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
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
Our employee of the quarter is Sarah. She is a smiling face at our front desk and works all ROCC locations. Sarah was nominated by co-workers for her great attitude and eagerness to offer assistance to patients and co-workers. Sarah has many talents and stays busy outside the office with neighbors, friends, her husband and her dog Pepper. Thank you Sarah for being a vital piece of the ROCC team.
Retina of Coastal Carolina’s Management Team members were among the over 400 physicians and managers who attended the 20th Annual ASRS Business of Retina meeting in Dallas, Texas. The American Society of Retina Specialists sponsors this opportunity for attendees to obtain coding and regulatory updates, discuss strategies for enhancing practice efficiencies and network with other retina providers. 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 educational opportunity.
As we close 2017 and await new opportunities to come, we want to express gratitude for all our blessings and best wishes for the new year. We are thankful for our staff, our patients and providers that we are pleased to work with in our efforts to deliver the highest level of retina care. Our annual open house provided an opportunity to thank our referring providers for their trust in our staff, and for each of us to kick off the holiday season.
2018 marks the beginning of the 21st year of Retina of Coastal Carolina. Dr. Igor Westra started the practice in 1997 after seeing the expanding need for retina care. 2017 brought new staff to ROCC, including the addition of Dr. Henry Holt. As Dr. Holt joins the provider staff, Dr. Erik van Rens, who came to ROCC in 1998, takes a little step back from his work duties to allow more time for family and other interests.
Continuing changes in treatment and diagnosis capabilities present challenges and opportunities. Our goal remains to ‘provide the best in retina care’.
Each fall, ophthalmologists from around the world together with staff members congregate to enhance their knowledge and share experiences at meetings held by the American Academy of Ophthalmology (AAO), its Executive Branch (AAOE) and the Joint Commission on Allied Health (JCAHPO). This year’s meetings were held in New Orleans. Continuing our tradition of enhancing our staff knowledge through continuing education, Dr. Erik van Rens, our Financial Manager, and three of our experienced certified ophthalmic assistants made the trip to take part in this opportunity. We were able to experience a little of the Big Easy outside of class time while interacting with other retina and teaching staff to continue our goal of providing the best in retina care to our patients.
Our most recent employee of the quarter is Noelle, our Executive Assistant. Noelle joined our practice 18 months ago. She is a jack (or jill) of many trades. Noelle has become that smiling face to go to for other staff from arranging meetings with other practices to helping address project needs in the office. That might be purging charts, moving boxes of files, unclogging toilets, repairing crates used to transport items between locations or running errands. That is in addition to her more routine report preparation and data entry duties. Thank you Noelle for what you do and for your positive demeanor and contribution to the ROCC team!
The Ophthalmic Coding Specialist exam was created by the American Academy of Ophthalmology and tests coding skills in all areas of ophthalmology. We are proud to have two of our staff members, Martha, our Billing Manager, and Heather, COA and surgery scheduler, pass the exam again to retain their OCS designation. The exam is required every three (3) years to assure staff remain up to date on coding changes.
ROCC is also proud that we had three other staff members successfully pass the exam: Janie, our Clinical Manager, as well as April and Kelsey, both COAs who assist with chart documentation for the physicians.
Congratulations to each!
Solar Eclipse Eye Safety
Written by: Kierstan Boyd
Information provided by American Astronomical Society
Reviewed by: Russell N Van Gelder MD PhD
Mar. 06, 2017
A truly awe-inspiring event, a solar eclipse is when the moon blocks any part of the sun from our view. The bright face of the sun is covered gradually by the moon during a partial eclipse, lasting a few hours. During the brief period of a total eclipse when the moon fully covers the sun (only a couple of minutes), the light of day gives way to a deep twilight sky. The sun’s outer atmosphere (called the solar corona) gradually appears, glowing like a halo around the moon in front of it. Bright stars and planets become more visible in the sky.
Watching a solar eclipse is a memorable experience, but looking directly at the sun can seriously damage your eyes. Staring at the sun for even a short time without wearing the right eye protection can damage your retina permanently. It can even cause blindness, called solar retinopathy.
There is only one safe way to look directly at the sun, whether during an eclipse or not: through special-purpose solar filters. These solar filters are used in “eclipse glasses” or in hand-held solar viewers. They must meet a very specific worldwide standard known as ISO 12312-2.
Keep in mind that ordinary sunglasses, even very dark ones, or homemade filters are not safe for looking at the sun.
Steps to follow for safely watching a solar eclipse:
Carefully look at your solar filter or eclipse glasses before using them. If you see any scratches or damage, do not use them.
Always read and follow all directions that come with the solar filter or eclipse glasses. Help children to be sure they use handheld solar viewers and eclipse glasses correctly.
Before looking up at the bright sun, stand still and cover your eyes with your eclipse glasses or solar viewer. After glancing at the sun, turn away and remove your filter—do not remove it while looking at the sun.
The only time that you can look at the sun without a solar viewer is during a total eclipse. When the moon completely covers the sun’s bright face and it suddenly gets dark, you can remove your solar filter to watch this unique experience. Then, as soon as the bright sun begins to reappear very slightly, immediately use your solar viewer again to watch the remaining partial phase of the eclipse.
Never look at the uneclipsed or partially eclipsed sun through an unfiltered camera, telescope, binoculars or other similar devices. This is important even if you are wearing eclipse glasses or holding a solar viewer at the same time. The intense solar rays coming through these devices will damage the solar filter and your eyes.
Talk with an expert astronomer if you want to use a special solar filter with a camera, a telescope, binoculars or any other optical device.
For information about where to get the proper eyewear or handheld viewers, check out the American Astronomical Society.
The Next Total Solar Eclipse: Aug. 21, 2017 across North America
On Monday, Aug. 21, 2017, a solar eclipse will be visible across North America (weather permitting). The whole continent will experience a partial eclipse lasting 2 to 3 hours. Halfway through the event, anyone within a roughly 70-mile-wide path from Oregon to South Carolina will experience a brief total eclipse. At that point, the moon will completely cover the face of the sun for up to 2 minutes 40 seconds.
The last solar eclipse with a path of totality (area where a full eclipse could be seen) was in March, 2016 in Indonesia and some small islands in Micronesia.
After the Aug. 2017 eclipse across North America, the next total solar eclipse will be in South America on July 2, 2019.