Wednesday, April 2, 2014

“Don't sit too close to the TV. It is bad for your eyes"

The time we spend with digital devices in our daily lives has increased dramatically over the past decade. Computers, tablet PCs, smartphones, and television have become an integral part of most peoples’ routines. More than 34% of people in the United States spend 4 to 6 hours a day with digital devices and 14% spend between 10 and 12 hours a day*. iPad apps even exist for infants, which are designed to enhance their development of certain motor and visual skills.


There has historically been a concern that doing "near work" might increase the chances of needing glasses later in life (although this has not yet been scientifically proven). Yet, perhaps of greater concern are the small amounts of light radiation that these newer electronic screens emit and the potential damage that could result to the eye.


Blue Light
Doctors, and most of the general public, have understood for years that Ultraviolet, or UV, light causes damage to the skin and eyes. What most people do not realize is that some blue light, also known as high energy visible light, is very close in wavelength to UV light. Similarly, large amounts of blue light may also cause damage, eyestrain, and fatigue to the eyes. Recent research from the Schepens Eye Research Institute suggests that higher levels of blue light may increase the risk of developing macular degeneration**. Blue light itself is present in natural daylight and helps us to stay awake, but as the quality of LCD and LED screens improve, they are emitting more and more blue light.


So, what can be done?
I do not foresee us giving up our laptops or smartphones anytime soon. If anything, our lives will likely become more dependent upon these devices. Many ophthalmic lens manufacturers have recognized the risks, and a variety of lens coatings are already on the market. My office offers choices from Hoya, including their Recharge coating, which has both blue light filtering and anti-reflective properties.


Ideally, electronics manufacturers could also develop the technology to add these blue light-blocking coatings to the device screens themselves, thus reducing emittance of the damaging light rays in the first place. I have had discussions with contact lens manufacturers about adding coatings to contact lenses and have been told that this is an area of ongoing research. I currently prescribe contact lenses with UV protection whenever possible.


Please feel free to contact me, or inquire with your eye care professional, for more information on these protective technologies.



Monday, March 3, 2014

What is Orthokeratology, or Ortho-K?

What is Ortho-K?
How Ortho-K Lenses Gently Mold
Orthokeratology is a treatment where a nearsighted, or myopic, patient places custom designed lenses in their eyes just before going to sleep. These special lenses gently mold the front surface of the cornea (the clear part of the eye that conventional contacts rest on) to correct the patient’s vision. The lenses are removed upon wakening, and contacts/glasses are then no longer needed during the daytime!


Is this surgery?
No. This is a gentle molding of the cornea.


Is Ortho-K reversible?
100% reversible upon discontinuation of the treatment


Is the treatment safe?
Absolutely, under the care of a certified Orthokeratologist. Dr. Neukirch is a member of the Orthokeratology Academy of America (OAA) and will only use materials and designs that are FDA approved. The only manufacturer to receive FDA approval is Paragon CRT, thus these are the only lenses he prescribes. Dr. Neukirch is happy to speak with your doctor or pediatrician should they have any questions.












Is this a new procedure?
Not entirely. Ortho-K has been around since the 1960’s. Ortho-K has historically been very popular in Asian countries, where myopia was much more prevalent. Recent advancements in computerized instrumentation and lens design has yielded dramatically improved results.
Ortho-K may help!


Can Ortho-K keep your eyes from getting worse?
Myopia typically progresses until a patient reaches 20 to 25 years of age. If Ortho-K is initiated before that time, peer-reviewed clinical research indicates that the treatment may slow this progression; sources are found at the end of this article.


Why am I only hearing about this now?
Multiple reasons: 1.) The first and only FDA approved treatment was Paragon CRT in 2011. 2.) Myopia has become much more prevalent in the United States within the past twenty years. 3.) The clinical research which confirms the link between Ortho-K and delayed progression of myopia has only been published in the last couple of years (sources below).


Has anyone at Carillon undergone Ortho-K?
Yes. Our staff member, Anna (previously -2.00 in both eyes), started her treatment this past December, and has been glasses-free ever since. Please feel free to ask her about her personal experience!


Small, gentle custom molds are made for every eye
Am I a candidate?
The best candidates for Ortho-K are myopic children and teenagers, whose eyes are still changing. However, adults (like Anna) can make great candidates, too. Unfortunately, certain prescriptions and corneal shapes may exclude patients from utilizing this treatment.


Okay, I am interested! What’s my next step?
Simply inquire at your next exam, or call our office. Our doctors can review your chart to see if Ortho-K is a possibility for you or your children. Ortho-K consultations are completely free of charge, if the patient has received a comprehensive eye exam at our office within the past year.


Where can I find more information?
In addition to the journal articles below, Paragon CRT has a great patient website at www.CRTvision.com. We also have pamphlets available at the Carillon front desk. Please feel free to email Dr. Neukirch directly at carillonvisioncare@gmail.com with any questions.
 Dr. Andrew Neukirch practices at Carillon Vision Care located in Glenview, Illinois.


Sources:
Myopia control in children through refractive therapy gas permeable contact lenses: is it for real? Koffler BH, Sears JJ. American Journal of Ophthalmology. December 2013.


Myopia Control with Orthokeratology Contact Lenses in Spain: Refractive and Biometric Changes. Jacinto Santodomingo-Rubido, César Villa-Collar, Bernard Gilmartin and Ramón Gutiérrez-Ortega. Investigative Ophthalmology and Visual Science. July 2012.


Trial. Pauline Cho and Sin-Wan Cheung. Investigative Ophthalmology and Visual Science. October 2012.

Sunday, February 2, 2014

Carillon Vision Care Celebrates 1 Year with IDOC. What is IDOC?

Celebrating 55 Years on the North Shore
As our patients know, Carillon Vision Care is a single location, doctor-owned, busy practice whose mission has always been to provide individualized eye care using the latest technology and highest quality materials available.  When I became the owner of the office in 2011, the landscape of the profession had changed drastically since Carillon opened its doors 55 years ago. Reimbursements from medical insurances and vision plans have been dropping dramatically, while the costs of providing care continue to rise. This poses a challenge to all eye care providers (Ophthalmologists, Optometrists, Opticians, and especially practice owners) to operate more efficiently, in order to maintain their standard of care and the quality of products offered.


These changes have driven doctors to utilize buying groups, business consultants, and doctor alliances, which (for a membership fee) may ultimately allow an office to run smarter, not harder. I spent the first two years at Carillon becoming familiar with the benefits of these organizations and deciding which would have the most positive impact on our practice and our patients’ experience.


In February 2013, I decided to join IDOC (Independent Doctors of Optometric Care), which is an alliance of eye care providers that represents more than 1,700 practices across the United States. IDOC hosts an annual 4 day conference which is centered on improving practice management. Numerous classes are offered to both doctors and staff members with topics including: customer service, recruiting the best employees, staff management, as well as receiving updates on the latest products, technologies, and treatments.  It also serves as a forum to exchange ideas and discuss business strategies with other forward-thinking practitioners.  Local groups also meet quarterly on a smaller scale.


The single largest expense in almost every practice is the cost of goods, essentially purchasing the inventory of eyeglass frames, lenses, and contact lenses. With the buying power of 1,700 offices, we have negotiated significantly reduced prices with vendors through our IDOC membership, a benefit that would not typically be available as a stand-alone business. These discounts enable our office to save thousands of dollars per month and keeps our prices in line with, if not less than, many local chain stores.


Since joining IDOC exactly a year ago, we have seen our patient volume rise significantly and our costs of goods trend downward in 2013 vs. 2012. This increase in efficiency has allowed the practice to purchase additional technology, expand our eyewear inventory, and pass the quality and savings onto our patients.  We are also actively looking to hire another staff member and doctor to expand our team. I have no doubt that IDOC has enabled me to streamline our practice, and in turn, I can spend even more time doing what I really love, working directly with my patients.


To my fellow eye care professionals, please feel free to reach out to me if you have questions about IDOC or my practice in general. The 2014 IDOC Conference is happening April 3-6, 2014 in Atlanta and is open to all doctors. The registration is free if you register by February 7th. I hope to see you there!

Stay tuned by following us on Google Plus or Facebook for next month's article and our upcoming newsletter on Corneal Reshaping and Orthokeratology, exciting methods that allow near-sighted patients to no longer wear conventional glasses or contacts without surgery.

Monday, January 13, 2014

Behind the Scenes at the Carillon Optical

My blog entry this month is shifting the focus from eye care to eyewear, as I wanted to take a moment to discuss what our lead optician, Phyllis, has been up to in Carillon’s optical. With years of experience, Phyllis not only has an eye for helping patients find the most aesthetically perfect pair of frames, but she is also exceptionally knowledgeable of the latest brands and materials for both prescription glasses and lenses. I am quite proud of the services and products that our optical has to offer, and we work diligently as a team to make sure all patients’ vision needs are met.


Unlike many of the chain locations, which are owned by a vision insurance company, Carillon’s optical has the freedom to select the lines that we think are the best for our customers. Our well thought-out collections range from durable, yet fashionable children’s frames (with brands like Flexon, Nike) to designer lines (Fendi, Coach, Ray Ban, Kate Spade, etc.). Yet, what truly sets Carillon’s optical apart are the high quality, independent lines that are unique and more difficult to find (Lindberg, Tom Ford, Europa, etc), which offer glasses that are often fully customizable and/or entirely handmade. Our opticians meet with the representatives from each frame line at least 4 times per year to bring in the newest designs. Due to the volume of eyewear that we purchase, discounts are negotiated with our vendors, and these savings are passed on to our customers. We fully stand behind our products and choose to offer only the highest quality eyewear to our patients. Therefore, we intentionally do not carry outdated or consignment items.

The quality of the prescription lenses themselves are undoubtedly just as important. Although we do have a machine (called an edger) that allows us to cut prescription lenses in-house, it is typically reserved for emergency situations. Instead, we choose to use an outside optical laboratory, which offers extremely specialized and high precision equipment to manufacture most of our patients’ lenses. Carillon has worked with Hoya, a local lens laboratory, for over 25 years. Through this partnership, patients receive the best quality lenses in a timely manner and at minimal cost.


Within any optical, Carillon or elsewhere, the quality of the eyewear is a direct reflection of the staff, their training, and credentials.  The state of Illinois does not mandate that opticians have any licensing whatsoever, which means that an “optician” might have only had a few days worth of experience. Carillon only employs licensed and experienced opticians. The measurements of prescription eyewear (pupillary distance, segment height, vertex distance, etc.) are complicated and can greatly affect the quality of vision.

In conclusion, I hope you enjoyed our little “behind-the-scenes” look into how our optical runs and the reasoning behind some of our optical decisions. As always, we will continue to do everything we can to make both your exam and optical experience the best it can be at Carillon Vision Care.

Sunday, December 15, 2013

Thanks for the past three years!

THANKS!!!!!
I would like to take a brief moment and thank all of our patients, my wonderful staff, and my helpful healthcare colleagues for the past three years since I came to Chicago! The number of active patients at our office has nearly doubled, we have been able the acquire all of the latest, top-of-the line ophthalmic diagnostic and testing instruments. Last but not least, I now have a phenomenal network of eyecare specialists in place that I have gotten to know personally and can truly trust with my patients' care.

2014 already looks to be an exciting year. We are presently searching for yet another staff member, and I have began the process of finding the next doctor to bring on board. The specialty contact lens practice within the office has also been picking up steam lately. There will be plenty more info in early 2014 regarding some exciting options for these advanced lenses, so stay tuned.

I will now share the opening letter of our latest newsletter that our patients receive three times a year for those readers whom do not receive our mailings:

Letter from Dr. Neukirch
While the city has been busy upgrading Waukegan Road, we have been even busier upgrading our office. It certainly has been an exciting past few months.

Corneal Topography
This fall Carillon Vision Care gained a new state-of-the-art Corneal Topographer, an instrument that allows us to fit and design the most advanced custom lenses for patients. It is especially useful for patients with high astigmatism that could not otherwise wear conventional contact lenses. Also, the newly implemented Optikam digital spectacle fitting system allows the most precise measurements when fitting Progressive Bifocal/Trifocal prescription glasses.



We are pleased to have added a new line of designer eyewear by Tom Ford, which features styles that are both contemporary and classic. A recently upgraded computer server and network continues to keep your medical data safe, and we can access it even faster. Last but not least, I believe genetic testing is going to be a huge game-changer in all of medicine, and Dr. Agrest and I are very proud to be some of the first practitioners in the Chicago area offering genetic testing for Macular Degeneration in our office (more info on this may be found in my previous blog entry).


I was a little hesitant to continue Carillon’s tradition of publishing patient newsletters when I arrived in Glenview nearly 3 years ago. Yet, much to my surprise and delight, I have received overwhelmingly positive feedback from many of our patients every time! A sincere thanks to all of you that take a minute to read about what Carillon Vision Care is doing to provide the best care possible. The Carillon staff, Dr. Agrest, and I love our profession, and we are always seeking ways to make your experience at Carillon even better.


Happy Holidays to your and yours!

Sincerely,

Dr. Andrew Neukirch

Sunday, November 17, 2013

Corneal Topography, What is That?

I would like to take this opportunity to briefly explain what Corneal Topography is and why your doctor may use this instrument.


The cornea is the clear tissue  at the very front of the eye. The cornea may be seen as you look at the iris; the colored part of the eye. This is the structure that a conventional contact lens sits on. The shape of the cornea is responsible for determining a great amount of your eye’s refractive power, or prescription. Corneal Topography allows your doctor to measure and map out the exact shape of your cornea.

Keratoconus
Topography is not typically performed on most patients. An instance where it becomes helpful is when a doctor may see a very irregular spectacle or contact lens prescription and suspects that the patient may have an early form of a corneal degeneration. The most common corneal degenerative disease is Keratoconus, a condition where the cornea forms more of a cone-like shape than a gradual curve. Early detection is now paramount as there are now procedures offered that may stop this particular type of degeneration before it progresses.


The instrument is also enormously helpful in fitting custom contact lenses or troubleshooting patients that are having difficulties with their present contacts. The immense amount of data provided allows your doctor the ability to design contact lenses that perfectly match the contours of your cornea providing the very best vision possible - better than any pair of conventional spectacles. The cornea maps also greatly reduce the chance that custom ordered rigid gas permeable (RGP), bitoric, bifocal, or progressive base curve contacts need to be adjusted or fine-tuned.


Topography also plays a significant role in the evolving field of myopia control (keeping kids’ and teenagers’ near-sighted prescriptions from increasing). I will talk more about this in the upcoming months.

Carillon Vision Care recently added a brand new Medmont E300 Topographer to our practice. This particular instrument is not only one of the most accurate topographers available, but its software interface provides beautiful visual cornea maps that are easily explained to the patient. We are very proud to offer this advanced technology to our patients that will benefit.

Tuesday, October 22, 2013

Genetic Testing for Macular Degeneration

Age-related Macular Degeneration (AMD) is a leading cause of vision impairment and blindness in the developed word. It occurs when the macular region of the retina, which is responsible for the images in the center of our visual field, begins to wear out. This process occurs from either yellow, “drusen” deposits below the macula in “dry” AMD, or less commonly due to new, abnormal blood vessels that form below the macula in “wet” AMD. Either way, the result is gradual, central vision loss that is often most apparent initially when reading. While these changes are irreversible, recent studies indicate there are steps that at-risk patients can take to reduce the chances of developing AMD or to limit its progression. The risk for developing AMD increases with advanced age in the general population and is compounded by smoking. However, there is also a known hereditary component to the disease, and those with a positive family history face a higher risk.

Macula Region is in the center
The current standard of care for treating patients with a confirmed diagnosis of AMD, as well as prophylaxis for those with a family history, is to provide prescribed dietary supplements, a practice based on twelve years of data from the Age Related Eye Disease Studies (AREDS 1 and AREDS 2). Additionally, medications can be prescribed for wet AMD to retard the development of the blood vessels that damage the macula.

Newer developments in the field of AMD include options for genetic testing, which were typically very expensive until recently. The Macula Risk Test is now available for no out-of-pocket expense through most health insurances, including Medicare, for patients that have an existing AMD diagnosis, whether an early or later stage of the disease. The data from this test provides your optometrist or ophthalmologist a better risk assessment and will help guide their treatment plan; research published as recently as August 2013 identifies specific combinations of two genetic markers and corresponding therapies that can improve the disease prognosis.

The Vita Risk DNA Test varies slightly, as it is designed specifically for patients that do not presently have AMD. This test can help to guide therapy, because if no AMD risk genes are identified, zinc had been proven to provide the most protective effect. Yet, in patients with AMD risk genes, zinc provided no protection and actually minimized the benefits of the antioxidants found in both of the AREDS formulas. This genetic testing format is not yet covered by health insurances, but is still relatively low cost to the patient.

Certain genes mean increased risk
We are excited to offer both tests at Carillon, which take less than 2-3 minutes and only require an oral cotton swab from the patient’s cheeks. The samples are then mailed off to the genetic laboratory and results are obtained and discussed in approximately a month, either over the phone or in person.

More information for my fellow medical colleagues may be found here (http://www.arcticdx.com/home), and I certainly encourage them to add this valuable service to their practice.

Disclaimer: Dr. Neukirch does not have any financial interest in the company that provides this genetic testing.

Dr. Andrew Neukirch practices in North Suburban Chicago at Carillon Vision Care in Glenview, Illinois and may be reached directly here.



Genetic markers and biomarkers for age-related macular degeneration. Robert J Ross, Varun Verma, Kevin I Rosenberg, Chi-Chao Chan, and Jingsheng Tuo

CFH and ARMS2 Genetic Polymorphisms Predict Response to Antioxidants and Zinc in Patients with Age-related Macular Degeneration. Carl C. Awh, Anne-Marie Lane, Steven Hawken, Brent Zanke, Ivana K. Kim