Capital Eye Consultants
 
Capital Eye Consultants   
Spring 2013 Newsletter

Capital Eye Consultants
Greetings!

We hope you find this 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
Center Director's Desk
Jetrea For Vitreo Retinal Surgery
CEC...Your One Stop Shop
Surgical Observation Day
    From The Center Director's Desk

 

 

                 Who Is Your Friend??

 

 

It used to be that Capital Eye Consultants, Virginia's first and only true optometric co-management center, was the only friend that optometry had in the ophthalmic community.  After all, we were started by a pro-active group of local optometrists who partnered with OMNI Eye Services to bring together an optometrist and ophthalmologist to provide medical and surgical care for optometrically referred patients. 

 

While OMNI went out of business over the years, a number of the Centers retained the initial mission statement and became very successful co-management centers.  With the advent of PRK/ LASIK, other management companies appeared on the scene taking advantage of the synergy of optometry and ophthalmology.  TLC was such a company, providing education and co-management opportunity for corneal refractive surgery in the infancy of that exciting technology.  In its peak years, TLC moved away from optometric referral to direct advertising and in-house O.D.s providing pre- and post-op care.  As the refractive surgery arena contracted, TLC began to turn back to O.D.s as a referral source.  At Capital Eye Consultants, we have always had the O.D. in the driver's seat.  We have a fixed fee for refractive services.  The O.D. sets the global fee and receives whatever portion of the co-management fee exceeds our fixed fee.  I know one O.D. whose co-management fee averages about $1,700 per case; the 20% fee would be about half that amount!  If that is what you are receiving for co-management services, maybe you need to look at CEC again.

 

In the cataract arena, the advent of multifocal lenses and laser cataract surgery caused a spike in ophthalmology overtures to optometry.  At Capital Eye Consultants, we have been Medicare co-managers with optometry from the beginning.  We also have co-management of multifocal IOLs that applies to private as well as Medicare insurance.  More importantly, we do not provide post-surgical prescriptions and we don't have an optical.  Recently, one of our competitors opened an optical shop and another competitor from across the river has an optical in the Maryland office.  I will not be surprised to see more ophthals opening opticals in these times of decreasing reimbursement for surgery.  Does it make sense to help build the practice of your future competitor?

 

Only CEC has the proven track record of optometric support.  In the early days, it was in-house training and CE programs on a monthly basis.  Dr. Baldinger was the only ophthalmologist to testify for optometry in our legislative hearings expanding scope of practice for optometry.  Throughout over two decades of business, we have remained true to optometric referral and have changed with the times.  The expanded scope of optometric practice has meant that we no longer are a leading provider of routine medical eye services.  Today, we concentrate on cataract surgery, refractive surgery, retinal care and oculoplastics.  Dr. Mattern and I have a very large glaucoma practice for those who are not in the practice mode to take care of this disease.  We also provide specialty glaucoma testing as an � la carte procedure for those who need it.  Finally, Dr. Baldinger provides laser PIs as well as selective laser trabeculoplasty (SLT) for optometrically-referred glaucoma patients.  In light of that, we pretty much do everything short of filtering surgery.  We invite you to refer patients for a second opinion or co-management.

 

I see three paths for optometry in the future.  One is to take the road of pharmacy and become employees for the large national chains.  The Virginia Optometric Association has fought this in the past.  Second is to follow the Academy of Ophthalmology model and become an employee in a large ophthalmology-owned practice.  The third is to try and maintain control of the primary care market and provide secondary medical and, hopefully, some day, surgical services that our profession is trained and able to provide.  To follow the third path, we need true friends.  I hope you count Capital Eye Consultants among your true friends.

 

Jim Powers OD

 

 

 

   Jetrea For Vitreo Retinal Surgery

 

 

The FDA has approved ocriplasmin, or Jetrea, for the treatment of vitreomacular adhesion (VMA).  Jetrea chemically causes a posterior vitreous detachment (PVD) and may avoid vitrectomy for many retinal patients.

 

The new drug, Jetrea, is delivered as an intraocular injection into the vitreous.  The resultant chemically induced posterior vitreous detachment may stop or improve conditions involving the vitreo-macular interface, including; vitreomacular traction, or vitreomacular adhesion, epiretinal membranes and macular holes.

 

 

 What is Vitreomacular Adhesion?

 

 Vitreomacular adhesion is part of a spectrum of surgical macular conditions including epiretinal membranes, macular holes and VMA whereby the vitreomacular interface causes traction on the macula. 

 

VMA, the more mild of the three, is a condition whereby the vitreous will "tug" or "pull" on the macula to cause a small amount of macular edema.   We used to call this VMT, or vitreomacular traction.

 

On the other end of the spectrum are macular holes and epiretinal membranes.

For the purposes of this post, VMT and VMA are synonymous.

 

 

How to Diagnose VMA

 

  •      Macula may be normal by SLE/90 D
  •      No obvious PVD
  •      OCT demonstrates loss of foveal pit

  jetrea

 

 

 

 

 

jetrea2


Posterior Vitreous Detachment

 

When we are born, the vitreous naturally overlays the macula.  This vitreo-macular interface has the potential to cause epiretinal membranes (ERM), macular holes and vitreomacular adhesion (VMA).

 

Causing a PVD can possibly cure, improve, or repair the macular problem by mechanically disrupting the physical traction on the macula.

Vitrectomy is the Gold Standard

 

The cure for ERM, MH and VMT has been vitrectomy.  Vitrectomy is highly effective way to separate the vitreous from the macula.  This is a crucial step in peeling ERMs, fixing macular holes and curing VMT/VMA. 

 

 

When to Refer Your Patients

  

There are two situations where I see Jetrea potentially useful in the clinical setting.

 

Patients suffering with mild vision loss or distortion, so called "symptomatic VMA,"  due to vitreomacular adhesion might consider Jetrea.  For certain situations where surgery is not possible, Jetrea can be injected in the office with the drug taking effect within several days.

 

I also see Jetrea exceptionally useful for cases of impending macular holes.  There are many patients who have a thin ERM and partial thickness macular hole with only mild vision loss. 

 

Jetrea has the potential to remove the ERM and allow the hole to either close or stabilize, thus preserving vision, but without the need for face down positioning required by conventional vitrectomy requiring intraocular gas.

 

This is a viable treatment for certain macular diseases, and best of all, may offer an alternative to the rigors and costs of surgery. 

 

All the best,

 

"Randy"

 

Randall V. Wong, M.D.  Retina Specialist
Capital Eye Consultants 
www.RetinaEyeDoctor.com

 

 

 

 

 

 

   CEC...Your One Stop Shop For  

Refractive Surgery

 

Unlike, many of our competitors, CEC offers our refractive surgical patients  a number of refractive surgery options to obtain the best vision outcome.   The 55 yr old  hyperope is not likely to be satisfied with a LASIK/PRK procedure and will more likely have a higher quality vision result with greater stability with a refractive lens exchange.  Similiarly, a -10,  30 yr old patient will have a higher quality vision result with an ICL (Implantable Collamer Lens) than a laser vision correction procedure.  We can help select the procedure that provides the best possible outcome for your patient based on our extensive experience with all these treatment modalities.  Feel free to call us at CEC to discuss your patient before you even send them in for a consult.   With over 10,000 LASIK/PRK cases and  over 22,000 IOL based procedures performed at CEC,  we can help make your patients dream become a reality.  We actively co-manage ALL these patients and as Dr Powers indicated in his earlier article, put the OD in the "driver's seat" to choose what they feel is an appropriate fee for the laser vision correction procedures. 

 

 

  Surgical Observation Day for ODs    

                          

 

The doctors at CEC are happy to bring back a program we have provided in the past where local optometrists can observe state of the art cataract, pterygium, and retinal surgery.

 

Dr. Baldinger performs cataract surgery with standard, toric and multifocal Restor IOLS, and sutureless pterygium surgery at the HCA Fairfax Surgical Center located on Main Street in Fairfax, VA.

 

The day of the surgery you will:

  • Be in the OR with Dr. Baldinger viewing a high definition large screen monitor with exquisite detail of the surgery.  
  • Shadow Dr. Baldinger in the preop area, the OR, and while he meets with the family after the surgery. 

 

Dr. Wong performs retinal detachment surgery, repair of macular holes and removal of macular pucker and sutureless (25 gauge) retinal surgery "up close and personal" through either the operating microscope or monitoring system at the Woodburn Surgical Center. This state of the art facility is located in front of INOVA Fairfax Hospital on Gallows Road.  Fridays are usually the best day to schedule with "Randy."  If interested, please contact us at CEC.

 

We offer

  • Flexibility in the scheduling of your visit
  • Spend the entire day with our surgeons or watch a couple cases, whatever your schedule allows
  • We could coordinate a specific type of surgery you may want to observe.  
  • A complimentary catered lunch on the day of the surgery

 

Please contact Litrue Harris for Dr. Baldinger's surgeries and/or  Brigitte O'Brien for Dr. Wong's surgeries. Dr Wong can also be emailed at  [email protected]

Unfortunately, no CE credits are offered with this program, but we would certainly like to have you attend. We look forward to your visit. 

 

 

 

 

                      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