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Back to School…

…But an eye exam first!

As the days start getting shorter and the kids come home from camp, thoughts turn from the playground to the classroom. In addition to shopping for school supplies, and bugging their kids to complete their summer reading, parents should make sure that their child’s visual needs are attended to with an annual eye examination.   Some parents are under the mistaken assumption that if their child is having trouble seeing they will tell their parent or teacher. In my experience, this is not always true. Some children might be afraid of the eye exam, or don’t want to wear glasses. Others might be worried that their teacher would think that they are not paying attention if they ask the teacher to read something off the board. Regardless, an exam by an ophthalmologist can easily determine the need for glasses.

 

This simple and non-invasive exam can often detect a refractive error that, when corrected with glasses or contact lenses, can make the difference between a successful student and one who might struggle.  Simply stated, a refractive error is a change in the shape of the eye that causes images to be out of focus on the retina, the film in the back of the eye. By simply refocusing the image with glasses or contact lenses the once blurry image becomes clear again.  The most common refractive error is myopia, or nearsightedness. These children can see much better close up than far away. At home, parents may notice that their kids sit too close to the TV or read with the book up to their faces. Less common is hyperopia, or farsightedness. In contrast, farsighted children have a harder time reading and may get headaches after long periods of close work.  Astigmatism happens when the cornea, the clear front surface of the eye, is shaped more oblong, like a football, rather than being perfectly round. Astigmatism can be found in combination with nearsightedness or farsightedness, or by itself.   For younger children, it is critical that the refractive error is diagnosed early, because a large degree of myopia, hyperopia or astigmatism in both eyes, or a large difference between the two eyes, can lead to a preferential relationship between the stronger eye and the brain to the detriment of the weaker eye. This can lead to a weak or lazy eye that can be difficult or impossible to fully correct once the child reaches early adolescence.  Fortunately, all refractive errors can be corrected with glasses, and most with contact lenses.

 

Once the eye exam has been done, and a prescription for glasses given, choosing glasses that your child will actually want to wear to school is next. Many parents choose to buy more than one pair to ensure against the inevitable loss or breakage. Polycarbonate, shatter-resistant plastic lenses are the law for children. I also recommend scratch resistant lenses, and anti reflective coating, which can help with the glare of fluorescent lighting off of smart boards in many classrooms. The antireflective coating can also lessen the reflection of your child’s glasses if they are photographed with them on.  Many parents ask me when is an appropriate age to fit their child with contact lenses. In my practice, I don’t have a set age. Contact lenses are a responsibility, and good hygiene is critical. If your child is the one who leaves the toothpaste uncapped and the water running and has to be reminded to use deodorant, then they are probably not ready for contacts. I once fit a precocious eight-year-old with lenses, and I have plenty of eighteen-year-olds who still shouldn’t be wearing them.  Contacts come in all varieties. While hard or gas-permeable lenses still exist, a vast majority of my patients wear soft disposable lenses. Gone are the days of a single lens that patients keep for an entire year. The disposal schedule varies from 3 months to monthly, to 2 weeks or even daily disposables. The choice of lens depends upon the patient and their needs. The daily disposable lenses are the ultimate in convenience, since they eliminate the need for solutions or storage cases. It is less to pack on a business trip or vacation. I often recommend these lenses for kids going to sleep away camp where hygiene will be suboptimal at best.

 

Another option for kids college age and older, when they tire of glasses and contact lenses, is to do what I did- have laser vision correction performed on your eyes. Speaking as both a patient and a surgeon, I echo my many happy patients and can honestly say that it was one of the best decisions of my life. After almost 30 years of daily glasses and contact lenses wear, I’m still amazed when I wake up in the morning and I can see clearly, even 12 years after my surgery. Unlike glasses and contact lenses, not every refractive error can be corrected, and not everyone is a candidate for the procedure, but a simple consultation can usually determine if laser vision correction is appropriate. But that is a topic for my next column….

Not Your Parent’s Cataract Surgery

In my 20 years as an ophthalmologist, nothing has given me more gratification than the ability to remove a cataract and restore someone’s vision.  A cataract is a clouding of the natural lens that occurs with advancing age.  Trauma, certain medications, and diseases can also cause cataracts, but like wrinkles, anyone who lives long enough will eventually develop cataracts.  Cataracts are so common that surgery to remove them is the most common surgical procedure performed in the United States. Symptoms of cataracts include blurry vision at distance and/or near, difficulty seeing or driving at night, and glare from sunlight or oncoming headlights.

The good news is that cataract surgery has evolved from a very complicated and risky procedure with a prolonged and difficult recovery period to a marvel of modern medicine.  Modern cataract surgery is performed in an outpatient setting, with most patients returning to normal activity within a few days.

In the early days, cataracts were removed by “couching”, which involved striking the eye with a blunt object to dislocate the clouded lens into another area inside the eyeball.  Through the 1960s and 1970s, the lens was removed in one large piece through an incision in the eye, which meant stitches, long recovery periods, and often, hospitalization.  After surgery, since patients could not see without a lens inside their eye, they required thick “coke bottle” type glasses.

Artificial lens implants at the time of surgery became commonplace in the 1980s. They were invented when Sir Harold Ridley, a pioneering British ophthalmologist, discovered that World War II fighter pilots who sustained eye injuries and had pieces of their plastic windshield inside their eyes tolerated the material without infection or inflammation.

These days, cataracts are removed by breaking up the clouded lens with tiny ultrasound equipment and vacuuming out the debris through a tiny 3mm opening.  These incisions are so small they rarely require stitches and seal themselves.  Instead of “coke bottle” glasses, a foldable lens implant made of acrylic or silicone is inserted through the same tiny 3mm incision and positioned inside the space left by the cataract.  This modern procedure results in very rapid recovery and little to no down time from regular daily activities.

In the past few years, the explosion in technology has taken a very safe and successful surgery and made it even better.  New vision correcting lens implants have allowed me to correct my patients vision and eliminate the need for distance and reading glasses after surgery.  It is very exciting to hear patients describe their experiences with independence from their old glasses after surgery, especially when they were so dependent on glasses beforehand.  With the use of astigmatism-correcting and multifocal lens implants, I can correct the vision of almost any cataract patient at the time of surgery.  Post-operative day one, when I remove the eye patch in my office, is often the most satisfying day for everyone.

The advances don’t stop with lens implants.  Our surgery center was among the first in New Jersey to offer laser-assisted cataract surgery.  This new technology automates certain delicate parts of the procedure, softens the cataract making it easier to remove with ultrasound, and makes the incisions with increasing precision.  We also have a device that attaches to the operating room microscope called an aberrometer that measures the eye during surgery, improving the selection of the lens power and improving my patients resulting vision.

All in all, it’s an exciting time to be a cataract surgeon.  I set the bar very high for my patients and myself.  I not only aim to remove the cataract safely and successfully, but to eliminate the need for glasses to the best of my ability.

Despite all the new technology, I still use my skills in the old fashioned technique, when I travel to third world countries.  There we don’t have access to modern ultrasounds and microscopes, so I still remove cataracts in one piece.  Even with the old-fashioned surgery, I get immense gratification in restoring sight.

 

A Message from Dr. Farbowitz

I just returned from the annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS) in New Orleans. It was a whirlwind 3 days of lectures, presentations and demonstrations of the latest and greatest techniques and technologies in ophthalmology. It reminds me of why I became an ophthalmic surgeon more than 20 years ago.

In what I expect to become a regular blog, I hope to be able to open a window to the wonders of the human eye and the amazing things that we can do in this incredible specialty.

So first, a little about me. I’m a comprehensive ophthalmologist, which means I take care of a wide variety of eye conditions in patients of all ages. I have a special interest in laser vision correction and new technology cataract surgery and lens implants. I have been in practice in Short Hills, NJ for the last 15 years.

I was one of those kids who knew he wanted to be a doctor, specifically an ophthalmologist from a young age. Embarrassingly, my ambition in my high school yearbook was “opthalmologist” misspelled. (Many people miss one of the “h”s. It’s ophthalmologist. It makes it worse that I was the editor of the yearbook! But fortunately my grades were better than my spelling and proofreading. I went to Johns Hopkins in Baltimore, as premed. Even back then, I enjoyed writing, and chose a writing seminars minor. I was science editor of the school paper, and wrote for the alumni magazine. Medical school at NYU followed, and then training at Long Island Jewish medical center and UCLA. So that’s my path to my current practice.

In the day to day practice of medicine, it is easy to lose sight (no pun intended) of the advances that have taken place even since I began practice in the mid ’90s. Like only a few other surgical specialties, ophthalmology has been the beneficiary of the explosive growth in technology.

Every year when I return from one of these conferences, my head spins with the myriad of ways that I can improve the quality of my patient care. Whether it is an automated camera that takes panoramic pictures of the patient’s retina through a tiny pupil eliminating the need for dilation, or a sophisticated microscope attachment that measures the eye during cataract surgery and predicts lens implant power, the possibilities seem endless.

So while I’m at the midpoint of my career as a surgeon, I feel like a kid in a candy store. And things will only continue to get better. We are blessed in our field that we have some of the brightest and most creative minds in medicine and biotechnology at work making major advances in eye care and surgery.

Keep your eyes peeled (I have to quit with these puns!) on this space for regular posts on the wonders of the human eye and some exciting developments that I think will really help my patients.

A word about New Orleans- this was my second trip back since hurricane Katrina 11 years ago. The city pulses with vibrancy and color, and southern hospitality is alive and well in the big easy. But As I passed the superdome and spent time in the convention center, I couldn’t help but think about the loss of life and property that happened here a short decade ago. New Orleans is back, but the scars remain.

Practice News

It’s been an exciting couple of months at Short Hills Ophthalmology.

 

We have considered, researched, and prepared our new Credit Card on File (CCOF) Policy for over a year, and finally, we brought it to our patients on September 1st.  We are pleased to report that our staff and patients have exceeded our expectations for a very smooth transition!

 

Although this policy may be new for many of our patients, CCOF is not new for many medical offices across the country.  It is getting more and more difficult to support our practices in light of declining insurance payments and increased patient deductibles, copays, and coinsurances.  Some offices have even gone as far as to stop accepting medical insurance and only accepting cash payments at time of service.  Doctors can no longer afford to extend credit to their patients after they receive the determination of the insurance company.

 

Doctors can no longer afford to extend credit to patients;

what does that even mean?”

 

When you see Dr. Farbowitz, a medical claim is generated for your visit and sent to your insurance company.  The claim tells the insurance company who you are, what was wrong, and what was done by the physician.  Each patient’s insurance policy and benefits can be different from other patients, even from the same insurance company.  When the insurance company receives it, they compare it to your insurance policy and benefits and pay or deny the claim.  We have no way of knowing what their determination will be when you come in for your visit.  Extending credit means that, after the 6-8 weeks it takes the insurance company to respond to your medical claim, we must bill you and again await payment in the amount you were determined to owe.  Patients who do not pay their bills and are sent to collections are very costly, but ALL patient billing is costly, even when you do pay your bills on-time. Banks and financing companies extend credit, and charge many fees and oftentimes high interest rates to cover their costs and turn a profit.  Doctor’s offices, however, are losing money on this practice every single month of the year.

 

When a patient sees a doctor, it is the patient’s responsibility to pay for that service, either directly or indirectly.  There may be other agreements in play, such as the patient’s insurance company’s agreement to pay for certain medical expenses (benefits), and the doctor’s agreement with the insurance company to accept a certain amount for the medical services as payment-in-full (contracted rates).  Those agreements can make it confusing for patients to understand that they are financially responsible for the visit.  If doctors are to stay in practice, it’s imperative that we bridge the gap between the day the medical claim is paid by the insurance company and the day the final patient payment is received and the claim is closed.  Our CCOF policy ensures that, while remaining sensitive to our patients, we can close claims in a timely and fair fashion after the insurance company determines how much the patient owes.

 

At Short Hills Ophthalmology, we understand that this may be the first time our patients are asked to leave a credit card on file at a doctor’s office.  Our sincere hope is that our patients understand that, in order to continue providing the services and care that you deserve, we have to work smarter.  Patients are not being asked to pay more than they have in the past, they are only being asked to ensure that we will receive their portion of the payment without us incurring billing costs (or collection fees) in a timely manner after their insurance makes the determination.

 

It is also important for patients to remember that this policy is not personal in any way.  We cannot favor some patients over others by allowing them not to participate in our CCOF policy.  Regardless of your insurance coverage or history of payment, it is discrimination to require some patients and not others to file a credit card.  Policies and coverage change on a regular basis, and we do not judge or discriminate between patients on their need to leave a credit card on file.  This policy is applied to every patient, and will actually save our patients the time and effort of paying our bill!

 

Please feel free to contact our practice manager, Joy Saah, with any questions or comments:

  • by phone at  973.379.2544 on Tuesdays or Fridays, or
  • write to her anytime at JoySHeye@gmail.com.

 

Please feel free to browse our Credit Card on File Policy documents HERE:

 

CCOF Letter

CCOF FAQs

CCOF Policy

CCOF Auth

 

Have you heard about Care Credit?

Short Hills Ophthalmology is proud to offer financing plans through Care Credit!

Eye care financing

Your eyes have what it takes to live your best life in full technicolor detail, whether it’s reading a book, sightseeing in foreign lands or making sure you are in optimum health. Your CareCredit healthcare credit card can help you protect your eye health with a way to pay for the costs of vision care for you and your family, including:

  • Routine eye check-ups
  • New glasses
  • Sunglasses
  • Contact lenses
  • Dry eye treatments
  • Cataract procedures
  • Standard (single-focus) IOLs
  • Multifocal and toric IOLs

LASIK eye surgery financing

Set your sights on living a life without glasses!

You deserve to look and feel your best, that’s why CareCredit makes it easier for you to pay for life changing refractive eye surgery, like LASIK. Use your CareCredit healthcare credit card for LASIK financing and pay for your eye surgery in convenient monthly payments. When you use your CareCredit healthcare credit card for your LASIK financing, the answer to 20/20 vision is literally right before your eyes.