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 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.
Retina of Coastal Carolina took part in the October 2017 Life Boomers and Seniors Expo held at the Wilmington Convention Center. Our staff greeted attendees, offering free Optical Coherence Tomography screening which was interpreted by one of our retinal physicians. Optical Coherence Tomography (OCT) testing is non-invasive and uses light waves to map and measure layers of the retina. It can provide information to diagnose various diseases of the macula, optic nerve and/or retina.
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!