Gap Billing for Cataract Surgery May 2018 — Newsletter:— Gap Billing for Cataract Surgery Dr Richard Barry is now offering Gap Billing for Cataract Surgery, for government pensioncard holders. For any patient who is a government pensioncard holder and is privately insured, Dr. Barry will offer a minimal out-of-pocket cost for cataract surgery. The surgical fee will be at most $400-$500. This will significantly reduce the overall out-of-pocket cost for private cataract surgery and will assist those most in need. Dr. Barry continues to offer no-gap billing for emergency vitreoretinal surgery for insured patients. This offer has been greatly appreciated by the patients that you have referred and we thank you kindly for your support. In most of these referred cases, surgery was been performed within 24 hours and often on the same day. As of June 2018, Dr. Barry will also be operating out of Canberra Private Hospital and their new, state-of-the-art, ophthalmology theater. emergency cases needing surgery on the same day or within 24 hours will have even more theater accessibility. For more information call the team at Blink Eye Clinic on 02 51040929 or email hello@blink.clinic — Referring children to Blink Eye Clinic Dr. Barry is always available to help in emergency situations, for any patient, regardless of age. However, in regards to pediatric patients, Blink Eye Clinic will accept referrals of patients who have reached visual maturity, essentially from the age of 9 onwards. Patients who have not reached visual maturity would be better served with a pediatric ophthalmologist who can best manage refractive issues. Patients under 9 years of age who specifically have retinal issues will be accepted at Blink Eye Clinic.
For more information call the team at Blink Eye Clinic on 02 51040929 or email hello@blink.clinic May 2018 — Case of the Month:White on red...— History
— Examination
— Imaging UWF
OCTInner retinal oedema consistent with arterial occlusion. OCTNo obvious cystoid macular edema. Disturbance of normal hyper-reflective and hypo-reflective OCT bands. — Differential Diagnosis
— InvestigationsChest x-ray and extensive blood workup including: — DiagnosisCRVO with cilioretinal artery occlusion— DiscussionRetinal vein occlusion is the 2nd most common retinal vascular disease after diabetic retinopathy. The vast majority of patients with retinal vein occlusion are over 50 but some studies have reported 10 to 25% under the age of 50. Systemic hypertension and vascular disease are important risk factors for CRVO in patients older than 50 years. Other risk factors for CRVO have been found to be diabetes mellitus and hyperlipidemia, black race, male sex, peripheral artery disease, stroke, hypercoagulable state, ocular hypertension and primary open-angle glaucoma. Systemic hypertension is less prevalent in patients with CRVO under 50. The etiology of CRVO in younger patients seems to be multifactorial. Hypercoagulability is often reported as an important risk factor, in particular, the increased prevalence of activated protein C (APC) resistance, and deficiencies of anticoagulant protein C, S and antithrombin III have been reported to be predominant risk factors for CRVO in younger patients. High levels of homocystein and anticardiolipin antibodies, have also been found to be risk factors for venous thrombosis and arterial vascular diseases. Temporary hyperviscosity, in which the blood haematocrit increases, for example, as a result of severe dehydration due to high alcohol intake, fasting or following intense exercise, has been linked to younger adults with CRVO. Less commonly infections like hepatitis and HIV as well as autoimmune conditions including Lupus are associated with CRVO in younger people. Hypercoagulability from malignancies also need to be considered. Refer to table 3 below: Systemic abnormalities associated with retinal vein occlusion in young patients. Sinawat S et al, Clinical Ophthalmology, February 2017 Ocular disorders such as diurnal IOP fluctuation, primary open angle glaucoma and pigment dispersion syndrome have also been associated with CRVO in younger adults. Combined central retinal vein and cilioretinal artery occlusions are reported to represent 40% of all cilioretinal artery obstructions. Approximately 5% of eyes with CRVO also have a cilioretinal artery occlusion. Cilioretinal artery occlusions makeup lesson 5% of all retinal arterial occlusions. The pathogenesis of this rare condition remains controversial. It appears that the cilioretinal artery occlusion occurs subsequent and secondary to the central retinal vein occlusion. Since the perfusion pressure in a cilioretinal artery is lower than in a retinal artery, a cilioretinal artery occlusion is more likely to be caused by optic disc swelling and/or reduced cilioretinal artery perfusion following central retinal vein occlusion. Cilioretinal arteries are present in about 20% of eyes. Occlusion of this artery usually is in one of 3 forms:
Brown et al. found 90%, 70%, and 0% of eyes achieved 20/40 or better vision in the first, second, and third group, respectively. The vision was surprisingly poor in this particular case presented here, and no improvement has been documented to date, with investigations still pending. Often the severity of visual loss in these cases is more dependent on severity of the vein occlusion rather than the cilioretinal artery as there is often sparing of much of the fovea in cases of cilioretinal artery occlusion. Paracentral visual field defects, however, often persist. No treatment was offered in this particular case and the patient was referred to his general practitioner for further workup. hello@blink.clinic www.blink.clinic |