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An Iowa OD Who Developed an Industry-Leading Neuro Rehab Specialty

Offering glasses just wasn’t enough.

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DR. DEANN FITZGERALD STARTED practicing optometry in Cedar Rapids, IA, in 1984. In 2006, she founded the non-profit Spanda, Inc., which combines optometry with other healthcare specialties and took her as far afield as Kenya. Soon, she decided to expand Spanda’s activities to her own community. Spanda opened Cedar Rapids Vision In Motion (CRVIM), a vision wellness and rehab clinic, in 2007. What started as a 1,600-sq. ft location with an occupational therapist and a single employee now occupies 6,000 sq. ft and employs two athletic trainers, seven therapists and two ancillary staff.

THE IDEA

A Door Opens

Vision therapy was on Fitzgerald’s radar screen from her earliest days in optometry, but it took some time for her to embrace it. “I originally went to school with the thought of providing therapy but Cedar Rapids was very medically oriented, with the University of Iowa just 20 minutes away. Which made it very difficult at first to want to do therapy.” But by the 1990s — the “decade of the brain” — she sensed a door opening.

THE EXECUTION

Bridging the Gap

Dr. DeAnn Fitzgerald

CRVIM deals with a larger variety of diagnoses and issues than we can list. The services Fitzgerald’s team have developed bridge “the gap between assessment and treatment” for patients of all ages who experience visual processing dysfunction. In other words, “It’s a brain thing,” as the practice’s mantra states. Since 2010, CRVIM has also been teaching, offering instruction to OTs, PTs, ATs and others, passing on Fitzgerald’s “Train your brain to see again” gospel.

Patients find CRVIM in a variety of ways. “We have the general practice so sometimes people come in for routine care and find out that we do other services to help with various problems.” Of course, there’s word of mouth, as well as the training conferences to which the CRVIM team are now often invited as experts. “I have patients come from a nine-state area for our services. With the training conferences, we try to collaborate with other OTs and PTs.” Among the many hats Fitzgerald wears, she is vice president of the Neuro-Optometric Rehabilitation Association (NORA), an inter-disciplinary industry group whose mission is to see that patients with physical or cognitive disabilities as a result of an acquired brain injury get full ocular health evaluation and optimum visual rehab services.
Fitzgerald doesn’t have the luxury of patterning CRVIM after anything in the industry, “because it doesn’t exist. But I look at what’s possibly working and couple it with things that work — multi layered therapy or integrated therapy for quicker recovery — so we combine vision vestibular and auditory and proprioception all together for a more intense and passive therapy that works well.”

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THE REWARDS

‘The Last Resort’

Fitzgerald finds working with neurologically challenged patients — “giving them back their life,” as she puts it — hugely rewarding, but along with the highs there are tough moments. “These patients have a lot of depression and emotional issues that you have to cut through to get them better.”
Fitzgerald established baseline testing for 1,400 metro youth football players over a period of three years. At first many parents didn’t see the need, but by year three every one of the players came in to get tested. She eventually donated seven laptops so these schools could do their own testing. The Pop Warner youth football league last year rated these schools’ testing system as the best it had seen.
It’s an anecdote that illustrates the complexity, and the importance, of CRVIM’s activities. “We do get very complex patients,” says Fitzgerald, “because sometimes we are the last resort.”

Do It Yourself: Develop a Niche Rehab Practice

  • BONE UP. Be prepared to learn on the fly. Says Fitzgerald: “Optometric education provides the avenues to do rehab, but I have logged countless hours in classes and reading … on … concussion and brain injury.”
  • LOOK AROUND. Fitzgerald advises finding someone who is doing what you want to do­—and learning. “It’s the quickest way to get where you want to go…We have a lot of doctors visit our clinic.”
  • BE USEFUL. Get into the community, says Fitzgerald, and “instead of telling people what you do — ask them what they need. Then help make it happen — often that is the ‘in’ to getting partnered with them.”
  • HIRE CAREFULLY. Fitzgerald says one of her biggest challenges has been finding staff that are competent but also compassionate.
  • PREPARE YOURSELF. Rehab can be taxing for both patient and therapist. Fitzgerald says of her patients: “They have a brain injury. We have to gently get them out of their own way so they can recover.”

After years covering some of the farther flung corners of the world of business journalism, Heath has more recently focused on covering the efforts of independent eyecare professionals to negotiate a fast-changing industry landscape. Contact him at heath@smartworkmedia.com.

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Best of the Best

These Machines Let Boutiques Create Bespoke Frames Right Inside the Optical

Luca Mariotti’s EYEFRAME system lets the optical owner exist totally independently from big frame makers.

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OTTICA MORI, AN optical and optometric practice in Pisa, Italy, recently ventured into producing its own frames on-site. That’s a serious step for any owner, but Luca Mariotti went one step further, building his own “desktop factory” — a small-scale frame manufacturing system designed to fit in an optical shop. Ottica Mori now uses Mariotti’s EyeFrame System to produce its own line of frames, Mocchialeria.

THE IDEA

One day, as Mariotti was working on his hobby-grade CNC router, his daughter Chiara asked him if he could use it to make a frame from a blank of cellulose acetate. The results were disappointing. But the experiment sparked a chain of events that would transform Ottica Mori’s business. “We started to evaluate the true potential of self-produced frames. It only took a short time to realize that the earnings could be very interesting .” Mariotti invested in a professional grade router. But what he really wanted — a machine small enough to fit inside an optical but with the capacity to produce quality frames from an array of materials — didn’t appear to exist.

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Mariotti hooked up with a manufacturer who agreed to custom build a machine, but the partnership was a disappointment; he didn’t get along with the company and the result was “a steel monster” too large to be used in the shop.

THE EXECUTION

Mariotti, who has a background in machine design, took matters into his own hands and now produces his own “EyeFrame System” CNC routers for opticians. Small enough to fit in an optical, they can machine acetate, plastic, wood, buffalo horn, aluminum, alpaca, brass copper, silver, gold and other non-ferrous metals.

Using the system, Ottica Mori gets about seven to 10 custom frame orders a day. Mariotti starts with an analysis of the customer’s corrective needs, then takes measurements of their face and head. “Then we suggest possible solutions, often making drawings and involving the people in the process. With a set of cellulose acetate samples we choose the color and then we start to make the CAD drawings,” he says, referring to the software system that produces the final frame design.

Tracers are used to order lenses from a manufacturer, which are placed in the frames before final adjustments are made. “The tracer is also used to calculate the thickness of the lens prior to drawing the frame using a special tool we developed. Due to the fact that it is a custom frame, all the limitations we usually find are eliminated,” says Mariotti.

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THE REWARDS

Mariotti invested about $110,000 to develop the EyeFrame System and has produced four so far. It is aimed “mainly at opticians but we have raised the interest of industry too.” He is selling the system directly in Italy and looking for foreign distributors.

The practice’s custom eyewear business and small-series frame lines are also growing rapidly, and Ottica Mori now sells several M occhialeria frames a day, in addition to the custom orders.

“Our goal is to became a single line shop in two years,” says Mariotti. “People want a well-made frame, [and] the assurance that they can find spare parts in the future … Obviously the capability to have custom-design frames has led to some strange requests, but usually people want quality.”

On a personal level, he says, “It is the most important project in my life and it is very rewarding. I am proud of it. It is a family project and I am very happy to work with my sons. At the age of 56 this project is changing my life.”

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Best of the Best

At This Wellness-Focused Pennsylvania Boutique, Eye Health is Just the Start

Combining eyecare and eyewear with a range of self-care offerings, they treat not just the eye, but the rest of the body as well.

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WHEN SISTERS DR. Giulia and Paola Tinari opened Sorella Optique and Eyecare in Paoli, PA, a suburb of Philadelphia, their aim was to go beyond treating vision and eye health in isolation. They see eyecare as an integral part of overall wellbeing and wanted their practice to reflect that.

THE IDEA

Both sisters have been involved in overall health and wellness since their college days. “We’ve always had a strong belief in healing from within and getting to the root cause of any problem,” says Paola. “We think it is important to blend Eastern and Western medicine when treating not only the eye but the rest of the body. When you practice a healthy way of living, then incorporating it into your business is second nature.”

THE EXECUTION

The emphasis on wellness is evident in the products and services offered at Sorella, the advice Dr. Tinari dispenses, and the overall patient experience. “We created a soothing environment so patients feel at ease the moment they step into the office,” says Paola. “Dr. Tinari stresses the importance of good nutrition, not only for ocular health but overall health, and recommends supplementing with various antioxidants including lutein and zeaxanthin, bilberry, asthaxanthin, omega-3, and vitamin C.” Dr. Tinari likes to keep up with studies in nutrition and often recommends anti-inflammatory products to help reduce inflammation especially in diabetic patients or those with a family history of eye diseases like macular degeneration. Sorella offers vitamins at the office for patients to take home and are looking to bring more into inventory.

The practice’s website also links to PRN, an online vendor of a range of vitamin formulas designed to bolster many aspects of eye and vision health, including products targeting the health of the macular and retina regions of the eyes, and “Dry Eye Omega Benefits,” a formula designed to ease symptoms of the condition, among many others.

Sorella’s dry eye practice also makes use of the MiboFlo Thermoflo treatment. Says Paola: “Dry eye is very prevalent in today’s society. MiboFlo targets inflammation in the meibomian glands. Just like getting a deep tissue massage, this treatment offers patients relief by breaking down inflammatory byproducts and improving their tear film.”

Alongside their independent frame lines, Sorella Optique and Eyecare makes space for body care products such as Zents, a line of organic lotions, soaps, body washes and other items containing ingredients ranging from oolong tea to sandalwood and orris. The products claim to relieve conditions such as psoriasis and eczema, as well as provide de-stressing effects.

To get the wellness message out, the practice relies heavily on its active Instagram presence and has plans to launch a monthly blog that patients will receive via email.

THE REWARDS

The Tinari sisters find the ongoing self-education and patient-education that a devotion to wellness entails enhances their lives as businesspeople and as ECPs. “We recognize that people today have an interest in bettering themselves. We love offering patients alternative ideas to help heal and be preventative in their journey to wellness,” Paola says.

Like any niche, wellness is a passion, says Tinari. “What is it that you are passionate about in our field? If you love seeing pediatric patients and dread geriatrics, then stop, focus on what you are into. You may lose a few patients but gain so much by doing what you love all day long.”

Do It Yourself: Create a Wellness-Oriented Practice

  • HEAL THySELF. “Take care of yourself first,” says Paola Tinari. “If you are burnt out, your patients can sense it and your business will suffer.”
  • CROSS-MARKET. Setting yourself up as a wellness-focused practice opens up joint marketing opportunities; sound out a local spa or vendor of body care goods.
  • UP YOUR SERVICE GAME. In this field, excellent customer service is even more important than ever. Be prepared to always “do what is best for the patient.”
  • pick the right tEAM. Not everyone’s cut out for this line of work. Positivity and creativity are key, says Tinari. “Get rid of toxicity and your business will flourish.”
  • EDUCATE. Create a blog or newsletter to keep patients updated on the latest products and services.

 

PHOTO GALLERY (4 Images)

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Best of the Best

Sports Vision Training Can Be a Game-Changer for Your Practice

These Ohio vision therapy specialists demonstrate how they help see their athletes succeed and their practice grow.

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Vision Development Team founder
Dr. Alex Andrich

AT THE VISION DEVELOPMENT Team in North Royalton, OH, founder Alex Andrich, OD, and his wife Patti, an occupational therapist and a partner in the practice, offer standout vision therapy, treating kids with learning disabilities, brain injury patients and those with stress-related vision problems, to name just a few. But one aspect of their practice that really sets them apart is their top-flight sports vision training, which has helped Cleveland-area athletes of all ages, from school kids to adult professionals, address vision problems and improve their performance.

THE IDEA

Sports have always been a big part of the Andrichs’ lives; the couple met on Ohio State University’s alpine ski racing team. Alex also has a background in competitive beach volleyball and race-car driving, while Patti trained with the U.S. Olympic gymnastics squad. This competitive exposure allowed them to see how small improvements in skills can translate into big gains in performance. With vision being such a big part of sports, it was a natural fit for the couple to open a practice specializing in vision training.

THE EXECUTION

The practice as it exists today was built on Dr. Andrich’s background in VT. “Sports vision training is vision therapy practiced at the highest level,” he says. He took courses in advanced VT techniques and eventually obtained board certification through the College of Optometrists in Vision Development (COVD). He also says the education and training offered by organizations working in vision therapy such as the Neuro-Optometric Rehabilitation Association (NORA) and the Optometric Extension Program Foundation (OEPF) provide excellent models on which to build vision training.

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A typical VT case would be a child with eye-tracking difficulty causing reading problems, but as Andrich explains, “When a successful outcome is achieved the child can read better — but they can also hit a baseball better. Utilizing the latest vision therapy tech has also helped to advance my sports vision practice.”

“We go beyond looking at the eyeball and treat vision as a whole-body sense,” says Andrich. “In baseball it is important to see the ball clearly but the visual system tells the motor system critical information about ‘where’ and ‘when’ so the motor system can respond accurately.”

For the past year, Andrich has served as vision coach for the Cleveland Indians, a role he also performs for the Cleveland Monsters hockey team and the Gladiators, the city’s arena football team. He’s responsible for the refractive and ocular health needs of the athletes, but a big part of what he offers has to do with performance. Depending on the sport, he will test the athletes on up to 20 visual performance skills, then put together a training plan for each athlete. “All athletes require core vision skills like eye tracking and eye teaming, but certain sports like baseball require really fast visual reaction and processing speeds, whereas a hockey player benefits from good central/peripheral vision integration,” he says.

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The practice’s large, high-ceilinged therapy room gives the team room for on-site vision training using sports equipment.

THE REWARDS

Dr. Andrich says the main reward he derives from being a sports vision training practitioner is seeing his athletes succeed. “The best athletes set themselves apart by the amount of work they put into their sport,” he says. “Sports are competitive by nature, so the elite athlete is always looking to improve performance. Improving vision skills gives them a competitive advantage and success on the field.” And off the field, having sports vision as a part of his practice has definitely allowed it to grow, he says.

Do It Yourself: Practice Sports Vision Training

  • NETWORK. Get involved with colleagues who are doing sports vision by joining the International Sports Vision Association (sportsvision.pro).
  • START SCOUTING. Offer vision screenings for local high school and college or university sports teams.
  • BONE UP. Enroll in training that can lead to certification. Outfits that deal with vision therapy, including NORA (noravisionrehab.org) and COVD (covd.org), are ready to help.
  • CHAIR CHAT. The OD should ask each patient that comes through his exam lane about sports participation to start a dialogue.
  • GOT GEAR? Andrich has invested in eye-tracking and performance-testing equipment, including virtual reality.

 

PHOTO GALLERY (3 Images)

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