exams despite the fact that the exams could be covered under their existing insurance.