Ophthalmic Assistant Part 2


Wendy: Welcome back, and we're continuing our discussion on the Ophthalmic Medical Assistant Program that is offered in our continuing education division here of Greenville Tech. Joining me now is Dr. Hal Shaw of the Jervey Eye Group. Hi, Dr. Shaw.

Hal: Hello, Wendy.

Wendy: Welcome. We are delighted that you could be here with us.

Hal: Thank you.

Wendy: We know you are a very busy person, have a very hectic schedule; so, thanks again for joining us. You were very instrumental in developing our Ophthalmic Medical Assistant Program. You, as well as other doctors in the area, assessed the needs and developed a program with us. Talk to me a little bit about that.

Hal: Well, ophthalmic technicians are really indispensable to the practice of eye care today. So much of what we do is related to instrumentation, and it just would not be possible of the individual doctor to do all that he has to do or she has to do without good help in doing that. So, there is a tremendous need for ophthalmic assistants in this area; and there was a shortage of supply. So, Greenville Tech stepped up and has helped in that regard.

Wendy: That's wonderful. Now, from a doctor's perspective, let's talk about the importance of having an ophthalmic assistant in the office.

Hal: Just the logistics of patient flow make it necessary to have assistants. Ophthalmology is very equipment orientated. There's a lot of high tech gadgetry associated with it, and it simply is not physically possible for an individual physician to do all that is necessary in caring for a patient without the proper assistance. The ophthalmic assistants assist in acquiring the medical history. They assist in doing many of the tests such as visual fields, (?) photography, OCT, some of the higher technology type tests that are done is part of eye care. Life without ophthalmic assistants would be extremely difficult for ophthalmology.

Wendy: Very difficult for you; and certainly they provide a good, strong asset for your practice.

Hal: Absolutely, absolutely.

Wendy: Let's talk about vision care for a minute. Is it necessary that people have routine eye exams, check ups?

Hal: It really is. There are many, many conditions that would only be detected in the course of a regular eye exam that might not be symptomatic otherwise both in children and adults. An example in children would be lazy eye; a common example in adults would be glaucoma. Glaucoma is a blinding disease that may not have any symptoms until late in the disease course, and that can be detected during the course of a regular examination.

Wendy: Great! Now, I'm glad you said that because often times, you know, I don't have a regular eye exam routinely; and I kind of wonder sometimes do you also pick up problems, are problems identified, with routine exams, that you may not have symptoms, you know, normally.

Hal: Well, definitely. The eye is literally a window to the body. It has been called the most important diagnostic inch in the body, and there's scarcely a disease known to man that does not have manifestations in the eye. There are numerous medical conditions such as high blood pressure, diabetes, thyroid disease. There are other neurologic conditions associated with eye findings, since the eye is really an outgrowth of the nervous system, (brain tumors, aneurysms, multiple sclerosis, strokes, and many, many other diseases) that might be detected during the course of a routine examination.

Wendy: That we probably don't feel the symptoms of.

Hal: That's exactly right.

Wendy: Let's talk about macular degeneration. It's a leading cause of eye loss, vision loss of adults 50 and over. Talk about that illness.

Hal: That's correct, Wendy, and there's been a lot of publicity about macular degeneration recently. As the population ages, we are all more susceptible to this condition. Just this month there were some landmark articles in the New England Journal of Medicine about macular degeneration. For the first time, we actually have a treatment available that cannot only stop the effect of macular degeneration in some patients but can actually improve vision.

Wendy: Oh, great!

Hal: You may have read recently, there's been a lot in the newspapers about Lucentis (?sp), a new drug that is actually injected into the eye and has an effect on a protein that is produced in macular degeneration that creates new blood vessel formation and causes bleeding and scaring and is responsible for many of the severe cases of visual loss with macular degeneration. We now have a method of treating those cases and actually reversing vision loss, in some cases.

Wendy: And that's important to know that it can be corrected.

Hal: That is correct. Unfortunately, still it remains a problem in that that only applies to a subgroup of patients with macular degeneration. The dry macular degeneration that affects the majority of people in general is not associated with as severe a loss until its late stages, is not amenable to that type of treatment. So, it's important that patients understand that, although this is an exciting, new treatment, it is not something that's appropriate for every patient with macular degeneration.

Wendy: Now, what is more popular or more you're seeing symptoms of? Is it the wet or the dry macular degeneration?

Hal: The dry macular degeneration is far more common than the wet, but probably 80-85% of all cases of macular degeneration are the dry form; but that can convert to the wet form so that about 10-15% of the patients we see have the wet form of macular degeneration. That group, even though it's the minority of patients, forms the majority of patients with the most severe vision loss with macular degeneration.

Wendy: Now, what are some of the symptoms of macular degeneration? What should someone look out for?

Hal: Well, typically, patients may just notice difficulty reading, a little blur in their central vision; and early on, there may be minimal symptoms, just a need for more light, or difficulty seeing small print; and then as it advances and that center area becomes more blocked out, it may then be impossible for them to discern faces or read even large print.

Wendy: Great. Well, we're gonna take a break; and when we come back, we're gonna continue our discussion on lasik vision correction. We'll be back.

Wendy: We're back, and we're continuing our discussion on lasik vision with Dr. Hal Shaw of the Jervey Eye Group. Now, Dr. Shaw, lasik is a very popular procedure in correcting nearsighted/ farsighted vision problems. Talk about that procedure a little bit for us.

Hal: Well, you're right, Wendy. Refractive surgery, corneal refractive surgery has become a very important part of eye care today. You might recall, years ago, radio-keratotomy was used back in the '70s and '80s for correction of nearsightedness. And then, as we moved into the '90s, lasik really came onto the scene; and this is a much more sophisticated, refined form of corneal surgery to eliminate refractive errors (nearsightedness, astigmatism, and farsightedness). This is really a procedure that, for the right person, can be a life- changing and liberating operation.

Wendy: What's the success rate of it?

Hal: Well, the success rate is very high, in the high 90% range. As with any operation, there are potential complications--infection, the wound- healing problems. But, for the most part, this is a very safe and highly- effective operation.

Wendy: Now, do you recommend this for children also?

Hal: Generally, this is not advised for children. There are certain, selected instances in which corneal surgery similar to lasik might be performed in children; but, in general, this is an operation reserved for the adult population.

Wendy: Gotchu. Now, changing gears, let's talk about cataract in older adults, 60 and older. Let's talk about that. What should people look out for, what are the symptoms, what are some of the things that people should do to perhaps prevent some of these eye conditions, if you will?

Hal: Well, cataracts are really a normal process of aging. The human eye has a lens in the eye behind the pupil just like a camera lens; and, ordinarily, that lens is crystal clear. As it becomes clouded, it's known as a cataract. All of us, if we live long enough, will probably develop cataracts, although cataracts can occur from the newborn nursery to the nursing home at all age ranges. But, in general, as we age, we all tend to lose clarity of the lens; and, in time, when that lens gets sufficiently clouded to interfere with activities of daily living--driving, reading, hobbies, and so forth--then the cataract can be removed surgically and replaced with a lens implant. It's one of the most common operations performed in the world and is a highly-successful form of surgery.

Wendy: That is great. Let's talk about eye care for children. Is it necessary for children to have routine eye exams?

Hal: Yes, it is very important for children to be screened with an eye exam; and all children should certainly be seen for a preschool exam; and, ideally, should be seen within the first three years of life. If a problem is suspected, the child should be seen at any age, no matter how young. Children are not just small adults. The eye diseases that effect children are really different than what we see in the adult population. The child may have a crossed eye that is of such a small degree it may not be noticeable. A child could be farsighted in one eye or have a refractive error that would not be obvious so that the eye would never learn to see properly. And, if that occurs, the brain actually surpresses the image in the eye; and the child can develop a lazy eye and permanent amblyopia, or loss of vision.

Wendy: Wow, that's really important. Are there any early detection that parents should be aware of in children?

Hal: Certainly, if they see that there's a malalignment of the eye or if there's any unusual blinking of the eye or anything that has an abnormal pupil reflex so that you don't see the normal red reflex but, rather, a white reflex would be indications that an eye exam should be done. But I think the important point is to realize that many of these problems might not be evident in a preverbal child or a child who never knows anything different. So, regular, preventative eye examination is very important in children.

Wendy: Preferably, before going back to school is probably a good...

Hal: Absolutely, because if those problems such as lazy eye are not detected at an early age, then they become untreatable after age six or seven. So, preschool examinations are very important.

Wendy: So, it's important to have that done. Well, Dr. Shaw, we are so delighted that you could join us today and talk about the routine eye exams and also your contribution in developing Ophthalmic Medical Assistive Program. So, again, thank you; and love to talk to you again if we can get you back on our show. That'll be really great.

Hal: Well, we appreciate all that Greenville Tech has done to help with the Ophthalmic Assistive Program.

Wendy: Thank you. Thank you for joining us today. If you're interested in learning more about the Ophthalmic Medical Assistive Program, you can visit us online at gtbmc.com or give us a call at (864)250-8800. See you next time at "Momentum."