Healthcare

By Michael L. Hopen, M.D.
Ophthalmologist, Indiana Eye Clinic

October is National Seafood Month, and the Indianapolis coalition of the Seafood Nutrition Partnership is urging Hoosiers to incorporate more fish into their diet.

You may already know that fish and other seafood are a huge tool for better heart health. Cardiovascular disease is the leading cause of death in the U.S., and as a nation we spend $273 billion per year treating it.

Seafood is one of the healthiest proteins you can eat, high in Omega-3 fatty acids that help make up that “good cholesterol” you’ve probably heard your family physician talk about.

As an eye surgeon, I decided to join the SNP coalition myself as a way to let people know that seafood has another benefit of which they may not be aware: helping you see better. Eating seafood contributes greatly to the health of the eye, and can help stave off diseases that can rob you of your vision.

I have long recommended to my patients that they increase the amount of seafood in their diet. Omega-3’s are beneficial for various aspects of the eye, especially maintaining the health of the surface of the eye. Many vision problems can occur when the eye is not properly lubricated or the outer layer is weakened.

Seafood can be especially beneficial to the eyesight in young children and infants, as it is proven to contribute to vision development and nerve growth in the retina. Malnutrition can also increase susceptibility to eye conditions like cataracts and age-related macular degeneration (AMD).

In its Dietary Guidelines, the U.S. Department of Agriculture recommends we eat at least two servings of seafood a week. But only about 20 percent of Americans actually do. Hoosiers on average consume even less.

The health benefits of a diet high in seafood are clinically proven. Eating just eight ounces per week reduces the risk of dying from heart disease by at least 36%. Adults with blood levels high in the fatty acids found in fish on average live 2.2 years longer.

A lot of people don’t eat seafood because it wasn’t served much in their household growing up. They feel they don’t know how to cook it properly, or worry about the cost.

You can visit the SNP website at seafoodnutrition.org for recipes and coupons to assist in adding more seafood to your diet. Or go to seafoodindy.org for a list of local events this month. You can even sign up for their newsletter to receive regular updates and encouragement via email.

Any kind of seafood is good for you, whether you buy it fresh, frozen or even canned. Though try to avoid deep frying if you can – all that batter and oil is high in fat and bad cholesterol!

Make an effort this month to try some new seafood dishes. Experiment, find things you like and add them to your regular meal rotation. Together, we can enjoy longer, healthier lives – and better eyesight — if we just pick fish more often at meal time.

Flashers and Floaters

By Dr. Carissa M. Barina, Ophthalmologist

The majority of us will experience an occasional speck, spot or hair-like structure floating in our field of vision. When they come from inside the eye, they are termed floaters.

Most frequently it is a nuisance and of little or no concern, but sometimes it is a harbinger for a sight-threatening condition such as a retinal detachment. How do you know which is which? This can be difficult to discern.

There is a clear gel-like substance that fills the eye called vitreous. It is the consistency of gelatin when we are born. Over time, small clumps of cells or connective tissue can form in the vitreous. When the light passes through the eye hits them a shadow is cast on the retina, or sensing part of the eye, causing a spot in the vision.

These floaters can appear in many forms and configurations — dark spots, indistinct hair-like structures and circles being the most common. Often they move or float through the field of vision with eye movement. Typically, they are not serious and the brain slowly learns to ignore them through a process called neuroadaptation.

In some cases, a larger floater develops when the vitreous gel separates from the back wall of the eye, called posterior vitreous separation. This typically occurs as we age and the vitreous gel starts to liquefy. The gel can then shift or move in the eye and separate from its posterior attachment on the optic nerve. This leaves a much larger and often denser condensation in the gel, in turn, causing a more prominent floater.

It often is associated with flashes or streaks of light in the peripheral vision called photopsias, as the vitreous gel may also tug on its anterior attachment to the retina, irritating it.

Rarely, this tugging can cause a retinal hole — a tear that allows fluid to pass under the retina causing it to detach. The detached retina is separated from its underlying blood supply, which is sight threatening and often requires urgent treatment.

Typically, symptoms of a retinal detachment are more intense like a shower of floaters and flashes. But not always so. Therefore, is imperative to have an eye exam as soon as possible after of the onset of symptoms.

Other causes of floaters are bleeding in the eye from trauma or diabetic retinopathy. Or less commonly, inflammation in the eye.

Regardless of the etiology or cause of the floaters, they do not go away. They may become less noticeable, but brighter lighting conditions or use of backlighting such as a computer or handheld device may make them more apparent.

In rare instances when the floaters are large, sheet-like, and interfere with the overall clarity of the vision, surgical removal may be indicated.

If you are concerned about floaters or flashers impeding your vision, call the Indiana Eye Clinic today to schedule an exam. Or click here to request an appointment online!

The Future of Healthcare

By Dr. Charles McCormick III

Assuming you haven’t been asleep at the wheel of life, you may have noticed lots of recent changes in the way health care is delivered in America.

Obviously this is a concern to many families. Today I’d like to give you a “peek behind the curtain” at the regulatory and administrative challenges from the perspective of a practicing physician.

Consolidation of physician practices into larger groups has been a major theme for the last 25 years. “Larger than ever” is the common tactic for survival. By grouping together, doctors can share expenses for administration and medical equipment, such as diagnostic machines that can cost $40,000 to $65,0000 each.

Here at the Indiana Eye Clinic, we strive to be a practice on the leading edge of technology, offering high-end eye care such as corneal mapping, laser-assisted cataract surgery and in vivo optical analysis. We are able to offer these treatments to our patients because we have built up a substantial practice over nearly 30 years.

Now imagine you are a young ophthalmic physician entering the workforce, usually with a mountain of student loan debt and little access to capital. Each of these pieces of high-cost gear represents a barrier to being able to perform quality work.

Group practices share an economy of scale with pooled computer systems, human resource manpower, rent and other expenses. As a result, smaller patient  populations are underserved partly due to the poor capacity of smaller offices to amortize these costs.

Recently hospitals have been hiring physicians to serve in accountable care organizations (ACO). Having this third-party intrusion can further diminish a doctor’s capacity to ensure quality of care. The early data reports on rolling the doctor-patient relationship into a hospital ACO are not convincing.

Moreover, ACO physician satisfaction and compensation declines endanger sustainable working arrangements. Multi-specialty groups are likely to embrace similar strategies in hiring doctors, and unless they stay focused in promoting physician efforts for quality care, they will face similar challenges.

In this further build-out of health care groups, patients risk losing the personal attention they feel they deserve from the doctor entrusted with their care.

Many observers argue that healthcare is the most overregulated industry in the country. Medicare, Medicaid and the private insurance industry act as conduits for payment to hospitals, physicians, patients and pharmacists. Each channel is impacted by thousands of regulations, often with inadequate oversight, and subject to reimbursement fraud. The system is too complicated!

The Centers for Medicare and Medicaid Services (CMS) have sought to replace the International Classification of Diseases, ICD-9, with a new expanded ICD-10 that would increase the classification of all types of medicine from 28,000 codes to 260,000 codes. This is likely to further escalate unnecessary administrative expenses, but not enhance patient care.

CMS has already instituted physician quality reporting mandates that require electronic medical records, additional personnel and more technology. These added expenses are to be paid by physicians despite reduced reimbursements. So far in 2015, only 27% of practicing physicians have complied with the requested changes.

For Medicare, CMS has advised physician fee cuts of 2% to 20% this year – a nightmare that Congress may cancel with pending legislation known as the “doc fix.”

Further reductions in reimbursement will further constrain doctors’ capacity to comply or willingness to play along with onerous regulation. A significant number of Baby Boom physicians are choosing to retire instead of complying. In the eye care segment, we now have 11% fewer doctors serving a population that has grown by 11%!

The Affordable Care Act, commonly referred to as Obamacare, is a centrally administered plan that is neither affordable nor effective in addressing patient care needs, in my opinion. With ACA costs so absurdly out of order, many unintended consequences are in the offing. We may see more physician practices opting for a strict fee-for-service model, bypassing all third-party reimbursements like Medicare and private health insurance.

Finally, there is the issue of medical malpractice. Indiana has experienced less volatility in litigation than other states, due to a cap on emotional pain and suffering payments plus a physician panel review system established in 1975. Nonetheless, doctors are conditioned to regard a malpractice lawsuit as a “when,” not an “if.”

States with high rates for med-mal insurance essentially limit the service or deny access to it. Front-page jury awards, lifelong calculated disability and emotional pain risk are factored into insuring physician behavior.

Doctors and associated practitioners have much to be proud of in modern medical practices. However, the recent wave upon wave of regulations impacting the industry reflects our government’s attempt to address problems from Washington D.C. It will leave unintended potholes through which we all must navigate.