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Dr. Mali’s Top 5 Predictions for 2018

This is an article by Dr. Joshua Mali published by Ophthalmology Times.

1). Aflibercept and ranibizumab utilization will continue to soar to new heights in 2018.

The success of aflibercept (Eylea, Regeneron Pharmaceuticals) and ranibizumab (Lucentis, Genentech/Roche) injections will definitely continue in 2018. Regeneron just recently reported fourth-quarter 2017 sales of its flagship product, aflibercept, of $975 million, up 13.6% year over year. I anticipate sales will continue to flourish with aflibercept given its strong efficacy data and excellent long-term safety profile.

In 2017, ranibizumab became the first anti-VEGF therapy approved to treat patients with myopic choroidal neovascularization (mCNV) in the United States, in addition to receiving FDA approval for the treatment of all forms of diabetic retinopathy. The combination of these two new indications, as well as the availability of the ranibizumab 0.5-mg prefilled syringe, makes ranibizumab primed to continue its growth momentum in 2018. Overall, as the prevalence of exudative age-related macular degeneration (AMD), retinal vein occlusion, and diabetic macular edema continues to climb worldwide, these will be the two heavyweights in the anti-VEGF market in 2018.

2). The ForeseeHome device will be the new standard of care in AMD monitoring.

Described in one of my previous articles as one of the 5 greatest ophthalmic innovations of the 21stcentury, telemedicine represents a new frontier of our field focusing on two main principles: prevention and early disease detection. This philosophy is probably best illustrated in a disease like AMD, and the ForeseeHome device (Notal Vision) is the flagship telemedicine technology in ophthalmology today. The ability to immediately detect the initial conversion in a patient from dry to wet AMD is absolutely critical and basically determines a patient’s visual prognosis in addition to making our current therapies even more effective. Top that off with the recent Medicare coverage approval for the device and I believe ForeseeHome utilization will accelerate this year and become the new standard of care in AMD monitoring.

 3). Bromenfac will take a significant leading share of the topical NSAID market.

Bromfenac ophthalmic solution 0.075% (BromSite, Sun Ophthalmics) is a non-steroidal anti-inflammatory drug (NSAID) indicated for the treatment of postoperative inflammation and prevention of ocular pain in patients undergoing cataract surgery. Bromfenac is the active molecule that is designed for improved corneal penetration given the bromine component which allows for enhanced lipophilicity and ocular tissue penetration. However, the key feature of this medication is the delivery system (DuraSite) that allows the delivery vehicle to be more viscous and mucoadhesive—thus increasing retention time on the ocular surface and allowing for a higher intraocular concentration of bromfenac. I strongly believe that bromfenac, with its delivery vehicle, is able to create a much higher intraocular concentration (as compared with other topical NSAIDs)—thus resulting in a more efficacious response and will lead to increased utilization in the ophthalmology community in 2018.

4). Voretigene neparvovec-rzyl will be a successful pioneer for gene therapies. 

Voretigene neparvovec-rzyl (“voretigene,” Luxturna, Spark Therapeutics) is the first gene therapy for a genetic disease, first and only pharmacologic treatment for an inherited retinal disease (IRD), and first adeno-associated virus (AAV) vector gene therapy approved in the United States. With all these first-in-class titles, there will be new challenges ahead for this innovative advance in medicine. Drug cost reimbursement, insurance coverage, distribution, and marketing/education will be the critical topics that will require creative solutions.

However, I believe voretigene is more than ready for the battle and it will be very successful in pioneering this new frontier. The company has already put into motion an organized structural model to address these pivotal issues and they have the skills to deliver this exciting new treatment to patients across our country. They will be making history and writing the blueprint for which the entire class of gene therapies will utilize in the future.

5). Healthcare law reform will start to take shape.     

While complete healthcare reform has taken a backseat to other legislative priorities, I still strongly believe comprehensive healthcare reform will make significant progress in 2018. While it remains to be seen if complete repeal of the Affordable Care Act (ACA) or adjustment to existing healthcare law will be accomplished and signed into law this year, President Trump and Congress will be working diligently on a solution for healthcare reform.

In addition, the private sector may also be able to provide some assistance in developing healthcare solutions.

For example, it was recently announced that Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. are partnering on ways to address healthcare for their U.S. employees, with the aim of improving employee satisfaction and reducing costs.

Additionally, former CMS administrator Andy Slavitt has launched a new bipartisan nonprofit organization called the United States of Care to ensure access to quality, affordable health care for all Americans regardless of health status, social need or income.

Ultimately, it will take the efforts of all of us as Americans with different backgrounds and skills to solve this issue. I also have some ideas on how to develop our healthcare policy that will be satisfactory to all sides-patients, physicians, hospitals, pharmaceutical companies, insurance companies, and our government. So, if President Trump, any of our politicians from Congress, or members of these private sector initiatives are reading this article, feel free to call me. That being said, we must have stabilization of the United States healthcare system in order to allow all of us as physicians/ophthalmologists to continue to provide the best healthcare delivery for our patients.

2018 will definitely be a very exciting year for both ophthalmology and healthcare as a whole. As I have done in the past, I look forward to keeping you updated throughout the year!

Joshua Mali, MD, is a board-certified ophthalmologist and award-winning vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, Florida. He can be reached at 941-923-2020. Dr. Mali’s relevant financial disclosures include the following: Regeneron (consultant, speaker, stock shareholder, research funding), Genentech/Roche (consultant, speaker), Notal Vision Inc. (consultant, speaker), and Sun Pharmaceutical Industries Inc. (consultant, speaker).

Are Electronics Affecting Your Kids’ Eyes?

Phones, tablets and other electronic devices

How does electronics affect kids’ eyes?

Electronic devices. Our kids were raised with them. They can’t imagine life without them. And neither can we. But how are they affecting our kids’ eyes? We know first hand the strain that we feel after a long period at the computer. But what about our kids? According to the American Optometric Association, 83 % of our kids between 10 and 17 are using electronic devices 3 hours or more a day. Most parents are surprised to hear that. While we accept that we are using smart phones and computers for hours at work, it’s hard to imagine that our kids are spending so much time on them as well.

Another study published in Journal of Pediatric Ophthalmology and Strabismus found that smartphones and tablets could be contributing to increased dry eye problems in kids’ eyes. Dry Eye symptoms such as burning, tearing, eye fatigue are common complaints that we hear everyday at The Eye Associates, and increasingly so in kids. Gaming glasses, computer glasses and digital eyeglasses are being prescribed more and more in order to offer symptom relief as well as protection against harmful bluelight emitted by electronics. The American Macular Degeneration Associations has suggested a link between bluelight and macular degeneration. Let’s start protecting our kids’ eyes early from macular degeneration.

The difference between kids and adults is the self awareness of symptoms. Adults feeling eye strain will take a break and give their eyes a rest. We find that children, especially when playing a game, will continue using the electronic device. That is why it is important for the parent to step in and institute rules about electronic use. We recommend taking a break every 20 minutes. Also remind your kids to blink. So often computer users forget to blink.

Adults are also susceptible to digital strain. Some common symptoms are tired eyes, stiff neck and headache.

http://www.zeiss.com/vision-care/en_de/better-vision/better-vision-with-zeiss/your-individualized-zeiss-lens/digital-lenses-spectacles-for-users-of-mobile-devices.html

Click here or call 1-866-865-2020 for a comprehensive eye exam with one of our Board Certified Eye Physicians.

Medications and Eyes

Man holding a medicine bottle

Is your medicine affecting your vision?

Medications can have a great effect on your eyes and vision quality. That is why it is so important to take a list of your medications, both prescription and non-prescription, with you to your next eye examination appointment. People are surprised to hear that over-the-counter medications are at risk for side effects. And when people take more than one drug, the effect is compounded. That is why it is so important to tell your doctor about your drugs and any changes that may have been made in them.

For example, drugs used to treat hypertension can sometimes produce visual side effects such as blurred or double vision and dry eyes.  Those prescribed to treat arthritis inflammation may well increase the risk of developing cataracts. Common heart medications very often interfere with the perception of greens and yellows. Viagra causes light sensitivity and many see things with a blueish color. Anti-depressants are known to increase dryness in the eyes, as does medications for Parkinson’s Disease. These are just a few drugs with side effects that we see every day in our office.

We also see people using eye drops that can actually make your eyes worse. Avoid drops that ‘get the red out’. If  your eyes are red, then there is a reason. See one of our eye doctors to find out what is causing the redness. Drops like Visine narrow blood vessels to reduce redness, but then the eyes can become even more inflamed after using these types of drops.

Since your health is always our foremost concern, we will be able to better coordinate your treatment with the other physicians you are seeing if we know what medications you are taking. So do yourself and us a favor. Make an updated list of your medication and bring it to every appointment.

Is Astigmatism a Disease? Can it be corrected?

astigmatism

Could astigmatism be inhibiting her learning?

Astigmatism is often incorrectly thought of as an eye disease or eye health problem. It is simply a very common focusing problem that is caused by an irregularity of the curvature of the cornea (the front of the eye). Often in layman’s terms, the astigmatic eye’s curvature is compared to the shape of a football as opposed to a basketball.

Astigmatism is a refractive error just like nearsightedness (myopia) and farsightedness (hyperopia). When light enters the eye, it is not evenly distributed on the retina. This causes your eyes to have blurry vision.

Most people are born with some degree of astigmatism. Both children and adults can have it. In children, it can affect their school work and learning. The higher the amount, the worst the vision. You may just have it by itself, or in conjunction with nearsightedness and/or farsightedness.  Some common symptoms of astigmatism include headaches, blurred vision both near and far, eye fatigue, and eye strain.

Can I have Astigmatism and not know it?

Vision screenings, especially school screenings, often do not catch small amounts of astigmatism. It may only be found during a comprehensive eye examination. The reason is because there may be such a small amount and the person doesn’t realize that he/she is not seeing the best they can. Astigmatism is very treatable with glasses, contact lenses, LASIK, Clear Lens ReplacementBladeless LASER Cataract surgery and high tech lens implants.

Astigmatism and Cataract Surgery

If you have astigmatism, it is very important to consider it during the cataract surgery decision process. It can be corrected during upgraded cataract surgery and give you clearer, more crisp vision. Your choice of standard vs upgraded cataract surgery cannot be changed after the surgery. That is the reason it is a decision that should be carefully considered before surgery. Even those with nearsightedness and farsightedness have more vision correction options than ever before. This makes the decision process for cataract surgery more important than ever.

Be sure to ask your eye doctor during your eye exam if there are recommendations relating to astigmatism correction for your eyes. Call 1-866-865-2020 for a comprehensive exam appointment.

 

Kids and Sunglasses

child wearing sunglasses

child wearing sunglasses

Most parents are well aware of the long term benefit of polarized sunglasses in protecting their own eyes from degenerative eye diseases and UV exposure. But many parents don’t realize how important it is to protect your children’s young eyes too.Just as your would always put sunscreen on your child when they are out in the sun, you should always put sunglasses on your child when in the sun as well. Sunglasses are literally sunscreen for your eyes.

Typically before age 18, you get 1/2 of your life’s sun exposure, and before the age of 8 is when the most sun damage occurs. Even wearing a hat is not enough. Only 50% of the sun’s rays are blocked.

UVA and UVB Sunglass Protection

Kids should begin wearing sunglasses as young as 6 months old and they need to be good quality. Cheap sunglasses that don’t have UVA and UVB protection can actually be worse than wearing none at all. We recommend that children wear polarized polycarbonate lenses because of their safety as well as their inherent UVA and UVB protective properties. Choose sunglasses that block at least 99% of UVA and UVB rays.

Tips for Buying Sunglasses for Your Child

-Give your child guidance but let them pick out the glasses. They are more likely to wear them if they like the way that they look.

-Always get children glasses and sunglasses with polycarbonate lenses. They are the safest lenses on the market and will give your child the best eye protection.

-Wear sunglasses yourself. It is acts as a good role model as well as offering good protection for your eyes.

-Consider buying an elastic head strap to make it harder for younger kids to take off the glasses.

The Optical Gallery at The Eye Associates carries children sunglasses and can even order in more styles if you don’t find something that you like. Just stop by any of our locations and take a look.

 

How Do I Know If I Need An Eye Exam?

Many people believe that eye exams are only for people that wear glasses or contacts. Here are some other reasons to have your eyes examined:

Did you know that diabetes is one of the leading causes of blindness? Diabetics need to have a dilated exam at least once per year to look for diabetes changes in their eyes. High blood pressure can cause changes to the blood vessels inside the eyes and lead to complications. Cholesterol can also be seen in the blood vessels and can cause complications.

Some common eye diseases do not have any symptoms and will not alert you to come in for an appointment. Glaucoma slowly affects your side vision until it becomes so advanced that you are only left with a small tunnel of vision. Macular degeneration in its early stages may not cause problems initially, but in the advanced stages central vision will be affected. Both glaucoma and macular degeneration have a genetic component, so there is an increased risk if a member of your immediate family has been diagnosed with either of these conditions.

The Eye Associates offer patients efficient and accurate eye exams in Bradenton. If you a local Bradenton eye patient, do not hesitate to set up your eye examinations with our top eye experts.

What Kind of Information Should I Share With My Eye Doctor At My Next Eye Exam?

1. Eye health problems that run in your family such as macular
degeneration, cataracts, glaucoma, etc.

2. A list of prescription and non-prescription medications that you
take.

3. How you use your eyes at work such as computer use, work
outdoors, lighting, etc.

4. How you use your eyes at play such as hobbies, sports, etc.

5. Eye symptoms and difficulties that you are experiencing such as
headaches, blurred vision, sensitivity to light, etc.

– By Richard Hector, MD

Tear Osmolarity Testing for Dry Eyes

Accredited Dry Eye Center logo

Accredited Dry Eye Center Logo

Dry Eyes

Did you know that the human eye has over 2 million working parts?  Imagine all those 2 million parts working beautifully, and then suddenly there is a poor tear film covering the cornea, preventing a clear image from being formed for your brain’s vision center to use when you read, drive and text, causing dry eyes.

Achieving the right volume and mixture of lubricating fluids to be available for delivery with each blink is no easy task. To better analyze your tear film, we now can do a simple and quick in office test (called a tear osmolarity test) that not only helps us diagnose Dry Eye Disease, but also allows us to monitor the progress patients are making in their treatment programs. In the past, we were not able to objectively quantify the quality of a patient’s tears. Now we can do that with the Tearlab equipment.

When the tear osmolarity (salt content) test first came out, the results were not very consistent.  This was at first felt to be a deficiency in the machine.  Now we understand that this variability is the hallmark of Dry Eye Disease. Those of us who suffer from dry eyes are very aware of this variability.  We have our good days, and sometimes only a few good hours in the day. Many days are filled coping with the familiar battle of fluctuating vision and discomfort.

What cannot vary, though, is your dry eye treatment program. Maintain your fluid intake; do not over indulge in caffeinated beverages; apply your warm compresses, follow your lid hygiene regimen; and take your Omega 3 and Vitamin D. Do everything you can to give those 2 million parts in your eyes a clear image to work with!

Your Dry Eye Coach, Richard Hector

Important Reason for Eye Exams – Safety

<img alt; "safety of mom important to family"

Happy Mom with daughter and granddaughter.

Safety as we age is the most important thing. We all worry about the safety of our parents. Poor vision can have many adverse effects, such as depression, car accidents, and medication errors, but none of these are more concerning than a fall. Falls are among the leading cause of death for people age 65+, and people with low vision are at even greater risk. Reduced contrast, decreased depth perception, and a reduced field of vision can inhibit balance and the ability to detect obstacles. Increased safety is one of the most compelling reasons to have an annual eye exam.

Visual Factors That Impact Falls

Reduced field of vision – Objects that cannot be seen are a common cause of falls. Eye diseases such as Glaucoma, Macular Degeneration and Diabetic Retinopathy can rob one’s vision. Glaucoma affects ones peripheral vision, while Macular Degeneration and Diabetic Retinopathy can cause blind spots in the central vision.
Reduced depth perception – People with vision in just one eye may have problems judging distances, making it more dangerous to negotiate obstacles.
Reduced contrast sensitivity – Reduced vision also causes reduced contrast making obstacles and clutter hard to see. Curbs become nearly invisible and many objects can fade into the background.

Eye Exams Save Sight and Increase Safety

Increased safety is one of the most compelling reasons to have an annual eye exam. Did you know that some eye diseases do not have warning signs, and many can only be detected with a dilated eye exam. Cataracts can affect sight so gradually that you don’t notice the decreased vision. And half of all people with glaucoma are unaware that they even have the disease. Also, diabetics with diabetic retinopathy often do not experience symptoms when the disease is at its most treatable stage. The key to keeping good vision starts with the early detection and treatment.

Call 1-866-865-2020 or click here for a comprehensive eye exam today!

Young Women & Skin Cancer

Studies show that there has been a significant increase in skin cancers in young women, including the deadliest form of skin cancer, melanoma. Many experts believe that this in part is a blessing because it means that more women are getting skin exams at an earlier age and being treated during the early stages of skin cancer, when melanoma is most curable. “We need to get away from thinking that skin cancer is an older person’s disease,” says Dr. Paul Stevenson, Board Certified Dermatologist at Dermatology at The Eye Associates. ”especially in our area with the beaches, lots of fun-in-the-sun activities and the dangerous voluntary exposure to tanning beds.” We recommend that you do a monthly check of your own skin, and a yearly check by a professional.

Click here or call 1-877-816-3376 for a full body skin check with Dr. Paul Stevenson.

Reference Skin Cancer Foundation

Hear what some of our patients have to say.

Dr. Scott Han – Board Certified and Residency Trained Optometric Physician

Bradenton patient talking about Dr. Scott Han

Dr. Scott Han is a wonderful human being and excellent at what he does. He really knows his business. The people here are so nice and very professional. The whole office runs like a well-oiled machine! It’s a pleasure coming here.” Patient: C. G. at the West Bradenton office

Robert Friedman, MD – Board Certified Ophthalmologist and Fellowship Trained Glaucoma Specialist

Sarasota patient talking about Dr. Robert Friedman

Dr. Friedman was OUTSTANDING. I highly recommend him. The staff at Bee Ridge and the surgery center was most kind, helpful and considerate. A most pleasant atmosphere.” Patient: F. F. at the Sarasota office

Dr. Brian Foster – Board Certified Ophthalmologist and Fellowship Trained Corneal Specialist

Cataract surgery patient talking about Dr. Brian Foster

“I recently had cataract surgery in both eyes by Dr. Foster. What an amazing doctor…and not just him! Every single contact with The Eye Associates has been absolutely wonderful. The customer service I have received has been top rated from the beginning. Very refreshing to be treated so well and taken care of so professionally and caring. Thank you all!!! M. K. at the West Bradenton office and Ellenton