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!”
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.
Age related macula degeneration (AMD) is a very common cause of blindness amongst the elderly population. Utilizing US census data physicians have estimated by 2020 almost 3 million people were likely to develop AMD. Constant research is occurring to search for more advanced therapies to treat this condition.
AMD is often divided into wet and dry. Dry macula degeneration is far more common. Its presence is dedicated by a dilated eye exam. Wear and tear changes build up in the very metabolically active macula (the center part of your vision) at the back of the eye in patients over 50 years of age. Some AMD patients have genetic predispositions to developing their disease. Other patients have modifiable risk factors that they can control to help slow the progression of their condition. The most important of these is smoking, as smoking is known to accelerate disease progression. Other factors in your control include maintaining good blood pressure and exercise.
Wet AMD occurs when new blood vessels grow underneath the retina. These leak fluid and bleed potentially causing rapid changes in central vision. Thankfully treatment of this condition has been revolutionized by injections delivered inside the eye painlessly. In many cases sight can be preserved with prompt treatment.
Historically, only destructive laser treatments were available that attempted to limit disease progression of wet AMD. Research showed that immature new vessel networks like those found in wet AMD need a biochemical called vascular endothelial growth factor (VEGF) to grow and thrive. Originally used for colon cancer, Avastin was one of the first anti-VEGF to be injected into eyes. The results were a dramatic reduction in activity of the new blood vessels networks, limiting their bleeding and fluid leakage and either restoring or preserving vision in a lot of patients. Now there are 2 other anti-VEGF medications available to use in addition to Avastin. Choice is physician dependent and good arguments can be made to select all three.
If you are identified as having wet AMD you will typically be recommended to receive monthly treatments by your retina doctor until your disease is under control. At this point many physicians extend treatment, this attempts to reduce treatment burden whilst keeping the eye safe. A lot of patients can be safely extended, some have new vessel networks that need more medication to treat, and cannot safely be extended. In the future sustained release medications may become available reducing treatment burden for many patients.
Developments in AMD are occurring all the time, new ways to monitor for progression (including home monitoring), new technology to detect wet AMD earlier, and in the future surgical intervention with stem cell therapies are all in progress. If you are older than 50 and have a family history of AMD talk to your eye care provider about getting screened for AMD.
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.
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
Offices of Retina of Coastal Carolina have reopened and phone service is restored. Please note that only calls to our main numbers, 910 254 2023 or 910 355 0896 are routed to our answering service when the office is closed. We continue to reschedule patients not seen during the storm closing.
You may also message us through your Patient Portal.
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.
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