iStent: A New Glaucoma Surgery

Dr. White spent some of his time at AAO looking at new technologies for the care of Glaucoma. He has been saying for some time that multiple forces in medicine and in the economics of medicine are pushing toward Glaucoma becoming a surgical disease. Here is one of the new technologies he found:


"Glaucoma is a progressive disease that causes damage to the optic nerve.  At this time the only thing we can do is lower the eye pressure in order to stop any further damage. The vast majority of American Glaucoma patients control their pressure through the use of eyedrops. Part of the problem with this is remembering to take your eyedrops, and it's important to take your eyedrops properly. A new twist on medical care is having difficulty either paying for your medication, or getting your insurance to pay for the medication your doctor thinks is the right one for you.

Traditional glaucoma surgery is very effective, but there are a number of complications that can occur after even successful surgery. Ophthalmologists who care for Glaucoma have been on the lookout for new, better, safer Glaucoma surgeries for many years. The Glaukos company has invented a surgery using a micro-drain called the iStent for use as part of cataract surgery.

Briefly, the iStent is inserted in the natural drainage system of the eye to increase the outflow of the natural fluid in the eye and lower the eye pressure. The procedure looks very cool! I'm really looking forward to getting the special training so that I can add this to my standard surgeries. I think it will be great to not only improve people's vision with cataract surgery but also to be able to reduce their dependence on medications."


We will keep you up to date on the progress of the iStent at SkyVision.

From AAO: "Meaningful Use"

Dr. White was busy over the weekend! We'll spread his thoughts and experiences out over the next few days:


"Every convention is always filled with surprises. The not-so-good one this year was learning as we were all arriving that Medicare would be drastically reducing what it pays for patients to enjoy the miraculous effects of cataract surgery. That's really a bummer because it is the first effort to discover how low medical insurance can go before doctors stop treating patients because of cost.

Good surprises happen, too! I was visiting the company that makes our Electronic Medical Record (EMR), a company called SRS Software. SRS is a great company that has built an EMR around a very simple, but very important idea: an EMR should not interfere with the Doctor/Patient relationship. Radical stuff, huh? The SRS software allows doctors to continue to use whatever type of patient flow they have always enjoyed without adding all kinds of time to both the visit and the doctor's administrative burdens.

There is a government requirement that all EMR's demonstrate "Meaningful Use", a term that is defined in Washington by people who do not practice medicine. In its first few versions Meaningful Use was going to be a terrible burden on doctors and their practices, especially specialists like eye doctors. Through the efforts of SRS and other companies the final rules are somewhat less of a burden in general, but without creative thinking on the part of the makers of the EMR software it still looked like it was going to make things harder and slower in the office. Everything still pointed to a new paperwork hassle for docs and patients.

Here's where the pleasant surprise comes in: SRS stuck to their core philosophy and engineered a solution that looks like a winner! I was stunned when it was demonstrated to me. What looked like it would take at least an extra 10-15:00 for every patient every time they came in now looks like a one-time 5:00 entry and just a couple minutes each time thereafter. Believe me, knowing how good all to the staff at SkyVision is, and how much they care about providing a great experience for every patient, I just know they are going to make it look like "normal" in a very short time!

This is really fantastic news, and it was a really pleasant surprise, too! Stand by for SkyVision Centers to become fully on-board with Meaningful Use thanks to the fantastic work of everyone at SRS Software."


That sounds like something to get excited about!

"No-Touch" Laser Vision Correction

It's day one at the AAO! What's Dr. White been up to?


"Friday and Saturday are called 'Sub-Specialty Days' at AAO. These are highly specialized meetings where the leaders in the more specialized areas of eye surgery convene to really concentrate on that smaller slice of eye care. As I usually do, I am attending the Refractive Surgery meetings, and I might drop by the Cornea meeting for a bit, too.

The most interesting talk so far has been given by the very famous Dr. Lindstrom on doing Laser Vision Correction without using any type of flap or physical manipulation of the surface of the cornea. Dr. Lindstrom was specifically talking about late enhancements of prior LASIK cases, but it applies very well to patients who have had Advanced IOL Cataract Surgery, too.

Briefly, the laser that we use to do the treatment itself can also be used to prepare the cornea for laser. The epithelium, or "skin" of the cornea, is removed using the laser itself, and then the refractive treatment follows almost immediately. This helps to protect a previous LASIK flap, and after cataract surgery it will probably result in faster, more comfortable healing.

The fact that I have already learned something that we will be able to apply to our SkyVision Center patients before lunch is a very positive sign that this is going to be a very productive AAO!"


Exciting things are coming out of Chicago already! Keep us posted Dr. White.

Blogging and Tweeting: Dr. White at the AAO

Dr. White is attending the largest meeting of eye doctors in the world, the American Academy of Ophthalmology (AAO) meeting in Chicago. He's our Social Media guru, and he promised to keep us up to date on the happenings at the meeting.

Dr. White:

"I'm here with a couple of very specific goals in mind. Ophthalmology was dealt a serious blow, and all of our older patients will suffer because of the changes in how Medicare will be paying for cataract surgery. In a time when more and more people will need this surgery, when we already have a shortage of eye surgeons on the horizon, these changes will probably hasten the premature retirement of eye surgeons who will decide it's not worth it to soldier on. I will be talking with the representatives of the AAO and trying to make sure that we will be able to weather this storm at SkyVision. I'm sure there will be lots and lots of discussion about Medicare and cataract surgery.

Glaucoma is on my mind for this meeting. This disease of the optic nerve is going to be more common. Medicines like eye drops have been the mainstay of treatment, but there are several very promising surgical solutions that are being introduced this weekend. I have been telling our staff that Glaucoma will soon become a primarily surgical disease.

Lastly, with our aging population we know that there will be more people with visual handicaps that can't be helped with traditional medical, surgical, or optical means. As a profession we need to be better prepared for this coming problem. I will be exploring the world of low-vision rehabilitation this weekend."

So there you have it! You can also keep up with Dr. White on his Twitter feed @DarrellWhite. We'll report the "hashtag" to look for if you want to search for other docs attending, too. Looks like lots of stuff to come...See What's Next (R)!!