A Happy Patient

A patient recently shared this photo with me and offered that I could post it on my site.


This is the most fun part of my job!

Our New Addition

My wife and I are thrilled to announce the birth of our first child, Natalia!


While I try to keep my posts on this site “work-related,” I couldn’t help but share this fantastic news.  We haven’t known her long, but she is a very sweet baby and we are trying our best to savor every minute!

Treatment of Diabetic Macular Edema: Does cost matter?

A recent article compared the effectiveness of Eylea, Lucentis, and Avastin – all medications used as intravitreal injections to treat diabetic macular edema (eye swelling).

When we talk about intravitreal injections, we are referring to the application of injectable medications directly into the eye.  These treatments are used most commonly for conditions including diabetic retinopathy, macular degeneration, and vein occlusions of the eye.  For more information on the details of this therapy, please click here for an explanation I have written previously.

This article (click here) referenced a recent study by the Diabetic Retinopathy Clinical Research Network.  The study concluded that diabetic patients with macular edema and mild vision impairment responded equally to all three drugs.  On the other hand, patients with more significant vision loss regained more vision when treated with Eylea.

Currently, there are several medications that are commonly used as intravitreal injections.

  • Avastin is compounded as a generic from a pharmacy.  The price of a dose is under $50.
  • Lucentis and Eylea are sold as branded product.  Based on the type of treatment, the price of the drug ranges from approximately $1,200 to $1,800!

Given such a wide range of cost, how does a person determine which drug to use?  Patients, doctors, and insurance companies are all interested in the answer to this question.  Research studies, such as the one referenced in this post, allow us to make evidence-based choices that are conscious of both quality and cost.

Ideally, a doctor would not need to consider cost when determining the “best” treatment plan for a patient.  In the real world, however, many patients are responsible to pay for a portion of their medical care because of a deductible or co-insurance.  As an example, a patient with Medicare Part B (and no supplemental coverage) might be responsible to pay for 20% of their medical expenses while Medicare pays for the other 80%.  While a 20% payment on Avastin might cost a patient $10, for Eylea it could be close to $400!  Because these treatments are sometimes repeated on a monthly basis, you can see how the cost might add up quickly.

In my practice, I try to discuss the pros and cons of different treatments with my patients so that we can make the right decision together.  Fortunately, the more affordable medication works great in the majority of cases.  For patients who stand to benefit from a more expensive therapy, there are several things that might limit out-of-pocket expense:

  1. Many insurance plans have an out-of-pocket maximum.  If you reach this, insurance should cover 100% of your remaining medical expense for the year.
  2. Patients with Medicare often have the option of purchasing supplemental coverage.  Once Medicare pays for the first 80% of treatment, the supplement should pick up the other 20%.
  3. Manufacturers of the branded drugs admit that they are expensive.  Because of this, they offer co-payment assistance programs that can limit or eliminate a patient’s need to pay out-of-pocket.

While our understanding of complex eye diseases improves all the time, many questions still remain.  Can the data from diabetes be applied to other conditions such as macular degeneration?  Will insurance companies set rules limiting the use of certain medications over others?  For now, we can take comfort in knowing that we live in an age where therapies exist that can limit the effects of possibly blinding conditions.  As a physician, it is my job to stay current on the trends and treatments that will benefit my patients the most!

Glaucoma Awareness Month

I’m happy to join the American Academy of Ophthalmology in putting the spotlight on glaucoma for the month of January.

Glaucoma is a condition that is manageable, but often undetected.  This means that early diagnosis and treatment is the key to preventing vision loss.

Unfortunately, the early stages of glaucoma are usually asymptomatic.  That means that a patient may be losing optic nerve fibers – and possibly even losing vision – while feeling 100% normal!

For this reason, I recommend folks to have a dilated eye exam with an ophthalmologist, especially once they reach middle or older age.

Here are a couple of resources that can provide more information about glaucoma:

  • Click here for a recent article published by the American Academy of Ophthalmology that explains that approximately 50% of people with glaucoma are unaware that they have it!
  • Click here for an article that I wrote that explains many of the basic concepts of glaucoma.

Thank you for taking an interest in this condition.  With proper education and treatment, we can prevent blindness!

Happy Holidays!

Things have been quite busy at the practice lately – in a good way!

With many people having finally met their health insurance deductibles for 2015, we’ve been helping a lot of patients with their last-minute eye exams and eye surgeries.  The staff and patients have been great as we’ve tried to accommodate everyone who calls in!

On a personal level, the holidays always seem to inspire at least a few moments of reflection as we transition to a new year.  I’ve worked hard this year to develop a practice that reflects my standard of patient care.  Whether this means investing in new technology, working with my staff, or reaching out to the community, I’m always looking for ways to make sure that I am practicing medicine the “right way.”  Lately, Dr. Tenery (my partner) and I have had many discussions about the plans for the practice in the year 2016.  I am excited to build on the accomplishments of 2015 and focus on the care that I provide to patients, both old and new.

I am fortunate to have family in town for the holidays.  This includes my wife who is pregnant with our first child, my brother whose career keeps him in Silicon Valley, and my parents who are always supportive.  I wish happiness, success, and comfort to everyone reading this site as we move into our new year!

Early Cataract Surgery

Recently I was asked to discuss the pros and cons of “early cataract surgery.”

Often, ophthalmologists will discuss with a patient whether or not a cataract is “ripe for surgery.”  Read below for my response to this question:

By definition, everyone who lives into their 50’s or 60’s will demonstrate evidence of cataract on a complete eye exam. We are all born with a natural lens inside each eye that is normally perfectly clear. As we age, that structure becomes more dense, turns a yellowish-brown color, and can develop other imperfections. When the lens is no longer perfectly clear, we call it a cataract.

In the 21st century, cataract surgery has quickly become one of the most commonly performed procedures in America. Practically overnight, this surgery can improve the clarity, contrast, and quality of vision with a procedure that usually requires minimal recovery. As a surgeon, it is quite rewarding to share a patient’s reaction as they discover their new postoperative vision.

Historically, Medicare has had strict visual acuity criteria that determined the criteria by which a cataract surgery would be considered “medically necessary.” These days, the visual acuity requirement has been relaxed. Instead, an ophthalmologist must document a series of visual symptoms, caused by cataract, that are detrimental to the patient’s quality of life or safety.

Some patients are not aware that a person can have a cataract and still enjoy crisp, 20/20 vision. In fact, most people probably have cataract findings for over a decade before it becomes symptomatic. As ophthalmologists, we may say that a cataract is not “ripe” if it exists but the patient still retains excellent vision.

Despite the routine nature of cataract surgery these days, every procedure still has its pros and cons. Even in cases of perfectly performed surgery, there is always a slight risk of unwanted outcomes including infection, bleeding, or other unwanted changes to the vision. Additionally, while technology is always improving, our lens implants still can’t perfectly replicate all of the functions of the natural lens.

It is important to weigh patients’ possible outcomes against their expectations. If a person is seen in the office who has a cataract but does not feel limited by their vision, observation is always best. On the other hand, early cataract surgery may be indicated in certain scenarios. For example, if a patient demonstrates good visual acuity but is debilitated by glare when driving at night, he or she may be a good candidate for early cataract surgery.


Today I posted a new educational article that discusses glaucoma.

Glaucoma is a condition that is fairly common and often under-diagnosed.  Oftentimes a patient only has symptoms from glaucoma once it has become very advanced.  For this reason, it’s a good idea to have your eyes examined at least every few years once you hit adulthood!

For all of my educational content, check out the menu bar above or click me here!


Just a quick post today to announce that two new discussions on “cataract” have been added to the educational portion of the site.

I wrote these pages to discuss this very common finding that patients ask about on a daily basis.

For all of my educational content, check out the menu bar above or click me here!


I’m proud to announce a new section of this site dedicated to sharing educational content with patients.

All entries will be written by me.  My goal is to share information in a fashion similar to how I would counsel a patient in clinic.  Over time, I will be adding pages on many common topics and conditions (like cataract, glaucoma, macular degeneration, etc.).

Check it out on the menu bar or click me here!

Boss’s Day

Apparently yesterday was Boss’s Day.  I didn’t know this until my staff surprised me with a nice card and a little dessert treat as well.  Thanks, guys!

It’s such a pleasure to work with people who work hard every day and care so much about every patient that chooses our office.  I’m very excited to continue to build my practice with these folks!