Visit Booth #17 at AAO in New Orleans, November 10

All USRetina members and vendor partners are welcome and encouraged to stop by our booth to hear about the latest GPO offerings and news that may directly impact your practice.

Not a USRetina member but interested in learning more? Come by the booth to talk with a USRetina team member and see the difference a high value retina network can make.

Interested in attending AAO?  Click here to view more information about the event.

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USRetina New Member Spotlight: Q2 2017

USRetina is pleased to announce the newest members to the GPO.   The following member practices have joined our association this past quarter:

  • Oregon Eye Consultants (Medford, OR)
  • Retina Associates of Hawaii, Inc (Honolulu, HI)
  • Garland Eye Associates (Garland, TX)
  • Augusta Retina Consultants, Inc (Augusta, GA)
  • Eye Surgeons of Indiana (Indianapolis, IN)
  • Eye Surgeons Associates, PC (Monroe, MI)
  • Eye Physicians and Surgeons, P.A. (Wilmington, DE)
  • Khaled Tawansy, MD (Bakersfield, CA)
  • Milestones Retina Eye Care (Pasadena, CA)
  • Amitabh Bharadwaj, MD (Pinole, CA)
  • California Retina Associates (Chula Vista, CA)
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Post-Election Advocacy Briefing

It is far too soon to know where the dust will settle on many issues impacting our practices. What we can clarify for USRetina members is that no “stop work” directives have been issued to CMS staff as of this publication. In other words, all initiatives underway are still moving forward. However, everyone knows that a key item on President-elect Trump’s agenda is the repeal of the Affordable Care Act or at least the repeal of components of it.

CMMI, its funding, and demonstrations are most definitely in the cross-hairs. The proposed Part B demonstration is a CMMI/Affordable Care Act demonstration. It is still too early to know if the current administration will try to move it through quickly or abandon it.

Importantly, the MACRA initiative or Quality Payment Program is part of a separate piece of legislation to replace the old SGR. Therefore, it is not at risk at this point; however, the rules could be modified under the new administration.

The USRetina advocacy team will continue to keep members updated about our ongoing efforts in the coming days.

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Steve Charles, MD, Awarded the 2016 Retina Research Foundation Award of Merit

Congratulations to USRetina member Steve Charles, MD, FACS, FICS, who was awarded the Retina Research Foundation (RRF) Award of Merit at the Retina Society Annual Meeting in September. This prestigious award is to “recognize outstanding vision scientists whose work contributes to knowledge about the retina and retinal diseases.”

Dr. Charles is the Founder of Charles Retina Institute, and is an internationally-recognized vitreoretinal surgeon, performing over 36,000 retinal surgeries in 25 countries. Dr. Charles has helped shape many of the advancements used today in the treatment of retinal disease.

The mission of the RRF is to reduce the occurrence of retinal blindness worldwide by funding programs in research and education. Since 1978, RRF has selected many world-renowned scientists for the Award of Merit for outstanding achievements in retina research and momentous contributions to new knowledge about the retina or retinal disease.  It is certainly an honor that Dr. Charles is now included among this impressive group of recipients.

To learn more about Dr. Charles and the RRF Award of Merit, click here.

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Dr. Kourous Rezaei of Illinois Retina Associates Moderates International Survey Revealing Global Differences Among Retina Specialists

A recent “global trends” survey, moderated by Dr. Kourous A. Rezaei, ASRS International Affairs Committee Member and retinal physician at Illinois Retina Associates, has revealed significant discrepancies in practice between retina specialists in the United States and those in other regions. The survey gathered responses from over 1,100 retina physicians from a total of 40 medical societies, including the American Society of Retina Specialists.

The results revealed that retina specialists in the United States take a different approach to managing endophthalmities after intravitreal injection, compared with physicians in nearly every other global region.

“This, I think, is a big discrepancy between the U.S. and Europe,” says Dr. Rezaei in a recent article, “and also almost the rest of the world, where most of them do vitrectomy.”

72% of U.S. respondents said they would handle such cases with a tap and inject strategy. In every other region, less than 50% of respondents gave the same response. In most regions, pars plata vitrectomy is the most commonly used treatment strategy.

This wasn’t the only survey question to illustrate a difference between the US and the rest of the world. Another question asked whether visual acuity improves then stabilizes, or improves before declining in patients on long-term VEGF therapy. A majority of US respondents, 64.1%, said that visual acuity stabilized.

“This is the opposite of what the real-world data indicate,” notes Dr. Rezaei. To view the full survey, click here.

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Dr. Dante J. Pieramici Discusses “Managing Severe Open Globe Injuries Through the Years” in ‘Retina Today’

Dr. Dante J. Pieramici explores ophthalmologic history and the evolvement of ophthalmologic surgery in his recent Retina Today article entitled, “Managing Severe Open Globe Injuries Through the Years.”

For most of human history, open globe injuries — severe full thickness defects of the eye wall caused by traumatic injury —meant losing the affected eye or its vision. Lacerations, ruptures, perforation, or penetration of the eye made it impossible to restore vision, and surgical techniques put the patients in danger of infection and other severe complications. The prognosis for open globe injury patients prior to the mid-20th century was grim.

Today, advances in modern medicine have supplanted the pigeon blood, leeches, medicinal herbs, and other treatments that were the only recourse for ancient, medieval, and early modern physicians. By the 19th century, enucleation became a favored technique, as pioneered by George Lawson. The early 20th century brought advancements in X-ray imaging and magnetism, improving the ability to remove intraorbital foreign objects — especially those that were ferromagnetic — through a scleral incision.

Dr. Dante J. Pieramici is a retina specialist and partner at California Retina Consultants and Director of the California Retina Research Foundation. His recent article is the first in a series, which will continue to detail the history of open globe injury management. You can read the full article here: http://retinatoday.com/2016/06/managing-severe-open-globe-injuries-through-the-years/.

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Dr. Alan Kimura Participates in Colorado Society of Eye Physicians & Surgeons’ Day at the Capitol

Last month, Dr. Alan Kimura of Colorado Retina Associates attended the Colorado Society of Eye Physicians & Surgeons’ (CSEPS) Day at the Capitol. This event, organized by glaucoma specialist Dr. Leo Seibold of the University of Colorado School of Medicine, is designed to provide an opportunity for optometrists, ophthalmologists, and retina specialists to meet with state legislators at the Capitol.

This advocacy event brings together eye physicians from across the state, including many young physicians with a strong interest in advocacy. Among the attendees were Drs. Cara Capitina and Gabriela Rodriguez-Colon, the 2016 ambassadors for the American Academy of Ophthalmology’s Mid-Year Forum for Advocacy.

During the CSEPS Day at the Capitol, Dr. Kimura and his colleagues met with state legislators, including Colorado state representative Beth McCann. Among the topics discussed were scope of practice for optometry, the Surgical Scope Fund, and how beginning ophthalmologists can get involved in advocacy efforts.

Dr. Kimura is one of two physicians that lectures to ophthalmology residents at the University of Colorado. He focuses on incorporating advocacy topics into his interactions with these young physicians. “I always weave in population health, the patient experience of care, and costs into my retina lectures to them,” he reports. “Residency is the ideal time to speak about advocacy, for once residents are out of training and just starting their practice, it is very challenging to get them to take even a day off of work.”

Events like the CSEPS’s Day at the Capitol provide a prime opportunity for retina specialists and other eye physicians to connect with legislators to advocate for policies that improve the quality and availability of ophthalmologic care for patients. You can find out more about the event here: http://retinacolorado.com/practical-lessons-leadership/.

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AOSLO-retina-imaging

Adaptive Optics Light Scanning Ophthalmoscopy for Microvascular Retinal Imaging

Traditionally, the imaging and examination of macroscopic features has been instrumental in the early detection and treatment of retinal disease. Features such as arterial narrowing, arterial nicking, hemmorhages, and microaneurysms are key signifiers of retinal damage, often secondary to common health conditions such as progressive cardiovascular disease or diabetes mellitus.

In addition to these macroscopic signs of retina disease, recent developments in imaging technology have begun to enable clinicians and researchers to examine microscopic features of the retina in increasing resolution and detail. One promising emerging technology for non-invasive imaging of the retinal microvasculature is adaptive optics light scanning ophthalmoscopy (AOSLO). AOSLO uses deformable mirrors to correct for ocular aberrations, allowing for non-invasive imaging of nerve fibers, retinal microvasculature, photoreceptors, retinal pigment epithelium, and lamina cribosa.

One of the key advantages of AOSLO is its non-invasiveness. This makes it highly useful for early screening and detection of retina disease, which allows for earlier intervention and better clinical outcomes. For that reason, continuous improvement of AOSLO technology is of great value for retina specialists.

In a recently published review of the clinical literature in the International Journal of Retina and Vitreous, the current state of AOSLO for microvascular retinal imaging is assessed in detail. Key clinical applications include diagnosis of diabetic retinopathy, retinal vein occlusion, and sickle cell disease. The ability to image the retina in increasingly high resolution has opened up new possibilities for identifying clinical biomarkers, enabling early detection of retinal disease, and improving clinical outcomes through earlier intervention.

Adaptive Optics Light Scanning Ophthalmoscopy and Diabetic Retinopathy

Diabetic retinopathy, which can remain asymptomatic for years before visual abnormalities develop, has traditionally been diagnosed by detecting microangiopathy. However, histologic studies have demonstrated characteristics such as pericyte loss and basement membrane thickening. The currently available imaging modalities are not capable of detecting these histological changes, and to date, they have essentially been considered subclinical.

New developments in AOLSO have begun to facilitate the imaging of these structures. Studies using AOSLO have already been able to image these subclinical changes in vivo. This allows for the measurement of structural changes in aging healthy patients and those in the early stages of diabetic retinopathy, representing clinical biomarkers that could enable much earlier diagnosis and treatment.

The Future of AOSLO

The resolution of which AOSLO is capable is unprecedented, allowing physicians to image the vascular network down to the capillary level. This technology holds promising potential for enabling early detection of retina disease biomarkers, as not only is it non-invasive, but it allows for the imaging of microscopic signs of early retina pathology.

For more information on recent developments in adaptive optics light scanning ophthalmoscopy, you can read the full review here: Human retinal microvascular imaging using adaptive optics scanning light ophthalmoscopy.

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Dr. Joseph M. Coney Provides Retina Surgery Training to Ophthalmologists in Haiti

In May 2016, Dr. Joseph M. Coney, a retina specialist at Retina Associates of Cleveland, embarked on the first of many upcoming humanitarian mission trips to Port au Prince, Haiti. Dr. Coney, who serves as president of both the Cleveland Ophthalmological Society and the Ophthalmology Section of the National Medical Association, has agreed to a multi-year commitment to help train qualified local Haitian ophthalmologists in retina surgery techniques, addressing a previous lack of retina specialists in the country. Through Dr. Coney’s work, Haitian patients will be able to have access to retina surgeries that were previously unavailable in the region, helping restore eyesight in patients with retinal disease and vision impairment.

Training Haiti’s First Retina Surgeons
In the developing nation of Haiti, access to medical care is often quite limited. Currently, there are no retina surgeons in Haiti. Dr. Coney’s mission aims to change that. This humanitarian project is made possible by both SEE International and the Alcon Foundation. SEE International works with volunteer ophthalmic surgeons like Dr. Coney to provide medical, surgical, and educational services in developing countries, and donated surgical equipment to help make Dr. Coney’s work possible.

The goal of Dr. Coney’s humanitarian mission to Haiti is to train qualified local ophthalmologists in retina surgery, introducing new tools and techniques to restore sight in patients with retina disease. Thousands of Haitians suffer from common diseases of the retina, such as age-related macular degeneration. In the past, a lack of trained retina surgeons and necessary equipment has left these patients with debilitating visual impairments.

A Brighter Future for Haitian Retina Patients
Over the next few years, Dr. Coney will continue to make periodic mission trips to Haiti to provide retina surgery training. The undertaking will allow local ophthalmologists to provide sight-restoring surgeries that were previously completely unavailable, helping restore eyesight in patients whose retinal vision impairments were previously untreated.

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Dr. Paul E. Tornambe’s Contributions to Macular Hole Surgery Without Face-Down Posturing

“All you have to do to be successful in medicine is to do what is best for your patients.” Dr. Paul E. Tornambe received this advice from his father, a primary care physician, and it has been a lifelong influence on his career.

Dr. Tornambe, a retina specialist at Retina Consultants San Diego, has spent much of his life pioneering new surgical techniques and medical technologies to advance retinal medicine and improve patient outcomes. From surgical instruments like the Tornambe torpedo light, to his influential work with pneumatic retinopexy, Dr. Tornambe has made considerable contributions to retinal medicine. Foremost among these has been his work with macular hole surgery without face-down positioning.

A New Approach to Macular Hole Surgery

Among his important contributions has been pioneering macular hole surgery without the typical face-down posture. In the 1990s, Dr. Tornambe and two colleagues published a groundbreaking paper in Retina, titled “Macular hole surgery without face-down positioning: a pilot study.” In this study, the first of its kind, Dr. Tornambe and his colleagues questioned whether postoperative face-down positioning was really necessary. Although face-down positioning was considered to be important for successful macular hole closure, this had never been conclusively proven.

In the Retina study, Dr. Tornambe and his coauthors examined a total of 33 eyes in 31 patients aged 65-79. None of the patients in the study were positioned face-down. Over a follow-up period ranging from 6 to 40 months, with 73% of the patients observed for over a year, the success rate after one surgery was 79%. After additional vitrectomy surgery, the success rate rose to 85%.

The results of the pilot study illustrated that successful macular hole closure was, in fact, possible without the usual face-down positioning, which can be a significant inconvenience for patients with pseudophakic and phakic eyes.

Today, 26 years later, Dr. Tornambe continues to advocate for macular hole surgery without face-down positioning, especially for patients over 50, who nearly always require cataract surgery within a few months to a few years of a vitrectomy. Today, retina surgeons around the world have adopted Dr. Tornambe’s approach, foregoing unnecessary face-down posturing in the majority of older patients.

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