JUNE 2020
COLORADO RETINA NEWSLETTER
We're Back in Business!

Good news, we have opened up more appointment availability for all of our Colorado Retina clinics! It is not business as usual just yet, but, our team is diligently working to see all patients, new and routine, in a safe and timely manner. We are actively scheduling all newly referred patients, and those whose appointments were postponed or canceled due to COVID-19 restrictions. As we gradually increase our appointment accessibility for each of our 13 physicians and 6 Colorado clinics, this will allow us to better accommodate appointment timing and location requests for you and your referred patients.

As our in-clinic appointment availability expands, so does our surgical access. We received the green light to once again operate on non-emergent cases.
We are actively coordinating with our partner hospitals and ambulatory surgery centers to maintain as much access as we are able.

Our Lafayette clinic has re-opened, Englewood is back to hosting Saturday AM clinic, and our Frisco satellite office will be holding clinics on the following upcoming Friday's: 6/12 and 6/26, for established CRA patients only at this time.

We recognize there is still a sense of uncertainty as Colorado and local Denver Metro communities begin to reopen. While this change signifies a new phase in the pandemic, COVID-19 remains a great concern throughout the world. Most importantly our team continues to take preventive steps to keep our patients and staff safe. Please, continue to check our  website  for all updated COVID-related CRA protocols and procedures.

Thank you for hanging in there with us through the ever-evolving changes. We look forward to collaborating more and more as time goes on, and the new normal for eye care becomes better established.
New! TELEMED APPOINTMENTS
As much of our patient population is elderly and deemed "high-risk" for COVID-19 exposure, we've made it easy for those patients who are uncomfortable visiting our clinics to continue to access vitreoretinal care from home. We are providing Telehealth options, allowing established patients to safely, securely and conveniently be assessed by their CRA physician via online video conferencing.

For Telehealth appointments our physicians are approved to perform consults for established patients, with a limited anterior exam and discussion of new and/or evolving symptoms relating to the underlying retinal pathology.
Same as with any in-clinic service, your patients' progress notes and exam findings will be sent to your office after the completion of their Telehealth appointment.

Our Telehealth platform is 100% HIPAA compliant, and utilized through our EHR system. As most Telehealth appointments are covered by insurance, we do ask the patient also confirm with their carrier prior to scheduling. All Telehealth appointments are by request only, please instruct any patient interested in this service to call or email us directly to inquire or request pre-approval.
UPCOMING VIRTUAL CE/CME ACTIVITIES

In the midst of the pandemic, we're taking our educational activities virtual, meaning you can now earn CE/CME credit from the comfort of your own couch!
These courses are accredited at the Colorado state level, and will be held on a
bi-weekly basis.

Check out our EVENT CALENDAR on our website, for a full list of events specifically curated for vision care providers!
OCT REVIEW
in GLAUCOMA & RETINA
Thur, June 11th | 6-7 PM

CRA and Mile High Eye Institute are teaming up to bring you a one-hour fast paced course on Optical Coherence Tomography (OCT), an emerging technology for performing high-resolution cross-sectional optical imaging.
Dr. Zak Vest and Dr. Brian Joondeph, will provide a brief review of OCT technology, covering the technical aspects of OCT and potential issues that arise while interpreting data. We will dive into how to correctly read OCT data findings, signal strength for reliability, and provide education on how to efficiently utilize OCT technology for treatment guidance of glaucoma and diseases of the retina, including AMD and diabetic retinopathy. We will also cover the anatomic measuring capabilities of the current devices in service as well as an overview of their normative database.
UVEITIS
EXPLORING THE COMPLEXITIES
Wed, June 24th | 6-7 PM

Uveitis, a general, yet highly complex term for a group of inflammatory diseases with no one size-fits all description, responsible for between 10-15% of all cases of blindness in the US. Caused by inflammatory responses, uveitis is not just limited to the uvea, having the potential to wreak havoc throughout the eye and in other parts of the body.
CRA's uveitis gurus, Dr. Mark Dacey and Dr. Ashleigh Levison, will explore a variety of uveitis manifestations, underlying systemic diseases, presentation patterns and symptoms, the lengthy road to proper diagnosis, current treatment options, and the vision-threatening implications these diseases can have for patients.

You won’t want to miss few of their most peculiar uveitis cases!
FEATURED CASE
An Elusive Macular Hole Closed by Eye Drops Alone
Although no major studies have analyzed this phenomenon,
anecdotal evidence can be instructive.
A 64-year-old man presented with a
1-month history of blurred vision in his right eye (OD). His medical and ocular histories were unremarkable. On exam of his right eye and left eye (OS), VA was 20/40 and 20/20, respectively. Borderline high IOPs, mild nuclear sclerosis, and otherwise normal anterior segments were noted.

His fundus exam revealed macular edema OD; it was normal OS. Spectralis OCT (Heidelberg Engineering) high-speed 25-raster macular scans through, above, and below the fovea OD revealed macular edema and subretinal fluid (Figure 1). As the appearance was suggestive of a macular hole (MH), a high-density OCT scan was performed, revealing a small MH missed during the standard OCT scan (Figure 2) .

THERAPY AND RESULT
Given the small size of the MH and presence of edema at its edges, medical treatment with a topical NSAID was offered as an alternative to surgery.

The patient was prescribed ketorolac eye drops 0.5% three times a day OD. After 6 weeks, the MH closed and a small pocket of subfoveal fluid persisted, but no macular edema was noted. The patient’s visual acuity and symptoms had not changed (Figure 3) .

Over the next 4 months, the drops were gradually tapered. At the patient’s last visit, at which point he was using ketorolac once daily, the MH remained closed with reduced subfoveal fluid and unchanged visual acuity or symptoms (Figure 4) .

UPDATE ON THE CASE
After this article went to press, the patient returned for follow-up. As of February 2020, the patient’s VA was 20/30 and further fluid reduction had been demonstrated.
MILE HIGH MASTERS OF RETINA 2021
Mark Your Calendar!
MHMR - DATE CHANGE

Due to COVID-19, we had to change the date of our 11th Annual MHMR meeting to 2/28/21. MHMR is an educational meeting held in Denver, CO, geared toward primary eye care providers.

This free event, features rapid-fire lectures on a variety of retina and uveitis topics and complex cases. Attendees will learn about the best and most innovative diagnostic and treatment approaches in retinal surgery and care, as well as the optimal timing of referrals.

Sunday, February 28, 2021
@ Marriott Denver Tech Center
7:30am - 12:30 PM
4 CE/CME Credit Hours
RESEARCH
Extensive FDA-Approved Clinical Research Program
Colorado Retina offers a robust, in-house clinical research program to all of our patients.
We participate in some of the most innovative research and clinical trials surrounding retina treatments, diagnosis, and cures for blindness. 
Our research department has continued to see participating patients throughout the pandemic in a more limited capacity, with all the necessary precautions.

The department currently has 22 active studies and is screening
new patients for the following enrolling trials:

Alkeus Alk-001 – There is no treatment available for Geographic Atrophy secondary to AMD. AMD is characterized by an age-related degeneration of the retina. The root cause for this degeneration or why some people develop AMD while others do not, is unknown. Over 20 years ago, it was hypothesized that the dimerization of vitamin A may be a significant contributor to the etiology of AMD. The eye indeed uses vitamin A as a cofactor to sense light, and a striking chemical signature of the aging and degenerating retina is the accumulation of vitamin A dimers in the retinal pigment epithelium (RPE) and the underlying Bruch's membrane. In rodent models, high levels of vitamin A dimers correlate with poor retinal health, and a variety of mechanisms have been proposed by which vitamin A dimers may induce retinal toxicity. It has been argued that these mechanisms participate in the development and progression of AMD. ALK-001, the study drug, is a modified form of vitamin A. When taken once a day as a capsule, it replaces natural vitamin A in the body with one that forms vitamin A dimers more slowly. This study will measure the extent to which treatment with ALK-001 slows the progression of Geographic Atrophy.

Apellis Oaks APL2-304 - This is a 30-month, Phase III, multi-center, randomized, double-masked, sham-injection controlled study to assess the efficacy and safety of multiple IVT injections of APL-2 in subjects with GA secondary to AMD

Gemini GEM-NH-002 - An observational six-year study that seeks to determine genetic correlation with the progression of Dry Age-Related Macular Degeneration. Subjects are first tested for specific genetic variants of interest.
RESEARCH DEPT. CONTACT:
EMAIL our Research Team
Phone: 720-420-3265
Located in Red Rocks Medical Center, Golden, CO.
Frank Garcia, Director of Clinical Research 
EHR DIRECT MESSAGING update your contact info
To the right is our CRA physician email directory for direct messaging, allowing our referring colleagues to send messages directly to our EHR system to meet MIPS requirements.

If you currently have a direct email address for your EHR system, and would like for the Colorado Retina team to communicate through direct messaging, please send your contact info and email address to:

VIKTORIYA GONCHAROV
CLINICAL EDUCATION MANAGER
REFERALS

For your patients who may require vitreoretinal care, we hope you choose to refer to Colorado Retina.
Our team of thirteen retina surgeons are committed to providing timely, effective and compassionate care, while keeping your
practice informed of our findings and progress along the way.

To easily and quickly refer a patient to Colorado Retina, use our HIPAA compliant, fully secure, online referral form, found on our website . 
If you are unable to complete your referral through our online platform,
download our editab le PDF Patient Referral Form , and send it along with your patients' files. Please include the patients' recent exam and progress notes, OCT/FA images, demographics, and a copy of the patient's insurance card to  info@retinacolorado.com  OR fax to (303) 261-1601.

For non-urgent referrals: once your referral is submitted, please allow up to two business days for our team to process your request. Once processed, one of our staff members will call your patient directly to schedule their initial appointment with your requested CRA physician (if specified) . For urgent/emergent referrals, our triage team will asses the patients' symptoms, and depending on the diagnosis will either be seen same day or next day.

Reminder : For same-day urgent/emergency referrals and patients that need to be seen by a CRA physician within 72 hours, please do not email, fax or fill out our online referral form, instead please call our triage line ASAP at 
(303) 261-1600 x1 . For after hour emergent care, CRA provides a 24/7 designated on-call physician, available evenings, weekends, and holidays.
REFERRAL MATERIALS

Being referred to a retina specialist can often be scary for your patient to hear. When you refer a patient to our practice, we suggest you provide them with CRA’s take home materials that will help inform and educate first time patients of our process. Our referral materials ensure your patients feel informed and prepared for their first appointment with us.

To request informational brochures, appointment cards, referral forms, or other related materials, please use the button below. Please allow up to seven business days for materials to be sent to your office.
REFERRING COLLEAGUE BENEFITS
Don't Miss Out on the Perks of Partnership!

As your partner, we are here to serve you! We hope you take advantage of all the unique educational, fun, and resourceful benefits we offer...

  • CE/CME accredited activities: hosted virtually, at Denver's top restaurants' (hopefully starting again soon), or intimately at your office with the topic of your choice!
  • JCAHPO courses for your support staff
  • Hosted happy hours, dinners, and networking events open to all vision-care professionals
  • Surgical & clinical shadowing (on pause until COVID restrictions lift)
  • Subspecialty coverage in uveitis, ocular oncology/tumors, inherited retinal diseases.
  • Same-day appointment availability
  • Coverage of after hour emergencies with 24/7 on-call physician
  • Daily MD coverage, including Friday Frisco clinic and Saturday Englewood Clinic
  • FDA-approved, in-house clinical research program
  • Patient resources, including patient support groups with certified clinical counselors
We encourage open lines of communication between your practice and ours. We enjoy hearing from you, so please if you're ever questioning a possible retinal finding, would like to review a patients' OCT/FA image, or just want to connect, you can text, email or call to speak directly with a CRA physician.
Thank You for Your Support!
COLORADO RETINA ASSOCIATES, P.C.
Main: (303) 261-1600
Fax: (303) 261-1601
Connect with us