Medicare has now eliminated the use of consult codes in the office. You have to use the 92o04 or 992o4 codes (ophthalmology and E/M), but not that 99244 (consult). The difference is around $30-40. Of course, you’re going to end up treating the patient as a consult and writing a letter to the referring doctor like in any other consult, except you’re getting paid less, for no good reason. Yay!
As reported in the AJO, a small study retrospectively studied the effects of cataract surgery following successful macular hole repair. The study goal was to determine if cataract surgery influenced reopening of an initially closed macular hole.
Of 135 eyes of 130 patients, there were no reopenings after initial closure. The timing and need, however, of cataract surgery varied. Of the 130 patients, the cataract status varied; 22 were pseudophakic, 49 had simultaneous cataract surgery and …
The MedGadget blog recently reported on a new artificial eyelid muscle mechanism that may one day assist patients with problems with their “blink reflex” due to stroke, injury or disease.
According to a press release from the UC Davis Healthy System, surgeons from UC Davis Medical Center have demonstrated that artificial muscles can restore the ability of patients with facial paralysis to blink, a development that could benefit the thousands of people each year …
Man, these guys are brilliant. Fundus autoflourescence (FAF)comes from the RPE, so RPE blocked by retinal vessels are “dark adapted”. So when the retina is re-attached, if the retina is not placed exactly where it was before, one will see a “shadow” of autoflourescence next to the displaced retinal vessel, when ordinarily it would be hidden behind the retinal vessel. Confused? Doesn’t matter- read all about it in January’s Ophthalmology
Dear Doctor – is it okay for me to have cataract surgery if I am already suffering from macular degeneration?
I am 37. I suffer from Glaucoma in both eyes. I got information that Biomolecular Therapy can restore the vision by “cell heals cell”. They say that this technique is really popular and being used in Europe (around 70 years) such as Germany. Is this true? If so, why isn’t this technology being used in the United States?
Why do only a fraction of narrow angles proceed to closure? The answer is in iris volume. In susceptible eyes,the iris acts like a sponge and increases in volumes, absorbing fluid as it dilates, and thus crowding the angle, while in most eyes, the iris volume decreases as it dilates, and the angle remains narrow and open. A fascinating insight by very clever researchers, who demonstrated the iris volume changes beautifully using OCT.
Researchers report in Ophthalmology that intervention (frequent phone calls, instructional video) improves adherence, but interestingly, there was no difference in IOP compared to the control group. What’s remarkable is compliance with a once-a-day drop like Travatan was only about 50% (increased to 70% with intervention). No wonder our patients do poorly, and it reinforces in me the importance of ALT, phaco or even trab instead of giving a second or third drop.
An article in Ophthalmology confirms what many of us know- glaucoma progresses very differently among different people, regardless of the IOP. Pseudoexfoliation patients fare the worst, but other than that, we cannot tell who will progress quickly and who will go slowly. We have to be careful to be aggressive with the former and go easy on the latter- that requires frequent monitoring, and is part of the “art” of glaucoma. I think many of …
My 78-year-old mother has dry AMD and had cataract surgery on one eye a few months ago. Around the time of her cataract surgery her eye pressure was elevated (low 20’s) and the doctor started her on Lumigan. Her vision has continued to deteriorate. The doctor feels it is her AMD worsening, but she suspects the Lumigan is causing blurred vision. As this seems to be a side effect of most of the glaucoma medicines, …
As reported in the AJO, a small study retrospectively studied the effects of cataract surgery following successful macular hole repair. The study goal was to determine if cataract surgery influenced reopening of an initially closed macular hole.
Of 135 eyes of 130 patients, there were no reopenings after initial closure. The timing and need, however, of cataract surgery varied. Of the 130 patients, the cataract status varied; 22 were pseudophakic, 49 had simultaneous cataract surgery and …
Dear Doctor – is it okay for me to have cataract surgery if I am already suffering from macular degeneration?
Some surgeons are just plain brilliant. Tying the haptics to the iris really is no walk in the park. Instead, using a tiny titanium clip from the vascular surgeons, the haptics were easily clipped to the iris using a very simple clipper. Ta-da! Done. This needs to be tried in humans ASAP- almost certainly to be well-tolerated and easier on the eye.
Contrary to an important paper I read a few years ago, it is advisable to take into account the post-op refraction in the first eye and fudging your numbers for the second. The authors recommend adjusting the IOL by half of the error in the first. The earlier study adjusted it 100%, and that’s why it didn’t help. Nice pearl you can use next week!
Icon Biosciences, Inc., (IBI) announced that they are entering Phase 2/Phase 3 clinical trials for their proprietary sustained release system designed to control inflammation in post-op cataract patients. The product, IBI-10090, will be introduced into the eye at the end of cataract surgery and will release its product for 2-3 weeks before complete bioabsorption. IBI-10090 is based on the IBI’s proprietary Verisome™ drug delivery system. IBI has other products under testing based on this system….
The MedGadget blog recently reported on a new artificial eyelid muscle mechanism that may one day assist patients with problems with their “blink reflex” due to stroke, injury or disease.
According to a press release from the UC Davis Healthy System, surgeons from UC Davis Medical Center have demonstrated that artificial muscles can restore the ability of patients with facial paralysis to blink, a development that could benefit the thousands of people each year …
Voriconazole, a new triazole compound, showed efficacy in a very small series of resistant Acanthamoeba keratitis. This a vision-threatening disease, very difficult to treat, and it’s good to read of a new alternative when chlorhexidine and hexamidine don’t work
Diabetics may soon be able to wear contact lenses that continuously alert them to variations in their glucose levels by changing colors – replacing the need to routinely draw blood throughout the day.
The non-invasive technology, developed by Chemical and Biochemical Engineering professor Jin Zhang at The University of Western Ontario, uses extremely small nanoparticles embedded into the hydrogel lenses. These engineered nanoparticles react with glucose molecules found in tears, causing a chemical reaction that changes …
Researchers compared DSAEK. which transplants a small layer of stroma, with transplanting Descemet’s and endothelium alone, without any stroma at all. A higher percentage got 20/20 in the latter, which makes sense- less interface issues. The progress in this area of surgery is astounding, and promises to make it more standardized and easier.
i have Fuch’s corneal dystrophy. i was diagnosed 13 years ago. i am 55. my vision is very poor in right eye. there are two surgery options. corneal transplant and replace the corneal cells. which is the best? my left eye has 20/40 vision and will need surgery in a year.
Medicare has now eliminated the use of consult codes in the office. You have to use the 92o04 or 992o4 codes (ophthalmology and E/M), but not that 99244 (consult). The difference is around $30-40. Of course, you’re going to end up treating the patient as a consult and writing a letter to the referring doctor like in any other consult, except you’re getting paid less, for no good reason. Yay!
When (and it certainly seems like when and not if) phaco goes down to around $500, I will probably limit myself to straightforward cases, or maybe only those where I can implant a premium lens, and I will try to squeeze all my cases in 1 or 2 days a month. Otherwise, it makes no economic sense. I would imagine this is exactly what Medicare has in mind as a way to decrease reimbursements for …
If you are in private practice, you MUST be familiar with the following three modifiers- otherwise, you are losing lots of money:
-24: This is added to the EXAM code (ie, 92012) during the post-op period (often 90 days after the procedure), when you are examining someone for a different diagnosis (i.e., conjunctivitis 1 month after cataract surgery). Without this modifier, the exam will be denied, as it will be assumed it’s a post-op visit.
-25: Add …
In general- sure! But I typically go to hang out with my friends. Let’s face it- if you read the big three journals on a regular basis, and you check out websites to see the latest in surgical maneuvers, there’s not much you’re going to learn at the Academy. But if you go to make connections (i.e., you’re looking to move your practice), want to try LRI’s in a wet lab, or want to “test …
In a study published in the July issue of the Archives of Ophthalmology, researchers reviewed the closed retinopathy of prematurity (ROP) malpractice claims filed with the Ophthalmic Mutual Insurance Company (OMIC) to classify the reasons for the claims. Eight cases involved a failure of transfer of care after discharge of the patient from the hospital, 3 cases demonstrated long periods between follow-up exams, 1 case was due to a failure of outpatient referral to the …
Man, these guys are brilliant. Fundus autoflourescence (FAF)comes from the RPE, so RPE blocked by retinal vessels are “dark adapted”. So when the retina is re-attached, if the retina is not placed exactly where it was before, one will see a “shadow” of autoflourescence next to the displaced retinal vessel, when ordinarily it would be hidden behind the retinal vessel. Confused? Doesn’t matter- read all about it in January’s Ophthalmology
I was first diagnossed in 2002. My right eye was lasered 2x’s with hot laser. I remained stable until my left eye became active in 2005. I have had 3-PDT’s w/kenalog,just kenalog injections until the avastin was finally being given. to date I have had around 25 Avastin injections in my left, and recently my right eye has become active again, so now I am receiving injections in both eyes at the same time. I …
A small, but popular study published in the January issue of Ophthalmology finds no correlation between serum levels of Vitamin E and “inconsistent” results for Vitamin C and magnesium. The conclusions are based upon a meta-analysis of over 4100 patients.
Laboratory evidence, however, indicated possible associations between the antioxidants and magnesium. For instance;
…
Icon Biosciences, Inc., (IBI) announced that they are entering Phase 2/Phase 3 clinical trials for their proprietary sustained release system designed to control inflammation in post-op cataract patients. The product, IBI-10090, will be introduced into the eye at the end of cataract surgery and will release its product for 2-3 weeks before complete bioabsorption. IBI-10090 is based on the IBI’s proprietary Verisome™ drug delivery system. IBI has other products under testing based on this system….
As reported in Ophthalmology, a small prospective study finds improvement in patients sustaining retinal vein occlusion (RVO) treated with Avastin.
This study followed 29 eyes injected with 3 consecutive injections of Avastin. Each treatment was 4 weeks apart. Visual acuity and macular thickness were followed using ETDRS and OCT.
There were improvements in all parameters. The vision improved and was maintained to the end of the study at 12 months. Retinal thickness, as measured with conventional and …
