Province takes second look at how it pays for eye-disease medicine

Provincial health officials will meet today to decide whether to change the way government pays for the treatment of a serious eye disease in seniors.

On June 1, B.C.’s Medical Services Plan began covering both Avastin and Lucentis, two drugs used to treat the wet form of age-related macular degeneration (AMD), the leading cause of blindness among the elderly.

The plan sparked controversy because retinal specialists are being paid $530 per treatment, regardless of which drug they use. This became an issue because the costs of the two drugs are very different.

On Tuesday, Health Services Minister Kevin Falcon said that after administration and other expenses, it costs doctors about $345 per injection for Avastin, and $715 for Lucentis. This means, he said, that doctors lose money on one drug, but make it back on the other.

“You’ve got to have a fee schedule which fairly recognizes that where they will lose [money] in providing the appropriate medical treatment — i.e. using Lucentis — to some of their clients, they also, on using the Avastin for some of their other clients, will receive extra,” he said.

Falcon said officials had projected that under the fixed rate of $530, doctors would on average use the two drugs evenly.

Since the program began, however, doctors have been using Avastin — the cheaper drug — 68 per cent of the time.

Falcon said there have been 6,330 injections between June 1 and Oct. 5. Of those, roughly 4,300 were of Avastin, and 2,000 were Lucentis.

Falcon said his staff meet today with retinal specialists and the Provincial Health Services Authority to analyse the data and determine whether the fee structure needs to be changed.

Falcon warned, however, against jumping to the conclusion that doctors have been making drug choices based on money.

“I really don’t believe they would make decisions predicated just on financial incentives.”

New Democratic Party health critic Adrian Dix said the government should do away with the current structure altogether.

“They should pay for the cost of Lucentis, pay for the cost of Avastin and let the doctors make the decision about what drugs are best for their patients,” Dix said.

It’s not the first time the government’s plan has been criticized.

Dr. Jeff Blackmer of the Canadian Medical Association’s office of ethics said in June, as the program was launched, “It provides a potential for a conflict of interest.

“The danger here is that the government set up the program in a way that automatically, physicians get a financial incentive to choose one medication over the other,” Blackmer said.

He said he didn’t think doctors’ decision-making would be affected, but said the appearance of that potential was problematic and may lead patients to doubt their doctors’ motives.

Government officials were unable to say on Tuesday how the new payment plan had affected usage of the two drugs in B.C. because they did not specifically monitor what the usage was before June 1.

Avastin is a drug approved for the treatment of colon cancer, though ophthalmologists regularly use it off-label to treat AMD.

Lucentis is specifically approved to treat the quickly advancing eye disease.

In a written statement Tuesday, the makers of Lucentis said they have seen a “significant drop” in the use of their drug in B.C., though the company provided no specific numbers to support the claim.

“The structure of the system provides a strong financial disincentive against using Lucentis,” said the Novartis Pharmaceutical Canada statement.

“While we cannot discuss figures, we can confirm this is borne out by a significant drop in the use of Lucentis in B.C. since the system was implemented on June 1, 2009.”

Eyeglass Paradise in Beijing

Travelers to China think of Beijing as a shopper’s paradise, purchasing clothing, electronics and all kinds of souvenirs from large markets. Unknown to most visitors, Beijing also has a unique specialty market that often gets missed — The Eyeglass Market. The China Guide, an American owned travel company, describes Beijing’s Eyeglass Market as four floors of overflowing frames and sunglasses having everything from classic shapes to wild designs. It’s an added bonus that lenses are ready in 30 minutes.

Frames and lenses can be very expensive purchases, meaning that most wearers only have one or two pairs. Beijing’s Eyeglass Market provides a cheap solution for shoppers with prices for basic frames starting very low, around $15. The price is based on quality and there are plenty of opportunities for bargaining. Peter Danford, Managing Operator of The China Guide, says, “Prices are a fraction of what they would be in the west, from $20 to $200 depending on design, quality and style. I have been coming to this market for years. It’s amazing how much money you can save. If you wear eyeglasses, this place is a goldmine. With over 100 shops under one roof, it’s easy to compare and bargain. Having a guide to help you translate is a must.”

Lenses are also available in varying quality based on price, with the basic ones being very cheap. The Eyeglass Market will make up lenses in 30 minutes and does on-the-spot prescription exams free of charge. The exam equipment is modern and there are plenty of technicians so shoppers don’t have to wait. Technicians can also get prescriptions from shopper’s eyeglasses, for those who want to avoid an eye exam. Additionally, the Eyeglass Market can make up prescription sunglasses (even polarized lenses) with plenty of frames and styles to choose from. Different types of bifocals and gradient lenses are available too. All purchases come with a glasses case and cloth for cleaning.

The China Guide is offering shopping tours in Beijing for travelers who want to pick up special items and visit the less-touristy local markets, such as the Eyeglass Market. They will provide a private English speaking guide to help with shopping and bargaining as well as transportation. Trips to shopping markets can be combined with Beijing’s historical sights and a stop for lunch at a recommended local restaurant. The China Guide’s tours are flexible and customizable.

Causes for eye twitching

Eye twitching bothers many people and even drives them crazy. Actually, it is pretty common and mostly happens to the lower eyelid. Eyelid tics can last for weeks and even months but most of them are benign and harmless. However, there are still other forms of eyelid twitching that are more serious because they may caused by neurological conditions such as blepharospasm and hemifacial spasm.

People’s bodies react to stress differently, and some people may suffer from eye twitching caused by excessive stress, especially those with eye strain. Vision-related stress may result from eyeglasses wearing and long period computer use. People have persistent eyelid twitching that caused by vision-related stress should take an exam for potential vision correction. Insufficient sleep, too much caffeine and alcohol consumption can trigger eye twitches. These conditions are easy to deal with.

Eyelid twitching can also result from dry eye. There are many reasons for eye dryness, such as natural aging, excessive computer use, antihistamine taking, contact lenses wearing and so on. All of these reasons are curable by various treatments.

Nutritional imbalance is suspected to cause eye twitching, even though there is no scientific evidence. Experts suggest that patients should talk nutritional conditions with family doctor for professional advice, rather than buying random nutritional products. Histamine is also indicated to bring eyelid twitching, so that antihistamine eye drops or tablets may be prescribed to provide help.

Persistent eye twitching can be stopped by Botox injections, which can successfully terminate muscle contractions. Severe eye twitching may clamp shut your eyelid, and you should see a doctor for precise diagnosis.

What are the fashionable women glasses?

Since the first development of eyeglasses in Italy in 1284, many people benefit from the invention which makes the vision correction and eye protection possible. The design of the eyeglasses varies differently in the subsequent centuries, and now eyeglasses have become a fashion icon, for women glasses specially, rather than just a compulsory option to rectify the weak eyesight.

Many people are at a loss about how to choose a stylish and cheap prescription glasses for the range of women glasses is really exclusive and changing.eg:$8 eyeglasses,$10 eyeglasses and so on.They may ask the questions like these: what kind of face shape do I have? What type of women glasses do I fit? They look all over the internet for the answers. Finally, they find that the opinions on the types of women glasses choices are quite different and they are still at a loss.

Some people are the trendy follower of fashionable womens glasses. Therefore, celebrities often set the standard of eyeglass in their own eras with different and compelling styles. People wear the glasses just as the celebrities do. Ray Ban’s wayfarer women glasses wore by Hollywood superstar Audrey Hepburn on the poster in Breakfast at Tiffany’s and Masunaga’s rimless women glasses wore by US politician Palin during the vice president candidate campaign are all famous women glasses. People are of no reason purchasing this type of women glasses, not considering weather if the women glasses fit themselves.

There are two saying very common today. One is that what’s in style today may not be in style tomorrow, the other is what fit you well may not fit others. So in the fast developing world you can not choose everything in vogue, fashion trends are prone to change. What you are suggested to do is to hold on to your style, hold on to your womens glasses, and your style may come back to vogue some day later. Just pick up the things that look good on you, fit to you and can express your own personality.

The fashion industry is evolving quickly. One kind of womens glasses frames may have an average life of only about two or three years. They experience the slump and comeback process again and again, so the definition what are fashion about women glasses may difficult to make. If you want to be always charming and elegant, please choose women glasses which are suitable with you. Always keep confident is a secret to be fashion too.

How to Buy Sunglasses

It is generally believed that sunglasses which can keep off sunshine protect eyes. However, things are more complicated than expected. A pair of unqualified sunglasses would hurt your eyes, which is worse than not wearing one. Therefore, more caution is needed when we are going to buy sunglasses.

The first and foremost step when buying sunglasses is to check whether the lenses are smooth or not, for warping ones lead to the deviation of sight line while those mixed with air bubbles make one dizzy. In the meantime, do not buy sunglasses with too thin lenses, because they are inclined to deform in heat.

What comes next when buying sunglasses is to make sure the lens materials applied are capable to cut off UV rays. In fact as we can not discern this function with naked eyes, they only reference is the information—labels reading “100% UV-cut” or “UV400″ marked by manufacturers.

Moreover, try not to buy sunglasses that are blue and purple. Because the deeper the color is, the more capable they tend to cut off UV. Therefore, buy sunglasses that are dark grey, chocolate and black should be wise choices.

The last step is to try them on. It’s best to buy sunglass in a sunny day when the light is strong. Walk out the store and look around. If you feel dizzy or uncomfortable, this pair may be unqualified or not suitable to you.

Different people buy different sunglasses for different uses, but the basic principle for buying sunglasses is to choose one that guarantees security and eye protection.

Acute and chronic forms of glaucoma

Most types of glaucoma are associated with narrow filtration angle, which hinders the outflow of eye fluids so that high IOP is caused. High IOP spikes and damages the optic nerve, which is responsible for images transmission from the eye to the brain. Optic nerve damage in turn causes vision loss.

There are mainly two types of angle-closure (closed-angle or narrow angle) glaucoma: acute angle-closure glaucoma and chronic forms of narrow-angle glaucoma. Acute angle-closure glaucoma occurs suddenly and has symptoms such as eye pain, headache, light halos, dilated pupils, and red eyes and so on. If the high IOP is not removed within hours, acute angle-closure glaucoma is likely to bring permanent vision loss. Once suffered from acute angle-closure, patients should contact an eye doctor immediately for emergency treatment. Chronic forms of narrow-angle glaucoma have no obvious symptoms and develop slowly. Both acute narrow-angle glaucoma and chronic angle-closure glaucoma cause at least part of peripheral vision loss.

Narrow-angle glaucoma always causes the abnormal positioning of the iris. And there are reasons for this situation. In a normal way, eye fluids produced by ciliary (behind the iris) flows easily through the pupil into the anterior chamber. Once the back of iris adheres to the lens, eye fluids can not pass through this pupillary channel. The blocked eye fluids will push the iris forward until it closes the drainage angle in the anterior chamber.

Another reason for narrow angle is iris plateau, which is caused by the extreme close distance between the iris and the ciliary body. In this case, the peripheral iris tissue bunches up in the filtration angel due to pupil dilation, so that the angle is narrowed.

Narrowed filtration angle is also associated with certain eye problems such as hyperopia. Hyperopic people are more likely to have shallow anterior chambers and narrow angles. A tumor behind the iris also increases the risk of angle-closure glaucoma. Normal aging always enlarges lens and increases pupil block. The filtration angle is likely to narrow as people age. There is also anatomical difference between races that Asians and Eskimos have narrower anterior chamber angles than whites. Angle-closure glaucoma does not occur equally between genders in some races.

Acute forms of glaucoma may bring vision loss if high IOP is not removed within several hours. The drainage angle may be narrowed by many factors such as dim lighting, eye drop administration, medications such as antihistamine drops and so on. All treatments for narrow-angle glaucoma aim at removing high IOP within a short period, such as systemic medications, topical glaucoma eye drops, and laser or non-laser glaucoma surgery.

A variety of glaucoma surgeries

Glaucoma with high IOP probably brings high risk of vision loss, so that early detection and treatments including glaucoma surgery are important. Currently, both laser and non-laser glaucoma surgeries aim at either decreasing the production of internal eye fluids or increasing the outflow of them. These surgeries can remove the high IOP and stabilize normal IOP, thus optic nerve is also under protection.

In fact, surgery is not the only treatment for glaucoma. There are also some medications can control the development of glaucoma, such as topical eye medications and oral medications. However, some glaucoma patients do need a surgery to improve the drainage of their eye fluids. There are several glaucoma surgeries that are proved effective: selective laser trabeculoplasty (SLT), trabeculectomy and other variations.

Laser trabeculoplasty is performed by using a laser to create tiny holes in the filtration angle so that the outflow of eye fluids can be increased. And a SLT creates minimal heat damage to adjacent tissue, which is an adjunct to the patient’s ongoing eye drops. The study of SLT treatment for open-angle glaucoma is on the way.

The non-laser surgery trabeculectomy performs in another way. This procedure involves partial removal of the eye’s drainage system. Trabeculectomy can deal with severe glaucoma that is beyond ordinary eye drops, pills and laser trabeculoplasties by making a surgical incision into the eye’s drainage system and creating new channels for fluids flow.

Trabeculectomy also involves small plastic devices including shunts and implants, whose tiny tubes will be inserted into the holes created in the surgery. Offering a direct passageway, these tubes divert eye fluids to bypass the eye’s damaged drainage channel. These shunts are most made with silicone or polypropylene. They can be made with or without valves for drainage control. Complications of applying these devices also exist, such as too low IOP, mal-positioned implants and tube erosion.

There are also some new types of shunts that are either recently approved or in clinical trials. Reports show that they are safer, even if more complex. Ex-PRESS Mini Glaucoma Shunt and DeepLight Glaucoma Treatment System are two of those types.

Similar variations of trabeculectomy include trabeculotomy without tissue removal and goniotomy for infants and children. Surgeries involve iris treatment include iridotomy and iridectomy. The first type creates a hole in the iris to remove iris blockage and the latter type removes a small piece of iris.

By altering the eye’s drainage channels, minimal penetration surgeries can also improve the flow of fluids. These surgeries only create superficial incisions and are less likely to cause complications. Examples of them include a deep sclerectomy that invades the sclera and a viscocanalostomy involves viscoelastic.

There are still different opinions about the application of glaucoma surgeries. Some experts argue that glaucoma surgeries are far more expensive than long-term drug treatments.

A comparison between pinguecula and pterygium

Both pinguecula and pterygium occur on the surface of the sclera, so that many people are confused. In fact, these two eye problems are different in causes, symptoms and treatments.

Pingueculae are yellowish, slighted raised lesions on the sclera, while pterygia are wedge- or wing-shaped growths of benign fibrous tissue on it. Most pingueculae are found in the open space between eyelids, and pterygia may grow into cornea in extreme cases. Both of them are commonly related to overexposure to UV light, which is considered as a major contributor. Of course, these two eye problems can both affect people’s appearance.

In most cases, pingueculae and pterygia have no obvious symptoms. However, they have different signs in some cases. Irritation-caused pinguecula makes people feel something in the eye and some pingueculae may become swollen and inflamed, a condition named pingueculitis. Differently, some pterygia become red, large or thick. Large and advanced pterygia may cause corneal distortion and astigmatism.

Pinguecula and pterygium also have subtle differences in treatments, and they can both benefit from sunlight protection for eyes. Mild pingueculitis symptoms such as foreign body sensation can be eased by lubricating eye drops. Steroid eye drops or non-steroidal anti-inflammatory drugs can be prescribed to relieve serious inflammation and swelling. And more severe conditions of pingueculae require surgical removal.

Treatments for pterygium depend on its size and symptom. For small or slightly inflamed pterygia, lubricants or a mild steroid eye drop is enough, while severe pterygium needs surgical removal. A pterygium procedure can be operated either in the doctor’s office or an operating room and involves various available techniques. An eyelid speculum help you open the eye during the removal process, which lasts less than an hour. Pterygia may reoccur even after a surgical removal at a chance between 3% and 40%. The surgeon may suture or glue a piece of surface eye tissue onto the affected area, in order to reduce the recurrence rate. Drugs such as mitomycin can also be prescribed to slow metabolic processes.

Advanced Eyecare staff earns national recognition

In recognition of professional excellence, the American Optometric Association’s Commission on Paraoptometric Certification recently announced that Jolie Christianson, Phoebe Lucey, Paula Morrow, BJ Hunter, and Denise Burtzlaff, of Advanced Eyecare in Hot Springs, have successfully completed the first level of AOA’s national paraoptometric certification program and have earned the title of Certified Paraoptometric (CPO).

The staff of Advanced Eyecare now joins the growing ranks of more than 6,000 certified paraoptometrics in the nation. They have proven the level of required knowledge of optometric practice in areas of practice management, anatomy of the eye, eye examinations, refractive status, ophthalmic prescription, ophthalmic lenses, ophthalmic dispensing, contact lenses, eye disorders and terminology.

All those that pass the CPO certification exam have also met the requirements of work and school experience and are required to attain continuing professional development to maintain their certification. AOA’s CPC program is the only professional certification for paraoptometrics that is recognized worldwide. The CPC exams are offered four times per year in February, April, August and December at 24 regional sites and at various state/regional meetings throughout the U.S. The American Optometric Association is the acknowledged leader and recognized authority for primary eye and vision care in the world. AOA’s mission is to advance the profession of optometry and serve optometrists in meeting the eye care needs of the public by centering on improving the quality and availability of eye and vision care. Optometrists and other professionals look to AOA for professional standards, research and education leadership, which serve to enhance and ensure competent, quality patient care.

Advanced Eyecare is owned by Dr. Dallas Wilkinson and is located at 103 N River Street in Hot Springs.

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