I recently received this letter from a patient who had cataract surgery and I think it is important to share. As a healthcare provider, I do my best to make sure patients are treated fairly, but I, as all physicians, have little control over what the insurance companies or federal government will or will not cover and what they will reimburse. As physicians, we can bill an insurance company $1000.00 for a procedure, but we may get paid nothing, or as little as $1.00, depending on the insurance - company pre-determined fee schedule. Hopefully this will help clear some popular misconceptions about what doctors charge and what they actually collect.
If you have a bump on your eyelid and it is new, chances are it is probably a benign lesion, like a chalazion, skin tag or stye. If you have noticed, however, that the bump has been slowly enlarging over time, or if you have recurrent chalazia or styes on the same eyelid not involving the other eyelids, you should be evaluated by an ophthalmologist to make sure that it is not something more serious.
There are many tumors that can affect the eyelids. Some of the more common and serious tumors are basal cell carcinoma, squamous cell carcinoma, melanoma and sebaceous gland carcinoma. Most of the “dangerous” eyelid tumors occur in fair-skinned patients, who have a history of sun exposure. There is often a loss of eyelashes at the site of the lesion.
Basal cell carcinoma is the most common tumor affecting the eyelids, accounting for about 85% of all eyelid tumors. It is often located on the lower eyelid and looks like a “pearly” nodule that is non-tender. Squamous cell carcinoma of the eyelid often presents as a raised bump on the lower eyelid with an associated loss of eyelashes. Sebaceous gland carcinoma can often masquerade as chronic inflammation of the eyelids, as seen with blepharitis or recurrent styes or chalazia on the same eyelid. This potentially lethal tumor is especially worrisome, as it may be undiagnosed for years and it can spread to other parts of the eye and body. Malignant melanoma is a darkly pigmented area or bump on the eyelid, although some may not be pigmented. They are common in fair skinned individuals who enjoy being out in the sun, and account for the many of the deaths related to eyelid tumors.
If you have noticed an eyelid bump and are not sure what it is, not to worry. Make an appointment with your ophthalmologist today, who can examine it and perhaps even biopsy or remove it. The worst thing that you can do for yourself is ignore it, so please, get it checked out!
Many of you had to reach for your readings glasses before reading this article. If you are in your early to mid forties, you may be starting to develop the symptoms of presbyopia, and like many of my patients, you are probably not too happy with the idea of reaching for a pair of reading glasses. Presbyopia is the inability to focus at near due to aging changes in the muscles of the eye and the natural lens.
There are solutions to correcting presbyopia other than wearing reading glasses. Interesting surgical options, such as the Restor intraocular lens implant, are reasonable if you have cataracts. For those of you who do not have cataracts, you make consider getting fit for contact lenses in one or both eyes, to help with your near vision. If you already wear contact lenses for near sightedness, you may need an adjustment in the power to allow you to read more comfortably. You could also be a candidate for monovision with contacts or with lasik, in which your non-dominant eye is corrected for near vision and your dominant eye is corrected for distance vision. Monovision is not for everyone, so it is important to try it with contacts before committing to it. Bifocal contact lenses are another suitable option even if you have never worn contacts before. If you are not opposed to wearing reading glasses, sometimes over-the-counter readers is all you need. Its important to schedule an appointment with an ophthalmologist who can review your surgical and non-surgical options and get you reading 20/20 again.
With summer FINALLY here, you need to protect your body from the sun's harmful ultraviolet rays. UVA rays have been associated with cataracts and macular degeneration. UVB is associated with skin damage leading to premature aging and skin cancer. Be aware that not all designer sunglasses block ultraviolet rays. When shopping for sunglasses, look for glasses that block 100% of UV rays. UV exposure is also linked to the formation of pterygia and pinguecula, which can cause significant eye irritation as well as an unsightly appearance (no pun intended!)
Red, Itchy, Dry Eyes? It’s that time of the year again when eyes begin to itch, burn, tear up and feel dry. Most likely it’s related to allergic conjunctivitis. The overall prevalence of allergic conjunctivitis has been increasing since the 1980’s with over 20% of the population being affected. Seasonal allergy is the most common allergy affecting the eyes. The symptoms of allergic conjunctivitis may also begin earlier in the year as increasing temperatures have led to earlier spring time pollination. Allergic conjunctivitis is a type 1 hypersensitivity reaction whereby an allergen comes in contact with the eye and results in an inflammatory cascade of mast cell degranulation and histamine and cytokine release. This will lead to dilation of the blood vessels and itching. The inflammatory process also effects the production of the tear film and can result in the symptoms of dry eyes.Normal oral allergy medications can help with some symptoms of allergic conjunctivitis, but they can also cause or worsen the symptoms of dry eye. Typically we treat allergic conjunctivitis with several classes of drops including preservative free tears to dilute out the allergens and stronger agents such as mast cell stablizers, anti-histamines, and steroidal and non-steroidal anti-inflammatory drops. Some over-the- counter agents may be helpful, but may contain an ingredient that causes constriction of blood vessels in the eyes to reduce redness. Unfortunately, when these drops wear off, it causes a rebound vasodilation of the blood vessels and worsening redness.If you suffer from dry eyes, tearing, redness, itching, burning or foreign body sensation in the eyes, it may be time to check in with your ophthalmologist to see if you have allergic conjunctivitis or other causes of these symptoms.
Often, patients come to the ophthalmologist for a prescription for glasses or contacts, and are surprised to discover that he or she may offer many additional services. Ophthalmologists address medical issues affecting the eyes such as dry eye, glaucoma, cataracts, diabetes and eye allergies to name a few, but they can also address your cosmetic needs. Your ophthalmologist may be able to help you get out of glasses for both for distance and reading with new surgical innovations such as laser vision correction and cataract surgery with the new “bifocal” lens implants or monovision. She can also help patients who have chronic red eyes by diagnosing and treating the underlying condition. There are many anti-aging services that an ophthalmologist can offer such as improving the appearance of fine lines and wrinkles with BOTOX and dermal fillers, or eyelid enhancement surgery to improve the appearance of aging, droopy eyelids. BOTOX is also used in many patients for functional reasons such as to control a condition known as blepharospasm, in which the eyelids are constantly closing involuntarily. Blepharoplasty can also be a functional surgery if a patient is has a decreased ability to see in upgaze. Whatever your cosmetic or medical needs are, check with your ophthalmologist to see if he or she offers these services, you may walk out looking and feeling 20 years younger!
I have had several patients come to the office surprised to learn that ophthalmologists perform cosmetic procedures such as Botox injections and blepharoplasty. I often explain to them that as eye surgeons, we are trained to perform botox injections on patients with Blepharospam to relax the muscles around the eyes. Blepharoplasty is an integral part of restoring vision in patients with excessive upper eyelid skin, who may be suffering from superior visual field defects. As a refractive surgeon, procedures such as LASIK or cataract surgery to gain spectacle independence can also be considered in our realm of cosmetic services. Even treating chronic ocular allergy or dry eyes can lead to improved cosmesis, as these patients often suffer from "red eyes" or "puffy eyes". Finally, lets not forget "Latisse" for thicker, fuller lashes, a product that originated from a commonly used glaucoma medication. So when you visit your ophthalmologist, don't be surprised by the functional as well as cosmetic services that may be offered to improve your eye health and aesthetics.
Dr. Patel is currently Board Certified by the American Board of Ophthalmology and an active member of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Northern Virginia Academy of Ophthalmology and the Virginia Society of Ophthalmology. She is currently seeing patients in the Vienna, VA area with general ophthalmic conditions, corneal disease, cosmetic needs, dry eye and laser vision correction candidates.