THANKS

In late April we were glad to recognize our administrative staff at a lunch in their honor. These are the individuals you speak with on the phone, the smiling faces at our front desk and those folks who try to translate ‘insurance speak’ into plain English the rest of us understand.

This month we will show our appreciation to our clinic staff. These folks are responsible for the screening and testing before you see the physician, trying to keep pace with entering into the electronic health record system what the doctor is saying and assisting with in office procedures. Many also arrive to our main location early in the morning, traveling with the physician to one of our 3 satellite locations, often making it a 10 or 11 hour day. Without their commitment and efforts, our physicians would not be able to provide the level of care we are proud to offer at ROCC.
Thanks to all our staff members. As a now retired employee was fond of saying, “Team Work Makes the Dream Work!”

Yellow Post-It with Thanks You! written on it

Seen any flamingos?

No, it’s not a new symptom of a retina issue.  It is a recognition of a staff member for that extra effort to make a better experience for other staff, patients and physicians.  Prior recipients included Sara and Katherine (who you see at our front desk in locations others than Jacksonville) for their contributions to our Mardi Gras Day.  Staff enjoyed red beans and rice, gumbo and of course King cake!

Our latest ‘flamingo’ is Sabrina who commands the front desk in our Jacksonville office, as well as in Wilmington when that office is closed.   Thanks to Sabrina for brightening that space with her eye for marking the seasons and occasions.

Sabrina at her desk with Easter decorations.

WE GOTTA GO WHERE IT’S WARM…


Just in time for the streak of unseasonably warm February weather,
the ROCC office took on the look of the tropics.

Staff wearing colorful Hawaiian leis

With a background of beach balls, palm leaves and scenes of warm, sunny tropical beaches,
staff enjoyed a lunch of burgers with all the fixins, chips, salads and of course dessert!

Staff eating oustside

With the cold sure to return soon, we’ll remember the feel and taste of our brief trip to the tropics.

We will miss you…

Cindy

Cindy has been a fixture in our Jacksonville office for several years. She is a smiling face and offers a recognizable laugh for physicians and patients alike. Cindy is retiring this month and while we wish her many happy carefree years ahead, she will be missed by everyone who comes through our office.

Cindy, thank you for the care you have shown every patient and for your dedication to your work and to Retina of Coastal Carolina. She is all about ‘Team’ and leaves a legacy that will be hard to match.

Myopia and the Macula

Grid representing normal and abnormal macula. Description in the text.

Nearsighted individuals can develop problems in the center part of the vision. Very nearsighted individuals can develop thinning in the macula which is the center part of the retina. The macula is necessary for our finest detailed vision. Sometimes the thinning can disturb one of the layers of the retina which functions as a barrier between the underlying blood vessels in the choroid and the retina itself. Just like cracks in a pavement these thin areas can grow ‘weeds’ (new blood vessels). In fact a lot of pathologies in the macula that we treat have as there common path new blood vessel formation. Wet macular degeneration patients being the obvious example, here new blood vessel formation results from progressive degenerative change where age is the greatest risk factor.

The good news for myopic individuals is oftentimes their prognosis is better for their macula degeneration compared with their wet AMD counterparts. Patients with myopic choroidal neovascularization (new blood vessel formation or cnv) may experience distortion or a blur in their central vision. Oftentimes patients in this situation are extremely sensitive to any changes in their vision. If a patient has myopic CNV the standard of care is intravitreal medications (medications delivered inside the eye). Thankfully myopic patients often respond very well to treatment and can continue to enjoy good central vision for a long period of time. If you are extremely nearsighted it is important to get regular eye checks and if your ophthalmologist suspects myopic macular degeneration a retina specialist evaluation is always reasonable.

Henry Holt, MD
1801 N.H. Medical Park Drive
Wilmington, N.C. 28403

Updated Hurricane Florence closing information

Offices of Retina of Coastal Carolina will remain closed through Wednesday, September 19.

We will contact patients to reschedule any appointments after re-opening.

For emergencies call our main number

910-254-2023

 

HURRICANE FLORENCE CLOSING

Due to the projected impacts from Hurricane Florence, Retina of Coastal Carolina’s Wilmington office will close at noon on Wednesday, September 12 and remain closed Thursday, September 13 and Friday, September 14. Our location in Jacksonville will remain closed through Monday, September 17. Please check our website for updated closing information. Our answering service can be reached by calling our main number (910) 254-2023.

Myopia – Retina Pathologies and Treatments

 

 

Diagram of peripheral retinal pathology showing retina atrophies, larger blood vessels, vitreous gel becoming more liquid and contracting away from the retina causing holes.

Should everybody with peripheral retinal pathology be treated?

This is controversial. The best data that we have would indicate it is reasonable to observe a lot of peripheral retinal pathology as the amount of subsequent retinal detachments are infrequent therefore one would have to treat a lot of patients to prevent one retinal detachment. However if you ask any retinal surgeon which they would prefer to treat; an atrophic hole with laser in the office or a retinal detachment in the operating room I know which one they would opt for!

So how do we decide?

I tend to treat patients that are symptomatic with flashing lights, or who have had a retinal detachment in the other eye, or who have a strong family history of retinal detachment. The risk of laser is minimal so I also offer each patient with peripheral pathology the option of prophylactic laser. Regardless of the decision to treat or observe nearsighted individuals should follow regularly with an ophthalmologist. And those that have peripheral retinal pathology should see a retina specialist once a year.

Henry Holt, MD
1801 N.H. Medical Park Drive
Wilmington, N.C. 28403

Myopia and the Retina

Diagram showing light rays converging at a point before the retina, and therefore out of focus

Myopia is a refractive state where the light entering the eye is focused naturally before the retina. It can either be refractive which is often due to the shape of the cornea, or it can be axial which is related to the length of the eye. Most people in a retinal office have axial myopia. Their eye is longer than average. As a consequence the retina is thinner than average. This can cause a number of different issues.

In the periphery degenerative holes or thin areas in the retina (lattice degeneration) can form leading to chronic retinal detachment. In the center of the retina, the macula, degenerative changes and thinning of the retina can lead to new blood vessel formation which can cause irreversible central loss of vision.

Who is at risk?

Although there is no definitive cutoff pathological myopia is defined as a prescription of greater than minus 8D. In practice anyone with myopia and a family history of retina issues should get screened by an ophthalmologist to ensure their eye is healthy.

Henry Holt, MD
1801 N.H. Medical Park Drive
Wilmington, N.C. 28403

Many Options for Diabetic Eye Treatment

 

Diagram of a normal retina and one with diabetic retinopathy

Everywhere there are articles about the epidemic of diabetes in the world. The US has the highest prevalence of diabetes of developed countries. As a retina surgeon, I see the misery that this disease causes. My diabetic patients not only are on their way to blindness, but many of them are on dialysis, have lost legs, and suffer from many other unpleasant conditions. Fortunately in diabetic eye treatment, there have been many breakthroughs.

The most common cause of blindness in diabetics is swelling of the macula, the center part of the retina. This happens when the glucose level exceeds the normal level and damages the walls of the blood vessels. The traditional treatment was to laser where the leaks were and this worked well. However the average result was that the vision stayed the same so any vision that was lost before the laser treatment was permanent. Today we have antigrowth hormones that block the pathway that starts the damage and this allows the body to heal. The injections are placed through the white part of the eye and are usually given every one to three months. The vision often improves. The other amazing finding is that the severity of the disease decreases after several years of treatment. Treated patients are less likely to need more aggressive treatment like laser or hospital surgery.

Other drugs that decrease the swelling are corticosteroids, a prednisone like medication. These come in the form of slow release pellets lasting from a few months to one that lasts up to three years. I find these very helpful for patients that have difficulty with the rather strict appointment schedule. Some patients after stabilization with the antigrowth hormone drugs do well with the long acting corticosteroid pellet. Patients have a lot of anxiety about eye injections and they are relieved to have an injection that lasts years. Unfortunately for the patient with a lot of damage, these do not work as well as the antigrowth hormones.

Although we use the laser much less than 10 or 20 years ago, it is still vital for many patients. A newer laser, micropulse, stimulates the pumps in the retina to pump out fluid from the leaky diabetic vessels. It is great for patients that have mild amounts of fluid and don’t want to start injections. It is also useful for patients that have had some of the antigrowth injections and are reluctant to keep going. The results are not as good as with a strict injection schedule but still very worthwhile.

Earlier treatment still results in better vision. A large number of diabetic patients are still not seen promptly. Many don’t go for an eye exam when they are diagnosed with diabetes and also miss their annual exam. Patients may not understand the importance of the eye exams because diabetic damage does not cause symptoms until it is severe. The new treatments will prevent an epidemic of blindness only if used in time.

Igor Westra MD
Retina of Coastal Carolina
1801 New Hanover Medical Park Dr., Wilmington, NC 2840