Capital Eye Consultants
 
Capital Eye Consultants   
Fall 2011 Newsletter

Capital Eye Consultants
Greetings!

We hope you find this latest newsletter interesting and informative of new developments at our center and in the field of eye care

 

Sincerely,

 

Clinical Staff
Capital Eye Consultants
In This Issue
From The Center Director's Desk
The Lower Eyelid Dilemma
New Electronic Health care Records and Patient Management System.
Generic Xalatan ok???
From The Center Director's Desk

  Welcome to the Fall Newsletter.  I hope you will find the following articles enlightening about new services and opportunities available through co-management at Capital Eye Consultants. We are optometry's co-management center supplementing optometric practice with medical and surgical services requested by our referring doctors.  We do not write prescriptions for glasses or contacts...never have and never will.  Dr. Baldinger and I and the other doctors on staff are dedicated to the original co-management concept.  In the area of glaucoma, we are one of the leading providers of glaucoma services in Northern Virginia.  Jim Mattern and I appreciate the opportunity to help manage glaucoma patients for those doctors who are not in a work situation that lends itself to glaucoma treatment.  However, over the years, we recognize that many of our colleagues have taken on glaucoma treatment in their offices.  To supplement the medical treatment of glaucoma that you provide, Capital Eye Consultants recently purchased a Lumenis (SLT) selective argon laser trabeculoplasty platform.    As you know, this technology can be used as an adjunctive therapy to medical treatment or as an alternative to medical treatment in selected cases.  A good example would be a young patient for whom lower pressure is desired but a life-time of drop therapy is not.  

 

   Support from the optometric community has made CEC the leading provider of cataract surgery in the metro DC area.  We are also the leading provider of the Alcon AcrySof Toric and ReSTOR IOLs.  Our co-management system was designed to be Medicare-compliant and financially compensate doctors who participate in the care of these patients.  If you are not a provider, please contact me for more information about this program.  We are very grateful to have developed the reputation for quality service that has come about through your referrals.  We are updating our technology to continue to provide most accurate cataract results.  To that end, we just replaced our aging ORBSCAN with a Zeiss Atlas 9000 topographer.  Dr. Baldinger continues to provide all of his cataract surgery at Fairfax Surgical Center.  The convenient Virginia location in downtown Fairfax, as well as the skilled and compassionate staff there, are a significant part of our formula of success. 

 

  In the coming months, we will be going electronic.  We have chosen Greenway as our provider and will be replacing our practice management system this fall.  Shortly, thereafter, we will be going live with Greenway's electronic medical record system.  Those of you who have already gone electronic know the many challenges we are about to face.  Please bear with us as we make this transition.  In the long run, we of course hope for the greater efficiency and improved patient care that going electronic promises.

 

  The road to success is always under construction, so please let us know if there is anything we can do to improve the co-management services we offer.

 

 

James E. Powers, O.D.

 

 

The Lower Eyelid Challenge

 

 

  In my field of expertise, one of the most difficult surgical areas is lower eyelid cosmetic improvement of the tear trough (which is the combination of puffiness and dark circles under the eyes).

 

  I have been able to improve these areas with a combination of treatments, and not everyone requires all the procedures I mention below to achieve the goal of improving the appearance of their lower eyelids.

  

  In younger patient that haven't aged as much but still would like to see improvement, I usually use fillers. My favorite filler for this area is Restylane. If I see that there is some atrophy (decrease/depression) of the cheek bone or mid-face deficiency, I will combine the Restylane with a Radiesse injection in the cheek area. This gives a great lift to the cheek and boosts the lower eyelids, giving the area a much younger-looking appearance.

 

  With patients in the 40's and 50's, I may need to add Botoxor Dysportto decrease the crows feet (corners of the eyes).  I also frequently recommend that they have either Fraxel treatments of their lower eyelid skin or TCA chemical peels.  If I also see there is fat herniation of lower eyelids, I usually recommend having the fatty pockets conservatively removed via invasive outpatient surgery.  I still inject fillers in the lower eyelids of these patients, as well as in their tear trough area.

 

  In elderly patients, I usually recommend having subcilliary lower eyelid blepharoplasty with or without any fat removal (depending on any signs of fat herniation). These patients will benefit from Radiesse injections in the cheek area, since bone volume is lost from our faces as aging occurs.

 

  The use of fillers around the eyes is currently an off-label use of products. However, it is a very effective tool in improving these tear trough deformities of the lower eyelids.  The surgeon who is going to inject the lower or upper eyelids with any type of filler has to be very familiar with the anatomy and blood flow of these areas. The eyelids are very unforgiving, and any mistake in this area is going to be very difficult or even impossible to repair.  This is why I prefer products such as Restylane, which is a hyaluronic acid, a naturally occurring substance in your body that helps provide fullness and elasticity.  In the event that anything were to go wrong with a hyaluronic acid filler, it can be easily erased through the use of hyaluronidase.

 

  As an oculoplastic specialist, I have seen a number of patients who have received filler injections for the correction of tear through deformities with undesired complications.  I have been able to repair some of these complications, but others are almost impossible to repair, especially if a wrong filler was selected and a superficial technique was used.  In these situations, only time will be able to remedy the complications (such as heavy discoloration) as the product gradually wears off.

 

  Please don't mistake what I am trying to convey - fillers are great tools for improving the look of aging eyes.  However, the type and the technique by which they are injected in this area is a key to the success of the procedure.  Many of the semi-permanent or permanent products are really not designed for this area at all and should be used with extreme caution.

 

  I recently had the privilege of treating a man in his mid 70's.  He presented with a medical condition called entropion, which is a lower eyelid deformity causing the eyelids to turn in toward the eyes.  Entropion usually dictates surgical intervention to correct the eyelids, but now through the use of fillers, non-invasive measures can be taken.  He received great results with Restylane injections that I administered in his lower eyelids, as you can see in these pictures.

    

  When considering the use of filler injections of the areas around your eyelids, it is always best to choose a surgeon who is properly trained in the anatomy and blood flow of the eyes.  Maybe now is the time for you to consider rejuvenating the appearance of your eyes through the use of fillers!

 

  Soheila Rostami MD

 

New Electronic Health Care Records and Patient Management System.

 

  Capital Eye Consultants, P.C.  prides itself as a premier Ophthalmology practice in the Washington D.C. metropolitan area offering a variety of services and treatment options with a solid reputation.  Employing the "right" people and purchasing the "right" equipment are integral parts of our strategic planning.  We simply cannot set our sights on short term goals.

 

  Mr. J. Gomez our new Practice Administrator joined Capital Eye Consultants, P.C. in May of 2011. With a background in health care administration and health care education he spearheaded our search for the ideal EHR/PM systems. Mr. Gomez has spent the better part of the last 5 months attending presentations, conducting conference calls, reviewing data, on-site visits, and negotiating the final price.

 

 There were a multitude of factors and variables that needed to be accounted for prior to the finalization of any decision, such as:

 

  • Cloud vs. On-site server
  • EHR vs. EMR
  • Fully integrated EHR/PM vs. separate systems and vendors
  • Tablets for our doctors vs. workstations in every room
  • Replacing all hardware vs. upgrading
  • Specialty specific vs. general medicine
  • 50/10 compliant now vs. later  (ICD-10 will become mandatory October 1, 2013. Currently ICD-9 has approximately 16,000 codes. With the implementation of ICD-10 the number of diagnosis codes will increase to approximately 100,000)
  • User friendly requiring no training vs. Super user and on-site training
  • Could implementation occur prior to the initial meaningful use deadline?
  • Costs (Initial and recurring)

 

  After careful review of numerous systems, only one offered almost all of the above options and a whole lot more, Prime Suite by Greenway.   Prime Suite by Greenway is a robust, user-friendly, and stable system.  Everything is fully integrated which will ultimately increase efficiency, productivity, and patient satisfaction.

                                                                                                                                                

 Our goal at Capital Eye Consultants, P.C. is to treat every patient as a person, tend to their needs as an individual, and assist them in the healing process rather than treating them as a number.  Prime Suite by Greenway will assist us in accomplishing this goal by allowing us to do more with less. We will be able to communicate with a number of doctors, medical practices, clinics, hospitals, ambulatory surgical centers, pharmacies, insurance carriers, and merchant card vendors through direct and secure connections.  End result, increased face to face time between our patients and our doctors. The coming months are sure to be filled with both excitement and positive change.    

 

J. Gomez

 

 

 

Generic Xalatan ok???...well maybe

 

 

 

  The new generic Latanoprost was released this year.  This is a great boon to our patients or is it?  The cost of taking chronic medications can be quite daunting to our patients with some spending hundreds or thousands of dollars per month.  With generics costing approximately 80-85% less than name brand medications, this can be a huge savings and make the chronic medication easier to "swallow", if you will.

 

  We have all had the patient where the generic medicine doesn't work as well as the name brand especially with branded PRED FORTE 1%.  Remember the corneal melts associated with generic VOLTAREN?  It was rapidly removed from the market.  Recently, the FDA has reviewed the studies of 2070 human drug studies from 1996-2007 and have found "The average difference in absorption into the body between the generic and the brand name was only 3.5 percent."  Of course this is based on blood levels of the active ingredient.  What about medications like topical eye medications that are virtually undetectable in the bloodstream?  Upon speaking with the FDA, they assured me that with topical medications they require that the formulation is exactly the same as the branded medication and also check pH, tonicity, etc.  This doesn't explain the PRED FORTE 1% issue or what happened with generic voltaren.

 

  I do have to wonder about the ingredients like benzalkonium chloride?  We know that this ingredient in particular can enhance penetration into the globe by disrupting the epithelium.  The new LUMIGAN .01% has reduced the active ingredient by 66% and increased the BAK and achieved virtually the same result of pressure lowering as the LUMIGAN .03%.  So if the non- ingredients are not maintained, we could see a less efficacious medication.

 

  Manufacturing can also be an issue. With seven to ten manufacturers of generic Latanaprost rumored to be making the medicine, what will your patient be getting each month when they refill their prescriptions?  They could conceivably go for eight months and not receive the "same" latanaprost.  Typically I have not seen an issue with generic Timolol Maleate and we use it widely in our practice.

 

  With 70% of prescriptions being filled with generics in our country, time will tell how the new generic prostaglandins will do in the generic market.  We will have to more closely monitor these patients, at least initially, to ensure that we are getting the same results that we got with branded Xalatan.

 

James Mattern OD

 

 

 

 

 

 

 

About Us

Founded in 1986 by doctors of optometry in Northern Virginia, Capital Eye Consultants has provided 25 years of quality and comprehensive consultative/surgical co-management services for the optometrists and their patients in the Northern Virginia area. 

 

Capital Eye Consultants
3025 Hamaker Court
Fairfax, Virginia 22031
(703) 876-9630