Thursday, December 30, 2010

Skyvision Scores Top Twin Bridges Score!

Drum roll, please! Dr. Darrell White and Skyvision centers of Weslake scored the highest score yet recorded on the Twin Bridges Scale of cataract surgery quality. The Twin Bridges Score evaluates 100 consecutive cataract surgeries in patients who don't have any other major eye problems. The two measurements are vision (20/40 or better at 1 week post-surgery) and accuracy (+/- 1.00 from the planned post-surgery prescription). The highest possible score is 100. The highest recorded score to date is 99, the same score that Dr. White and Skyvision achieved!

That's right...Dr. White and Skyvision equalled the scores of the best cataract surgeons in America!

We expanded our evaluation to look at ALL cataract surgeries, including those that were performed on patients who also had complex cataract surgery or suffered from other diseases like macular degeneration or glaucoma. Our score on all surgeries, even without screening out paitents who had other, vision-threatining diseases, was 97. STILL one of the highest ever recorded.

We will continue to measure our results using the Twin Bridges Score as well as any other validated quality measurements. Congratulations to Dr. White and the entire Skyvision Centers surgery team!

Wednesday, December 15, 2010

Rating Cataract Surgery: The Twin Bridges Score

We introduced something called the Twin Bridges Score, a measurement of the quality of cataract surgery proposed by a very influential consultant, John Pinto. Mr. Pinto has 2+ decades of experience working in eyecare with ophthalmologists, eye surgeons just like our Dr. Darrell White. Here's a LINK to an animated video on cataract surgery to help.

The Twin Bridges study group looked at many possible quality indicators for cataract surgery in the hope that there might be a way to identify the best cataract surgeons in America. The three that they settled on take into account safety, technical ability, and accuracy/service. The safety issue is very easy to understand: what is the complication rate for an individual surgeon? Interestingly, in the original group studied the rate of surgeon-dependent complications was so low that there was no way to add it to a score. In other words, in any measurement of the top group of cataract surgeons in the United States you can't tell any difference between them on the basis of safety--they all have complication rates that are very, very low.

How well the cataract surgery goes can be determined, at least in part, by how quickly someone recovers from surgery. How quickly you see well, up to a level of vision that would at least allow you to drive a car. In most states that means 20/40 vision, and a reasonable time to look at this is one week out from the surgery. If your vision is already good here it is likely that you had well-done surgery. In fact, in the Twin Bridges group most patients had much better vision at one week.

Lastly, the accuracy of the implant power chosen is a reflection on the care that the surgeon and his or her team take in the planning and execution of the surgery. The Twin Bridges score looks at how close each patient came to the planned outcome or expected glasses prescription after the surgery. This all adds up to a score with a maximum of 100, where above 90 is where the best of the best are.

Where is Skyvision and Dr. White? Tune in...

Wednesday, December 8, 2010

No Cataract Benefit From Vitamins C and E

The search continues for some kind of prevention for the development of cataracts. A cataract is a clouding of the crystalline lens that sits just in back of your pupil. The only way to "cure" a cataract is to remove it.

We see all kinds of things in newspapers and magazines about new treatments for cataracts, or more commonly, new ways to prevent cataract formation or growth. Some of them even have some theoretic backing to them. This was the case with vitamins, specifically vitamin C and vitamin E which are anti-oxidant vitamins. One of the most common theories about cataract formation is that it is due to oxigen radical formation with age.

The "Physicians' Health Study II" is a very long-term study that has looked at many aspects of doctors' health in Boston. This particular study evaluated the possible benefit of Vitamins C and E in the prevention of cataract formation. More than 14,000 doctors are enrolled in the study. NO BENEFIT was found as far as cataracts are concerned with taking extra  Vitamin C or E.

So, it's back to the drawing board for now. Check back here for the results of Skyvision and Dr. White with the Twin Bridges cataract quality study; we think you'll be impressed!

Tuesday, December 7, 2010

A Visit From Dr. Parent!

We had the privilege of hosting Dr. Rex Parent and some of his staff here in Westlake on Monday! Dr. Parent is a very famous cataract surgeon from Fort Wayne Indiana who met our Dr. White in Chicago at the big American Academy of Ophthalmology meeting this Fall. At dinne the two doctors had a chance to talk about some of their clinical interests and Dr. Parent was intrigued by our Skyvision Centers Dry Eye protocols enough to come for a personal visit.

One of the technicians from Indiana, April, is a long-time sufferer of Dry Eye, so we put her through our full work-up. At the end we confirmed her diagnosis and made some suggestions on how she could be more comfortable. We had a chance to explain and demonstrate how we think about and take care of Dry Eye Disease, not only with April but with several of our own Skyvision patients who were gracious enough to partake in the teaching.

We hope that the visit was helpful for Dr. Parent and his staff, but especially for his patients. Dr. Parent was very clear that he wants all of his patients to receive the very best care possible for EVERYTHING, especially Dry Eye. We are all very flattered by their visit.

And April, make sure to let us know how you are doing!!

Monday, December 6, 2010

Rating Cataract Surgeons: The Twin Bridges Score

How can you rate cataract surgeons? It's very difficult to create any kind of rating scale for any  kind of doctor at all, really. There's just so much that goes into the doctor/patient relationship; it's really hard to know what to look at and how to rate that.

Some types of medicine do have measurements that we can evaluate when we wish to find some way to rate quality. Many of the surgical specialties are able to look at how infrequently a particular surgeon has complications in his or her operations, for example. As eye surgery has advanced over the last 20 years or so, every operation that your eye surgeon performs is much safer now, with many fewer complications than even 5 or 10 years ago!

With cataract surgery we can look at a couple of very simple measurements to evaluate the quality of the surgery and the surgical experience. We're in the vision business, after all, so we can look at how well you see! If we look at the best vision possible at the one week mark after cataract surgery we can know something about how well t the surgery was done.

We also know something about eyeglass prescriptions ! At the one month visit after cataract surgery we can look at how close the final eyeglass prescription is to the surgical plan in order to determine if the best cataract implant power was chosen, and if that implant was inserted well.

These two measurements, vision with your best glasses one week after surgery and the amount of prescription in the glasses, are part of what makes up the "Twin Bridges Score", a way to rate cataract surgery and surgeons. Tune in this week as we explain a little more about this score, and to see how Dr. White stacks up in Cleveland and nationally!

Friday, December 3, 2010

Skyvision Customer Service

Do you know the Skyvision story? Skyvision Centers was founded by Dr. Darrell White, Dr. Scott Schlegel, and Dr. Gregory Kaye in Westlake, Ohio in January of 2005. The business was designed to be a customer service business with the sole product being eye care. It was essentially started from scratch with nothing but new ideas added to a committment to providing the very best level of eyecare imaginable!

Not a single other eyecare practice or medical practice was evaluated or benchmarked. The founders studied and benchmarked consumer service giants like Nordstrom's and the Ritz Carlton to see how they took care of their customers. We even spent some time looking at the practices of the Canyon Ranch Spa to see how they did things!

In order to show all of the staff members at Skyvision Centers what truly excellent customer care feels like, EVERYONE went on a customer service field trip. We had lunch at a Holiday Inn, and then had dinner at the Ritz Carlton. We shopped for cosmetics at Nordstrom's and then at Dillards. And finally, we experienced the check in process for at stay at both Holiday Inn and the Ritz. It's one thing to TALK about what customer care excellence is, but quite another thing when you EXPERIENCE the difference between good and great service.

We've done this a couple of times, and it's time to do it again! Stay tuned for updates and first-person accounts of what happens on our "Skyvision Centers Customer Service Field Trips" as we explore the best that Cleveland has to offer.

Thursday, December 2, 2010

Tear Osmolarity Part IV: Prescription Medicines

Sometimes an over the counter (OTC) medicine just isn't enough. Even if your artificial tear was chosen based on advanced testing like the TEAR OSMOLARITY test from Tearlab, it's still possible that you will not have enough relief from your symptoms. This is the time for prescription medicines for your dry eye.

Let's use a couple of simple, straight-forward examples of how our Skyvision Centers doctors use tear osmolarity in the process of choosing a medical treatment for dry eye. If you have symptoms from your dry eye syndrome that are making you uncomfortable, and artificial tears are not enough, there are two very good prescription eye drops to help: RESTASIS and AZASITE*.

Classic dry eye involves a low production of your own, natural tears. This is most often accompanied by an increase in your tear osmolarity. If you have dry eye, a decreased amount of tears (with or without evaporation), and a tear osmolarity ABOVE 308, we have found that Restasis is the first medicine to prescribe.

When your tears don't work well enough you have early evaporation of the tears from the surface of your eye. We call this the "Dysfunctional Tear Syndrome". It can be caused by several things, but observations made by Dr. Darrell White has led us to the conclusion that evaporation along with a tear osmolarity UNDER 300 responds best to an initial treatment with Azasite*.

The really neat use of TEAR OSMOLARITY is when you have low tear volume AND fast evaporation! If the "saltiness" test is below 300 or above 308 we can choose the initial treatment with confidence.

This strategy was first proposed by Dr. White and will be the subject of several academic publications in the near future.

*The use of Azasite for dry eye is a permitted "off-label" application.

Wednesday, December 1, 2010

Tear Osmolarity Part III: What Tear to Choose

At Skyvision Centers in Westlake all of our doctors use the TEAR OSMOLARITY test from Tearlab to help make the choice of which artificial tear product to use in order to make you feel better. There are SO many different brands and types of tears on the shelves in Cleveland's pharmacies it can be overwhelming, so we give you the guidance you need!

An osmolarity result of less than 300 is considered normal at Skyvision, and a result over 308 is abnormal. Our doctors combine this result with their observation of your natural tears and the surface of your eye to make their suggestions. Artificial tears presently come in 3 general categories: surface stabilizers (for evaporative dry eye), hydrators or supplements (for low tear production), and what we call "utility infielders" or all-purpose (for mixed dry eye).

If you have a high tear osmolarity, a result over 308, we will generally prescribe a hydrator like THERA TEARS, or OPTIVE. If your osmolarity is less than 300, especially if your tear break-up time is short (lots of evaporation), we have confidence in SOOTHE XP, BLINK, and SYSTANE BALANCE. If you have some symptoms with a result between 300 and 308, or if your osmolarity is low but you don't have lots of evaporation, good all-purpose tears like REFRESH and SYSTANE ULTRA often do the trick!

Dry eye is more than just saying "use tears", and we are committed to helping you use the best choice FOR YOU!!