Volume 04 | February 2017
When you hear hoofbeats…
A medical school professor told his students over 70 years ago “When you hear hoofbeats, think horses, not zebras.”  In other words, when the patient tells you about their problem, the doctor thinks of the most probable conditions first.  
So when one of my patients on a 10 minute phone conversation told her primary care physician (PCP) last summer that she was getting headaches, the PCP suggested she try an over-the -counter migraine analgesic. However, before they hung up, the PCP changed her mind and suggested the patient also get an MRI.  Something about their conversation (maybe the fact that the patient had no prior history of migraines) made the doctor think of the possibility of “zebras.” It turned out the patient had a brain tumor (benign), underwent surgery and now has an excellent prognosis.  

We at Chicopee Eyecare use this same “think horses, not zebras” philosophy when we examine your eyes and when the your symptoms and our exam findings agree, our diagnosis is invariably correct.  But when things don’t quite add up, we need to think outside the box and widen our differential diagnosis possibilities. Don’t ever hesitate to discuss with us concerns you have about your eyes when you think something isn't quite right.
We hope you're enjoying this mild winter.  And if you're a skier, sorry!  Whether you are a new or returning patient, thank you for the confidence  you have placed in us as your optometrists. And if you have never been to our office, we welcome the opportunity to serve you.  

Your email address has been saved  in our secure database. Our intention is to offer monthly newsletters on topics that we hope will be helpful and of interest to you. Please don't hesitate to call us if you ever have any questions or comments.

And you can do us a small favor!  Please like us on Facebook  and maybe subscribe to our YouTube channel where you can watch Dr. Momnie insert a contact lens on a six month old baby or Dr. Guzek-Latka discuss diabetes and how it affects the eyes, all at Chicopee Eyecare, P.C.   Thank you again for choosing our office. Our goal is to safeguard your eyes and help you achieve a lifetime of clear and comfortable vision.
Dr. David C. Momnie
 Dr. Camille Guzek-Latka
 Dr. Julianne M. Rapalus
Corneal Inlay Surgery:  Enjoy life without
depending on reading glasses

I read the above headline recently but before I address the article, a little background. 

There is no escaping presbyopia.  The natural lens of the eye, located just behind the iris (the colored part of the eye), begins to lose flexibility with age and by the time we’re in our forties, presbyopia kicks in.  Our arms just aren’t long enough!  Some people can avoid reading glasses or progressives (bifocals)—they’re nearsighted and can read without their glasses, or they’re nearsighted in one eye and farsighted in the other eye.  But most of us become dependent on reading glasses.

There is now a new technology called a corneal inlay that can reduce this dependency on glasses.  It’s a small, thin, plastic wafer that is surgically implanted on the non-dominant eye.  The KAMRA inlay, according to the company, is intended for patients between the ages of 45 and 60 years old who have not had cataract surgery and who need reading glasses with +1.00 to +2.50 diopters of power.  Some of the risks include dry eye, glare, halos, and more difficulty driving at night.

We at Chicopee Eyecare have a better solution for patients who need reading glasses—contact lenses.  Wearing a single contact lens in the non-dominant eye achieves the same effect as the above corneal procedure.  And one-day disposable lenses cost as little as $0.50 each. Disposable bifocal contact lenses have improved significantly in the few years and are very affordable.  So, the choice becomes between corneal inlays, a $4,000 surgical procedure, reading glasses or contact lenses. Or move reading material back and forth at arm’s length like a trombone player!

An alarming increase in nearsightedness? 
A couple of weeks ago, I was interviewed by Brittany Murphy of Western MA News (Channel 40, 3 and Fox 61) about children’s vision and the alarming increase in nearsightedness (myopia). 
And while the incidence has increased to about 25% in the U.S., it’s a global phenomenon with a prevalence of up to 90% in some Asian countries like South Korea and China.
I told Brittany that nearsightedness is the result of a complicated interaction between genetic predisposition and environmental exposures.   Unfortunately, too many children are spending several hours a day staring at a screen eight inches away, even while riding in a car.  (I recall as a teenager riding in a car and looking out a window playing a license plate game. Kids are now texting or watching a video on
long car trips). 
What can parents do? First, limit a child’s exposure to no more than two hours a day.  And second, Kick your kid outdoors! The underlying mechanism is unclear but there is evidence that two hours a day outdoors has a significant positive effect on children’s eyes.
Click HERE to see the TV video.  
Case study of the month

This month’s case is about an infant Dr. Momnie fit with a contact lens several years ago.  The child was born with a cataract in one eye and underwent cataract surgery at eight weeks old.  A congenital cataract in one eye or both eyes needs to be removed as soon as possible to avoid permanent vision loss, which is called amblyopia.  Glasses are not practical and contact lenses offers much better optics.  The infant wore the contact lens full time and wore a patch on the other eye (“the good eye”.)  Dr. Momnie and Dr. Guzek-Latka have fit several children with pediatric contact lenses in the past but rarely fit them now due to advances in intraocular lenses (IOLs), the same type that are implanted in older people who have age-related cataract surgery. By the way, think of the stress on the child’s parents who have to insert and remove the lens on a daily basis. Thankfully, most children who have cataract surgery nowadays get an IOL, eliminating the need for a contact lens.

How much do doctors charge?

A recent article in Medscape Medical News reported that certain medical specialties bill Medicare far more than the Medicare rate.  According to the article, the medical specialties that had the largest markup relative to Medicare rates were anesthesiology, radiology, pathology and emergency medicine.  Coincidentally, these are specialties where the patient doesn’t get a chance to choose a particular doctor. By contrast, those specialties that charged the closest to Medicare rates were general practice, dermatology, allergy/immunology and psychiatry.  These are specialties where the patient usually has the option to choose a particular doctor.  The article concludes that patient protection legislation may be in order for high-deductible plans and out-of-network patients who often receive high “surprise” bills from an anesthesiologist, radiologist or emergency room physician.

The Eyes Can Tell Us A Lot About Your Health
Here are a few symptoms that may tell us you have a
health problem.
  • Sudden onset of blurred vision.  The first thing that comes to our mind is diabetes.  High blood sugar levels affect the chemistry of the lens, located behind the iris. There are many other possibilities including high blood pressure and even multiple sclerosis.
  • Night blindness.  A disease called retinitis pigmentosa affects the rods (not the cones) of the retina, resulting in difficulty seeing at night.
  • Flashing lights.  Flashing lights in one eye is invariably a condition of the retina.  However, when the flashing lights start in one eye and travel to the other eye over the course of 10-20 minutes, migraine with aura is highly suspected.
  • Loss of peripheral vision. A common cause of losing part of your side vision in both eye is stroke.  A stroke on the right side of the brain would affect the left half of one’s visual field in both eyes and vice versa.
  • Painful eyes.  Red and painful eyes can be the result of an inflammation of the iris, called iritis.  Some causes of iritis are shingles on your face and auto immune diseases like rheumatoid arthritis or sarcoidosis.
The best thing a person can do when experiencing any new symptoms is to write down the time of onset, how long it lasts, and whether one or both eyes are affected.  Paying attention to your vision will help us direct you to the proper treatment that you need.

Chicopee Eyecare
wishes you a
Happy Valentine's Day
February 14th.

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Office Hours
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Our office and optical department are open during the following hours:

Monday                  9:00 am - 5:30 pm

Tuesday                 9:00 am - 5:30pm

Wednesday            9:00 am - 5:30pm

Thursday                9:00 am - 6:30pm

Friday                     9:00 am - 5:30 pm

Saturday                9:00 am - 12:30 pm   

                 Sunday Closed

         One of our doctors is always available for emergencies on nights, weekends and holidays.   Call (413) 592-7777 and our answering service will put you in touch  with an on-call optometrist.

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Chicopee Eyecare · 113 Center Street · Chicopee, MA 01013 · (413) 592-7777 info@chicopeeeyecare.com
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