News

A Flash of Light

A flash of light

Erik van Rens, MD
Last week, I was asked to see a patient as an emergency work-in. She experienced

sudden bright light flashes and floaters.

Once she was in my office I had a chance to listen to her symptoms in more detail.

She had a sudden onset of bright stroboscopic light sensations, followed by seeing

dark spots. These lasted for about 15 minutes, after which they disappeared.

Her symptoms turned out to be related to a fairly common phenomenon called

ophthalmic migraines.

Most people associate migraines with severe headaches, but often eye symptoms are

the only manifestation of a migraine attack.

These are often very elaborate and can be very frightening, but are harmless.

Patients often see kaleidoscopic patterns with bright colors in a strobe-like fashion.

Sometimes these are followed by blind spots, usually starting in the periphery, but

these can move to the center, blocking vision temporarily. Most attacks last less than

30 minutes, after which vision returns to normal.

This patient could be reassured and she was glad it was not serious.

These flashes are quite different from the symptoms of a more dangerous

phenomenon called vitreous detachment, when the vitreous gel that fills the eye cavity

shrinks and pulls away from the adjacent retina.

This is a process we all will go through, usually as we age, but often earlier in near

sighted eyes.

These light flashes are very brief, like a shooting star, and are mostly seen in dim or

dark conditions upon eye movements. Ultimately they are followed by the sudden

appearance of floaters, some of which are permanent.

A vitreous detachment happens only once, and is benign in most cases. Sometimes,

however, it is the beginning of a bigger problem, when the gel cannot separate from

the retina and tears it. This will lead to a progressive accumulation of fluid under the

retina, forming a retinal detachment. Usually, the patient is aware of a progressive area

of vision loss, that will get worse until all vision is lost.

A tear in the retina can be treated with laser, and often will prevent the retina from

detachment.

So, if a sudden onset of bright and brief light flashes, and floaters occur,

visit an eye specialist as soon as possible, preferably with 24 hrs.


Melanoma

Just a Freckle?

 

Igor Westra, MD

Retina of Coastal Carolina

1801 N.H Medical Park Dr.

Wilmington, NC 28403

910-254-2023

 

Time flies! I didn’t realize that I hadn’t seen Mr. K for about five years. He had been seeing me annually for many years because he had a freckle in his left eye. Recently he had noticed a shadow in his vision. I had a sick feeling in the pit of my stomach when the technician told me of his symptoms.  I felt even worse when I saw the photos that he had taken of his left retina. I told the technician to go ahead and do an ultrasound of the eye.

 

Freckles of the retina are quite common. The medical term is “choroidal nevus” and these are composed of the pigmented cells that grow underneath the retina. The vast majority of these freckles are not dangerous but they may grow slightly and can become darker with age. A small minority, however, become malignant and invade the eye and metastasize to other parts of the body to eventually kill the patient.  This is called malignant melanoma and treatment is not very successful.

 

When a nevus is discovered in a patient’s eye, the doctor typically will get photographs and follow the patient on a regular basis, usually getting photographs each time. If there is any suspicious aspect to the nevus, the patient is referred to the retina specialist. I usually recommend follow up every four months when a nevus is first detected and then after a year, annual exams. In addition to photographs, we may do analysis with ultrasound and sometimes with angiography.

 

My office usually calls patients to remind them of their appointments. Mr. K had moved and his phone number had changed so he never received the call.  He knew that he had missed his appointments but felt that after all these years of follow up his lesion must be benign. Unfortunately it was not.

 

One option for treatment is radiation to the eye using a special holder that is attached to the eye for two to three days. Pre-radiation a biopsy can be done and sent for analysis and prognostic information. Another option is to cut the tumor out from between the layers of the retina. In Mr. K’s situation the tumor was too large and the eye had to be removed. The tissue showed highly invasive cells and the DNA was consistent with cells that were inclined to metastasize.  Nine months later tumors were discovered in his liver and six months later he died.

 

I tell my patients not to lose sleep over the nevus in their eye but make sure that they keep it checked out. Freckles on the skin that can be watched pretty easily and cut off and sent for testing. The choroidal nevus needs specialized equipment to monitor it and cannot be removed without causing eye damage. Fortunately this is a relatively rare cancer and with early detection the prognosis is good.


17th Annual ASRS Meeting

Members of our Management Team had the opportunity to attend the 17th Annual ASRS Business of Retina meeting in Dallas, Texas.  Kim, Janie and Martha took advantage of this yearly opportunity to attend sessions and have discussions with other practices devoted solely to the diagnosis and treatment of issues related to the Retina subspecialty.  The American Society of Retina Specialists sponsors this one and a half day session every spring, utilizing members’ expertise as well as those of various outside experts.   It provides the opportunity to remain up to date, as well as network with other retina leadership.  We learn together, commiserate together over constantly changing governmental regulations, anguish over obstacles to patient care by insurers as well as deal with the ongoing challenges of running a business.  Thanks to our physicians for this opportunity.


Employee of the Month

Kelsey is our most recent Employee of the Month. Working with ROCC since November 2013, Kelsey quickly became a patient favorite. Her upbeat smile and down home sensibilities have made her a valuable asset to the ROCC team. Kelsey works in our Wilmington and Jacksonville locations. She scribes with the doctor, handles patient set up for injections as well as conducting testing and being involved in dictation. Great job Kelsey!


2017 Codequest Event

Staff Attend AAO’s NC Codequest

Annually, the American Academy of Ophthalmology and the North Carolina Society of Eye Physicians and Surgeons sponsor a one day coding event.  This year’s presentation was held on February 4 at the Grandover Resort in Greensboro.  ROCC had 5 certified ophthalmic assistants and ophthalmic technicians attend this educational meeting led by the Academy’s Director of Coding and Reimbursement.  Topics focus on Coding Competency, recent changes in CPT coding.  This includes examples of correct coding for general ophthalmology as well as specialties including retina and glaucoma


ROCC Staff Attend International Ophthalmology Meetings

martha_spikejanie_euntitled-9842_e


Martha and Janie, our Billing and Clinical Managers respectively, attended this years meeting of the American Academy of Ophthalmic Executives in Chicago. This annual meeting offers an opportunity for staff to interact with other practice representatives in administrative centered meetings held in conjunction with the Academy’s medical meetings, attended this year by Dr. Westra. The AAOE offered classes related to Human Resources, Coding, Billing, Compliance, EHR and Management.

In related health care meetings, April and Kristy, two of our Certified Ophthalmic Assistants, attended JCAHPO offered courses related to various aspects of ophthalmic testing and procedures. ROCC strongly supports continuing education for staff and regularly provides opportunities for staff to expand their level of knowledge and remain up to date on the latest developments in ophthalmology.