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Posted on 09-20-2017

We have invested over $100,000 to bring new technology, OCT Angiography from Zeiss, which will be especially helpful for our patients with diabetes and diabetic retinopathy, as well as our glaucoma patients. I made this purchase yesterday at the Vision Expo West.  This is my twelfth consecutive annual visit to the Vision Expo.  It is the largest American conference designed for eye doctors and other eyecare professionals, about 15,000 attended this year.  It is also the best venue to keep updated on spectacle eyeglass trends and fashions.  Each year we usually add one or two new lines.  All of the major fashion brands are represented.  Most of the best new styles of eyeglasses are introduced each year at Vision Expo.  There were over 600 companies exhibiting, in over 180,000 square feet of space, It can be quite overwhelming.  Also, all of the major manufacturers of medical technology for Optometrists and Ophthalmologists are here.  It is the best way I have found to actually see and experience all the latest technology.  I will summarize some of the highlights of my experience below:

Introducing new technology to Saipan:   OCT Angiography, from Zeiss.

We just purchased the OCT (ocular coherence tomography) Angiography).  This is the latest technology first introduced last year.  OCT Angiography technology will allow us to identify the most dangerous forms of diabetic retinopathy at an earlier stage when treatments are most effective.  By using this technology, we should be able to prevent more vision loss, and ultimately blindness.  It is also very helpful for other conditions such as glaucoma, macular degeneration, corneal disease and infections, and even for treating certain dry, painful eyes.  While this technology is very expensive, and our reimbursements from insurance companies will not increase when we use it, we believe it is important in providing the best care for our diabetes patients.   I will discuss this further in a separate post in a few days.

New frame trends and styles

Vision Expo always has high style.  Each year we do a large percentage of our annual frame buying at the show.  It is exciting to see the very latest new arrivals, and be at the forefront of new trends.  There were some amazing new styles released this week.  I was especially impressed with the new Oakley and Ray-ban, also Guess and Harley Davidson had some new looks.  We will be receiving these soon.  We also reviewed several potential new designers.  We will likely be adding these over the next few months.  Stop by and take a look.

Corneal Cross-linking, new treatment to prevent blindness from Keratoconus

Late last year the FDA approved a new treatment for keratoconus called cross-linking.  Keratoconus is a dystrophy of the cornea, the clear window into the eye.  In the past, the majority of patients with this suffered severe vision loss or even blindness.  It is fairly common, and based on the mainland USA rate, we would expect about 75 people to have this condition in the CNMI.  Last year we sent several of our patients for this treatment, the results have been excellent so far.  I attended several presentations from the doctors at the world famous Wills Eye Hospital on this procedure.  The treatment strategies and timing are evolving, and it is critical we keep up on the latest.  We are hoping to bring cross linking to Saipan in the future.

Nutrition supplements for Diabetic Retinopathy

My patients ask me daily about natural treatments for diabetes.  By far the best natural treatment is lifestyle change, essentially eating healthy and exercising more.  As we all know these changes are very difficult to make.  There is no vitamin or nutritional supplement that can fully replace the effects of lifestyle or of prescribed medication.  However, there has been increasing evidence recently that certain supplements can help prevent worsening diabetic retinopathy.  Studies previously have indicated that nutrients such as pycnogenolbenfotiamine and lutein may decrease the risk of vision loss from diabetes.  The newest study The Diabetes Visual Function Supplement Study (DiVFuSS), showed the most dramatic and conclusive results so far.  The supplement tested combined the nutrients previously listed with others that have shown promise in clinical trials.   I remember the lead author Dr. Paul Chous from my grad school days at UC Berkeley, he was several years ahead of me.  Like my brother and I, Dr. Chous is also a Certified Diabetes Educator (together we are three of only ten eye doctors world wide who are also Certified Diabetes Educators).  The DiVFUSS study, published in the respected British Journal of Ophthalmology, showed significant improvement in visual function, and improvements in retinal bleeding, when diabetes patients took the supplement for six months.  It was a placebo controlled study, the placebo group did not show these improvements.  There were no adverse events during the study.  There was also an unexpected finding that the supplement seemed to reduce diabetic peripheral neuropathy.  Since this study was released last year, I have been heavily researching this and other similar studies.  At the Vision Expo I was able to talk with several leaders of our field.  Based on my research, and these discussions, I have come to the conclusion that this supplement is safe and effective, I will be recommending this natural treatment to the appropriate patients.

New technology for fitting and selecting glasses

Each year, with new technology our ability to measure and fit glasses as perfectly as possible increases.  About seven years ago we were the first in Micronesia to add digital phoropters to our practice (we remain the only office in Guam or Saipan with this technology).  Digital phoropters make the process of determining someone’s glasses prescription much less confusing, faster, and more comfortable.  We simply love having this technology, it makes these measurements fun (at least for me).  Over the last few years, a new generation of these devices has become available.  I looked at all of the available units this week.  We are looking to upgrade our system soon.

We have also been integrating new digital devices to make the best measurements for fitting lenses perfectly in a pair of glasses.  These measurements are especially critical for those who like me need progressive lenses or bifocals.  Perfect measurements make for much easier adjustment to new glasses and improved comfort and vision.  I looked at all the technologies available.  Unfortunately, none of them improve on what we already have available in the office.  We remain the only office in Guam or Saipan to offer this type of technology.

New Electronic Medical Records

We have had electronic medical records (EHR) in our office since 2005.  In other words all of our records are stored on (and VERY carefully and thoroughly) backed up on our computer and server system.  In recent years new systems for EHR have developed where most of the storage is in "the cloud".  These systems store records offsite, and when implemented well are more secure, with even less risk of system failure and loss of records.  This type of EHR has not been practical in the CNMI due to our unreliable internet connection.  With our new fiber optic cable coming in, we are hopeful that a very reliable and speedy internet connection will be consistently available.  I have been researching these systems for the last few years.  At the Vision Expo, I had a hands-on experience with all of the currently available systems. If our new internet connections prove reliable, we will be ready to upgrade to the newest generation of EHR.  This would allow us to focus more strongly on our patients, with less time facing away from them typing into a computer.

Many of you may have heard of the recent "ransom" wear scare in the US.  Many hospitals, as well as private clinics, had their electronic medical records hacked.  They then either payed a "ransom" or risked not having any access to their records and having the patient’s records released on public servers.  In some cases, even though a ransom was paid, the records were released publicly.  I attended several presentations on how to prevent this.  We will take every precaution we can to be more certain this will never happen to any of our patients.

Miscellaneous 

-New technologies in spectacle lenses that protect from blue light.  It has long been known that exposure to blue light, especially late at night can cause difficulty falling asleep. This is especially a problem in recent years, as many people are on their computer or smart phone just prior to going to bed.  The blue light also seems to increase the discomfort and tired eyes many people feel when using computers.  More recent data are showing a possible link with eye disease like cataracts and macular degeneration.  New technology in lenses is available which will filter the blue light away.  We will be making this available very soon in our clinic.

-New treatment for dry irritated eyes.  We have implemented new treatments over the last few years for painful, watery dry eyes.  These treatments, have greatly benefited so many of our patients.   The most effective treatment currently available for many patients is called Lipiflow.  I have been watching this technology since it first became available a few years ago.  Initially it was just not possible or practical to bring Lipiflow to Saipan.  The original cost  for a new unit was over $120,000, with the materials needed for each procedure performed costing the doctor over $1000.  The cost per treatment in the US mainland averaged over $2,000.  This is not covered by any major insurance company, so was self-pay.  In the last year the cost has come down to about 40,000  for the machine, with per procedure costs to the doctor of about $300.  Still the out of pocket cost for most patients is over $1000.  With the income levels on Saipan, it is not practical to bring it here.  Last month the Lipiflow system was bought by Johnson and Johnson (the same company that makes baby powder).  I spoke with their representatives at Vision Expo.  They are making great efforts to bring the cost down so more patients can benefit from the procedure.  With a large company like Johnson & Johnson behind them, it may be viable to bring this exciting treatment to Saipan and the rest of the CNMI.  I will keep you informed.  See this link or call me if you would like to learn more about Lipiflow.

Their was also more information presented on Xiidra Xiidra, released last year, was the first new prescription medication for treating dry painful eyes in the last ten years.  Ongoing studies and reports from my colleagues on the mainland are very impressive.  We would love to offer this to our patients.  Unfortunately, it is not on the formulary for any local insurance company.  The out of pocket cost is over $500 per month.  For this medication to stay effective, in most cases it must be continued over the long-term.   I have offered it to many patients, but so far no one here has been able to afford it.  Several new studies were presented at the Vision Expo.

-New contact lens options.   Technology in contact lenses has improved greatly over the last few years.  Now most people can wear lenses with all-day comfort and have excellent vision.  My favorite lens company was present at the Expo.  They are reformulating my favorite lens in a toric option.  Toric lenses are very good for people with higher amounts of astigmatism.  This lens should be available over the next few months.  I will be excited to introduce in on Saipan.

-New retinal camera technology.  Last year we purchased the Eidon AF.  It is a widefield retinal camera and gives amazingly detailed images of the back of the eye.  This allows us to follow diseases like diabetes and glaucoma more precisely and better time appropriate treatments.  At the time of our purchase their was no technology which rivaled our Eidon AF.  Last week at the Vision Expo Zeiss released a new camera the Clarus, with very similar features to our Eidon.  We will continue to watch these developments to be certain we are providing the best care to our patients.

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