I read with great interest a CNN article titled, “Prince William reveals how his poor eyesight helped with nerves when public speaking.”

The article mentions that when HRH Prince William felt uneasy, he would simply not wear his contact lenses.  This causes blurred vision such that he would then be unable to see the body language expressions of his audience.

Infact, Prince William describes a condition known as uncorrected refractive error (URE). Uncorrected refractive error is a leading cause of blindness throughout the world.  On World Sight Day 2006, the WHO estimated that 153 million worldwide suffered from blindness or visual impairment due to uncorrected refractive errors.(NIH article)

Lou et. al IOVS article (2016) states, “Uncorrected refractive error (URE), which affects a large proportion of the world population, is the major cause of vision impairment and the secondary cause of blindness. The Global Burden of Disease (GBD) Study 2010 estimated that in 2010, 101.2 million cases of moderate and severe visual impairment (MSVI), and 6.8 million cases of blindness were due to URE. Uncorrected refractive error may reduce educational opportunities, productivity, and overall quality of life.”

Other leading causes of blindness include age-related macular degeneration (AMD), diabetic retinopathy, glaucoma and cataracts.  These diseases account for most cases of adult blindness and low vision among people in developed countries. Because these eye diseases cause no pain and often have no early symptoms, they do not automatically prompt people to seek medical care. 

A thorough eye exam can also detect other health conditions, such as stroke, cardiovascular disease, diabetes, high blood pressure, autoimmune diseases, sexually transmitted diseases and some cancers. 

So a pair of eyeglasses — or in the case of HRH Prince William, contact lenses — can actually help with self confidence, overall vision and quality of life.

I spent many weeks in March & April — as my practice was shut down, surgeries cancelled, and stock market in free fall — in deep prayer for the well-being and recovery of one my best friends from childhood.

I had described Navin in my own wedding speech as, “a person whose spirituality and counsel have guided me for over two decades.”

The collective prayers of family and friends worldwide were answered when he improved, was released from the hospital, and spent the last many weeks in home rehab.

I hope you’ll take a few minutes to read his compelling experience.

Navin Girishankar’s “My COVID Story” can be found on LinkedIn here.

Regional Eye Associates has implemented COVID-19 safety protocols in our two-ophthalmologist practice. This includes standardized pre-screening protocols, expedited check-in & check-out, waiting room changes, required masks for all patients & staff, PPE, cleaning and extra safety innovations.  

Patients are screened prior to a visit for COVID-19 symptoms using CDC guidelines. On arrival, the patient calls the front desk at 856-795-8787 or rings the doorbell. The patient checks-in at a new check-in desk near the front door.  An ophthalmic technician performs a patient work-up. Patients, family members, and staff wear masks.  If a patient is able to walk by themselves, then family members are asked to wait in their cars during a patient visit.

The technician enters the chart visit information — including chief complaint, medical history, medications and compliance, visual acuity and testing — into our EMR (electronic medical record).

The ophthalmologist reviews the chart, speaks with the patient, and performs the examination.  Talking is limited when the ophthalmologist and patient are within six feet.  

The ophthalmologist will then discuss the treatment plan with the patient and family members. The plan may include continuing current medications, adding or changing medications, scheduling follow-up studies, consultations, and/or procedures. Medication prescriptions are sent electronically to the pharmacy. The patient receives a secure email via our patient portal at the end of the day or next morning. As well, our staff mails the patient a visit summary, co-pay receipt, and follow-up appointment date.

To schedule a consultation with Dr. Miano & Goel, contact Regional Eye Associates using the online form here or send a secure message via our patient portal.

If you have a sudden loss of vision, trauma, chemical injury or other injury, you should call 911 and go to the nearest emergency room.

The American Academy of Ophthalmology has an excellent coronavirus guide for eye patients here.

Due to the COVID-19 pandemic, ophthalmologists nationwide transitioned from performing usual services to a limited schedule of urgent and emergent patient visits only. As ophthalmologists continue our mission of protecting sight, telemedicine quickly became a useful method to evaluate patients for many ophthalmic conditions and without a slit-lamp evaluation.

I also recently started performing visual acuity and intraocular pressure (IOP) measurements in the parking lot. This service has proven especially helpful for my patients who are under treatment for glaucoma or are glaucoma suspects. Both telemedicine and parking lot patient evaluations will continue as clinical practices expand patient hours on a regional basis.

Patients are screened prior to a visit for COVID 19 symptoms using CDC guidelines. On arrival, the patient calls the front desk. My ophthalmic technician performs a patient work-up in the parking lot. The patient stays in the car. The patient, family members, and staff wear masks.  My tech returns inside and enters the chart visit information — including chief complaint, medical history, medications and compliance — into our EMR (electronic medical record). 

I review the chart and meet my patient at their car. Patients who are mobile are asked to stand next to their car (better ergonomics).  Elderly patients or patients with mobility issues stay seated. Best corrected visual acuity using a portable eye chart is recorded.  For patients who have retina issues or macular degeneration risk factors, Amsler Grid evaluation is performed. In addition, I place an anesthetic drop into each eye and perform IOP measurement with a portable tonopen. I examine both eyes.

I discuss the patient plan with the patient and family members. The plan may include continuing current medications, adding or changing medications, scheduling follow-up studies or procedures. I return inside to complete the patient chart and send medications electronically to the pharmacy. The patient receives a secure email via our patient portal at the end of the day or next morning. As well, my staff mails the patient their visit summary, co-pay receipt, and follow-up appointment date.

Four eye diseases — age-related macular degeneration (AMD), diabetic retinopathy, glaucoma and cataracts — account for most cases of adult blindness and low vision among people in developed countries. Because these eye diseases cause no pain and often have no early symptoms, they do not automatically prompt people to seek medical care.

Glaucoma in particular is a “silent disease.” Patients who have glaucoma are often taking ophthalmic medications to lower their eye pressure. As the COVID-19 social distancing guidelines continue, a parking lot visual acuity and intraocular pressure evaluation offers a convenient opportunity to monitor a patient’s ophthalmic status, optimize medication management, promote compliance and overall eye health.

To schedule a consultation with Dr. Goel, contact Regional Eye Associates using the online form here or send a secure message via our patient portal.

If you have a sudden loss of vision, trauma, chemical injury or other injury, you should call 911 and go to the nearest emergency room.

The American Academy of Ophthalmology has an excellent coronavirus guide for eye patients here.

One of my COVID goals was to create a monthly patient newsletter. The American Academy of Ophthalmology offers wonderful resources to help educate the public in monthly campaigns.

Delighted to promote May as Healthy Vision Month! Regional Eye Associates shares 5 steps to lower your risk of eye disease. Check out our inaugural monthly newsletter below or here!

5 Steps to Lower Your Risk of Eye Disease

By age 65, one in three Americans will have a vision-impairing eye disease. Many sight-threatening conditions can be treated if detected early enough.  In many cases, early treatment interventions can limit or eliminate the damage to your eyesight. During the month of May, Regional Eye Associates joins the American Academy of Ophthalmology to share valuable information on eye health and vision.

Four eye diseases — age-related macular degeneration (AMD), diabetic retinopathy, glaucoma and cataracts — account for most cases of adult blindness and low vision among people in developed countries. Because these eye diseases cause no pain and often have no early symptoms, they do not automatically prompt people to seek medical care. But a thorough checkup by an ophthalmologist — a physician who specializes in medical and surgical eye care — can detect them in their earliest stages. Early treatment is vital because it can slow or halt disease progression or, in the case of cataracts, restore normal vision.  

A thorough eye exam can also detect other health conditions, such as stroke, cardiovascular disease, diabetes, high blood pressure, autoimmune diseases, sexually transmitted diseases and some cancers. It’s not uncommon for a trip to the ophthalmologist to actually save a life. The Academy’s global community of 33,000 physicians urges you to follow these five simple steps to take control of your eye health today:

1. Get a comprehensive medical eye exam at age 40. Early signs of disease or changes in vision may begin at this age. An exam by an ophthalmologist is an opportunity to carefully examine the eye for diseases and conditions that may have no symptoms in the early stages. 

2. Know your family history. Certain eye diseases can be inherited. If you have a close relative with macular degeneration, you have a 50 percent chance of developing this condition. A family history of glaucoma increases your glaucoma risk by four to nine times. Talk to family members about their eye conditions. It can help you and your ophthalmologist evaluate your risk.

3. Eat healthy foods. A diet low in fat and rich in fruits, vegetables, and whole grains, benefits the entire body, including the eyes. Eye-healthy food choices include citrus fruits, vegetable oils, nuts, whole grains, dark green leafy vegetables and cold water fish.

4. Stop smoking. Smoking increases the risk for eye diseases such as cataract and age-related macular degeneration. Smoking also raises the risk for cardiovascular diseases which can indirectly influence your eye health. Tobacco smoke, including second-hand smoke, also worsens dry eye.

5. Wear sunglasses. Exposure to ultraviolet UV light raises the risk of eye diseases, including cataract, fleshy growths on the eye and cancer. Always wear a hat and sunglasses with 100 percent UV protection while outdoors.An ophthalmic examination helps to evaluate the overall health of the eyes and relationship to systemic diseases. 

Both Dr. Miano and Dr. Goel are board-certified comprehensive ophthalmologists. Visit our practice website to schedule an office visit or telemedicine consultation. 

To learn more ways to keep your eyes healthy, visit the American Academy of Ophthalmology’s EyeSmart® website.

I was honored to be a guest on the cutting edge podcast Wall Street to Main Street. Emily Advani & Reuben Advani have created a great venue to explore business, the economy and the stock market. We discuss COVID-19, telemedicine & my passion for protecting sight. Please check out the podcast and send me feedback!

Wall Street to Main Street: Episode 12 – COVID-19: TeleHealth, TeleMed and the Practice of Medicine

As we prepare for ophthalmology offices to open in the coming weeks, I wanted to share some pearls for the proper use of surgical face masks, gloves, and 3-D printed face shields in an ophthalmology office. I found some useful links below and made a short 2 minute video.

1. Use of Cloth Face Coverings to Help Slow the Spread of COVID-19 (CDC PDF)

2. How to Remove Gloves (CDC PDF)

3. 3D printable headband Face Shield DtM-v3.1 (NIH 3D Print Exchange)

From a spec sheet posted on the NIH link above, “This face shield protects the face by limiting aerosol and splatter exposure from the front and from above. It is a supplementary face shield created as an emergency action to provide backup personal protective equipment (PPE) options if the standard PPE is unavailable. This device has gone through a special verification process expedited strictly for the response to the COVID-19 pandemic.”

With thanks to Sona Dadhania, Ankur Dadhania and their parents for making 3-D printed face masks for frontline workers and healthcare colleagues!

With the Dadhania family help, I donated 30 face shields to the Abington – Jefferson Health OB-Gyn residency program. Thanks to the OB residents for being available 24/7!

(*** Bonus pearl: See my related blog post & instructional video: How to make a Slit Lamp protective shield in 2 minutes. )

I was honored to participate in the Prism Eye Rounds webinar, hosted by friend and world-renowned ophthalmologist Ike Ahmed, MD.

I gave a 6 minute talk (starts at 1:51:30), titled, “Love of learning in the time of COVID: Master Post-COVID skills.”

Prism Eye Rounds are currently held twice a week, and among the best learning opportunities during the COVID-19 pandemic.

With thanks to colleagues worldwide who continue to inspire and share their clinical and surgical pearls. #ProtectingSight

Due to the Coronavirus (COVID-19) pandemic, the American Academy of Ophthalmology now finds it essential that all ophthalmologists cease providing any treatment other than urgent or emergent care immediately.

I started wearing face masks in the office. I will continue to be available for urgent & emergent care. I have also instituted tele-medicine which has already proven valuable for patients who are under quarantine. Currently, I offer tele-health visits to established patients only.

Here’s a Quick Patient Guide to save time & optimize your tele-health visit.If you wish to have a tele-medicine visit, contact your ophthalmologist and provide the following information:

• Medical insurance. Traditional Medicare has started to cover tele-medicine visits due to the coronavirus pandemic. If you have a Medicare Advantage, commercial insurance or no insurance, inform the office staff. Depending on your insurance, a tele-medicine visit may include a co-pay, co-insurance, deductible or be considered a non-covered service. You may be asked to make a deposit prior to consultation.
• Pharmacy. Be sure to mention your current local pharmacy, pharmacy location, phone number and allergies! Many pharmacies are located at the border of towns and the exact address is helpful for EMR systems.
• Cell phone number. Please test your device, such as a smart phone (iPhone, Android), tablet (iPad) or desktop computer prior to your appointment. Video call a friend or family member for audio and video! You may want to use selfie mode on the device. In some instances, having a family member or friend available is most helpful to highlight eye structures during the consultation.
• Email address. This is critical for many electronic medical record (EMR) systems which utilize a patient portal. After your visit, you may receive an email with patient instructions.
• Video conferencing platform. Inform the office of your preferred communication platform and contact information. This includes either the cell phone number or email address associated with the platform. Your ophthalmologist may offer the following options:
  • A text to your cell phone. The text will include a link to open a special Doximity video call.
  • A telemedicine patient portal, such as Doxy.me.
  • Other platforms including FaceTime, Google Hangout, Facebook Messenger, Skype, WhatsApp, & Zoom.

• Visual Acuity & online measurements – The results from the free online tests will greatly help your ophthalmologist during your telehealth visit. All of Dr. Goel’s patients are asked to take a Pre-Test prior to consultation. Helpful platforms include:
  • Visual Acuity charts (PDF with Visual acuity & Amsler Grid, courtesy University of Arizona). This is the simplest to use and the chart is easily calibrated with a US quarter! Can be used from a desktop, tablet, mobile phone or printed.
  • Essilor Test Your Vision (Visual Acuity, Astigmatism, Light Sensitivity, Near Vision, Color Vision, Amsler Grid).
• Light source. A penlight, flashlight or good lighting area may be most helpful. A family member or friend can also use the smart phone (or a second device) with flashlight on.
• Appointment Time. The office will give you an appointment time. A technician or scribe may call you prior to your appointment time to review your chief complaint, symptoms, medical history, medication list, etc. This will likely be by a phone call. The ophthalmologist will then be able to call via video to review your history and perform a tele-health consultation.
• If you are one of Dr. Goel’s or Dr. Miano’s established patients (seen at the Cherry Hill, NJ or Atco, NJ offices within the last few years) and need an urgent / emergent visit, call Regional Eye Associates or use the online form here.
• If you have a sudden loss of vision, trauma, chemical injury or other injury, you should call 911 and go to the nearest emergency room.

Dear Colleagues,

I’ve made a quick 2 minute video which gives the dimensions of slit lamp protective shield. At the bottom of this blog post, I also include essential websites (AAO, AMA, Medicare) to keep up-to-date on coronavirus & telemedicine.

After I created the video, I used a utility knife to make a slit lamp shield using the harder plastic.

Website links for ophthalmology and practice administrator colleagues on Coronavirus & Telemedicine:

1. American Academy of Ophthalmology Coronavirus Updates (**Updated frequently. I recommend visiting the AAO site often**)
2. AAO/AAOE’s Telemedicine primer and essentials. How to code for phone calls, internet and tele-health consultations.
3. Medicare Telemedicine Healthcare Provider Fact Sheet
4. AMA Quick Guide to Telemedicine in Practice
5. American Academy of Ophthalmic Executives (AAOE). Among many benefits, practice administrators and leaders have access to a wonderful etalk listserv which has saved me thousands of dollars in practice management pearls. (Disclaimer: I am on the AAOE board)