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Archive for May, 2017

Georgia Society of Ophthalmology

Sunday, May 21st, 2017

The Georgia Society of Ophthalmology (GSO) is the only statewide organization representing Georgia ophthalmologists and their patients. The GSO’s activities include legislative advocacy, continuing medical education for ophthalmologists, and public education about important eye health care concerns.

Members of The Georgia Society of Ophthalmology are board-certified ophthalmologists (Eye M.D.s) in various practice settings throughout Georgia.  Our member physicians are wholly dedicated to lifelong learning and professional integrity in order to provide the best possible patient care.

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Cathy L. Graham, MD named the new director of breast surgery at Emory Saint Joseph’s Hospital

Friday, May 19th, 2017

Cathy Graham The Glenn Family Breast Center of Winship Cancer Institute announced that Cathy L. Graham, MD, will serve as the new director of breast surgery at Emory Saint Joseph’s Hospital.

An innovator in the field of breast surgery, Graham’s research interests include minimally invasive breast cancer therapies, aids to oncoplastic breast surgery and high risk breast lesions. In fact, Graham’s high risk breast cancer clinic specializes in preventive medicine for those patients with a family history or genetic predisposition to the disease. “Some of these may include atypical lesions, lobular neoplasias and high risk lesions, which are all risk factors for the development of breast cancer,” she says.

Graham’s model of clinical care is concentrated on providing early intervention for patients, including screenings and follow up. “Our focus is to identify cancer early so that it is a treatable disease,” she adds.

Additionally, Graham’s clinic manages benign breast diseases, a unique offering in north Atlanta. “Our community has a real need for a program focusing on benign diseases such as fibrocystic breast change, nipple discharge and lactation issues. An added convenience is that our specialized program allows us to care for patients in their own community,” she emphasizes. At the Glenn Family Breast Center at Emory Saint Joseph’s, patients also receive care from a multidisciplinary team, which includes specialists in radiology, genetics, medical oncology, radiation oncology and surgical oncology.

Graham earned her medical degree from the Emory University School of Medicine, and completed her residency at the University of Cincinnati. She is the former medical director of the Breast Health Program at St. John West Shore Hospital in Westlake, Ohio. She previously served on the faculty of Case Western Reserve University in Cleveland in the departments of Surgery, Medical Oncology and Anatomy and was medical director of the breast health program at St. John Medical Center and Southwest General Health Center, both in Ohio.

Prevention, early detection, and a multidisciplinary approach to treatment are hallmarks of the Glenn Family Breast Center at Winship, which oversees and coordinates breast cancer care and research throughout Emory.

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Arrive Alive

Wednesday, May 17th, 2017

By Charles Wilmer, M.D. MAA President-elect, and Natalie Wilmer

Handheld smartphones – i.e., smartphones that the driver is able to touch while a vehicle is in motion – pose the greatest and most unprecedented form of danger ever seen on the road.

And smartphone ownership is growing. In 2011, 52 percent of drivers reported owning a smartphone, and by 2014 that number had grown to 80 percent. The greatest increases in smartphone ownership are among adults age 40 and older.[i] However, our nation’s youth are catching up, and their numbers are growing.

Distracted driving activities include things like using a cell phone, texting and eating. Using in-vehicle technologies (such as navigation systems) can also be sources of distraction. While any of these distractions can endanger the driver and others, texting while driving is especially dangerous because it combines all three types of distraction. (Text messaging requires visual, manual, and cognitive attention from the driver.)[ii]

Drivers allowed to manually operate a smartphone when driving are killing the innocent drivers next to them. When texting, the average time your eyes are off the road is five seconds. When traveling at 55 mph, that’s enough time to cover the length of a football field blindfolded.[iii] It is not surprising then that distracted drivers veer out of their lane and into oncoming traffic.

At any given daylight moment across America, approximately 660,000 drivers are using cell phones or manipulating electronic devices while driving, a number that has held steady since 2010.[iv] A quick look at YouTube shows multiple examples of the tragedies that ensue.

Distracted driving is killing more people in Georgia, every year. More than 1,559 people died on Georgia’s roads in 2016. That’s 127 more than in 2015, and 389 more than in 2014. Twenty-five percent more people died in Georgia in 2016 compared to 2014 because of distracted driving.[v]

The Georgia Department of Transportation (GDOT) found 74 percent of the above accidents were directly tied to the driver’s behavior, often texting and driving. Sixty-five percent of the accidents were also caused by the driver failing to stay in their lane. In comparison, only 39 percent of fatalities had to do with car occupants not wearing any seat belts, according to GDOT.[vi]

These fatalities do not even take into account those “non-fatalities” in distracted-driving crashes, people who are never able to live a normal life as the result. Thousands of Americans struggle with back pain caused by motor vehicle accidents due to distracted driving, many of whom were the innocent victim.

Other states are enacting laws to prevent these fatalities and life-altering injuries.

  • Talking on a handheld cellphone while driving is banned in 14 states and the District of Columbia.[vii]
  • The use of all cellphones by novice drivers is restricted in 37 states and the District of Columbia.[viii]
  • Text messaging is banned for all drivers in 46 states and the District of Columbia.[ix]

For example:[x] In 2016, the Massachusetts Senate passed a bill banning the use of handheld cellphones while driving. The bill, S.2093, requires anyone who wants to use a phone while driving to use hands-free technology to both dial a number and to talk. The bill prohibits a driver from holding a phone while talking, inputting an address into a GPS, or composing or reading an electronic message.

The fines would be $100 for a first offense, $250 for a second offense and $500 for a third offense. These are the same fines that currently exist for texting while driving. There is an exception in case of an emergency.

When comparing data from other states or countries that have a handheld device ban, the U.S. appears to have the biggest death wish when it comes to driving while using cellphones, with Europe close behind. European governments are responding to the challenge with increasing fines and jail time. In London, the fine for a first-time offense is approximately $300 dollars and 6 points – the loss of a driver’s license for a young driver.

This proposal is meant to save lives by banning the physical use of smartphones while the vehicle is being driven, not removing the use of cell phone capabilities (such as verbal communication and maps). The use of smart phones for non-physical capabilities (e.g phone calls, navigation, etc.) is still allowed via Bluetooth technology or verbal commands.

Fatalities and recklessness related to distracted driving is primarily the result of someone taking their eyes off the road to physically hold and operate a smartphone, resulting in loss of vision for the length of a football field while operating a two-ton missile. That is what needs to change. Unless there is a law in place that allows police to cite people for touching their phones while the vehicle is in operation, people will not voluntarily change what they find easy until they or a loved one are involved in a life-altering collision due to distracted driving.

Some of my patients have asked why doctors do not stand up for the safety of their patients and stop this carnage. I have come face-to-face with this issue myself. We lost one of our finest physicians this past year due to a distracted driver who ran over him while he was biking with friends. His wife lost a husband, his children lost their father, and the community lost one of their best physicians. More than 3,000 patients will be forced to find another doctor, never again to see the one they loved for so many years.

The time to act is now at hand. Let us be bold to realize our weakness with cellphones and put them down before another tragic loss of life occurs. It may just save our life or that of a loved one.

 

[i] http://www.multivu.com/players/English/7292854-state-farm-distracted-driving-survey-cellphone-use/

[ii] National Highway Traffic Safety Administration. Facts and Statistics. [cited 2016 Feb 23]; Available from: http://www.distraction.gov/stats-research-laws/facts-and-statistics.html.

[iii] https://www.vtnews.vt.edu/articles/2009/07/2009-571.html

[iv] https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/811719

[v] http://www.dot.ga.gov/DS/SafetyOperation/DAAA – calculation done compared 1559 deaths in 2016 to 1170 deaths in 2014.

[vi] http://patch.com/georgia/alpharetta/impact-texting-driving-georgia

[vii] http://www.iihs.org/iihs/topics/laws/cellphonelaws

[viii] http://www.iihs.org/iihs/topics/laws/cellphonelaws

[ix] http://www.iihs.org/iihs/topics/laws/cellphonelaws

[x] http://www.masslive.com/politics/index.ssf/2016/01/massachusetts_senate_passes_ba.html

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Michael Jacobson, M.D.

Wednesday, May 17th, 2017

Dr. Jacobson graduated from Dartmouth College and the University of Connecticut School of Medicine. He completed his residency at the University of Maryland and his fellowship at the University of Illinois. A cofounder of Georgia Retina, he has been a principal investigator of numerous clinical trials and a speaker at state, national and international meetings. He has authored a textbook chapter and published numerous articles, abstracts and papers in peer-reviewed journals.

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What’s happening in Ophthalmology? More Than the Eye Can See.

Wednesday, May 17th, 2017

By Michael Jacobson, M.D.

Dr. Michael Jacobson

In this edition, we will explore and provide you insight into a wide range of ophthalmology topics. We will start at the front of the eye, the cornea, then delve deeper to discuss the lens and ciliary body. Lastly we’ll finish our eye edition focused on the back of the eye, the retina.

Hold tight onto this issue, as we will give you a whirlwind tour of these wide-ranging and fascinating topics that have meaning for all of us, not just our patients. After all, if you live a long life, you will invariably develop one of these problems.

We will discuss the latest and most exciting developments when it comes to refractive surgery, which gives individuals the opportunity to reduce their dependency on glasses or contact lenses. We’ve come a long way since radial keratotomy (RK) surgery of the 1980s. With the advent of newer techniques like laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK), we now have procedures that permit more consistent, predictable and sustained results.

This field is burgeoning, and the population of people that may be good candidates for some type of refractive procedure is enlarging. Even solutions for presbyopia, or farsightedness caused by loss of elasticity of the lens of the eye that compels most of us over age 40 to turn to reading glasses, is being addressed with surgical options. The future may even be more promising and is likely to surpass the vision correction results that we obtain with LASIK and PRK.

Did you know that 3 million people in the U.S. have glaucoma and that this blinding eye disease progresses insidiously because there are usually no symptoms?? Did you know you can have glaucoma but have normal pressure?

Increased pressure in the eye leads to blindness, and eye drops are usually the first line of treatment. New drug classes, each with a unique mechanism, has led to a diversity of eye drop options that we have used for the past 3 decades without any big developments. However there is a new drug class awaiting FDA approval which you can read more about in this issue.

Compliance has been a major obstacle in treating glaucoma patients with drops. Innovative sustained drug delivery devices may lead to improved outcomes, and these are addressed.

For those in whom drops are not enough, laser therapy remains effective to increase outflow or decrease inflow, but there have not been new big breakthroughs here. A momentous advance in glaucoma treatment has been the discovery that cataract surgery lowers pressure. This has been very good news for glaucoma patients as that can sometimes be enough of a drop in pressure to make a difference.

If that is not thought to be enough pressure reduction, then the opening of the eye during cataract surgery now affords the opportunity to insert micro-incisional devices to facilitate the drainage of fluid out of the eye. Our authors have been involved in their development. Additional novel approaches in this micro-incisional surgery arena will be highlighted.

More advanced glaucoma damage requires larger scale, macro surgery. These procedures create a pathway – essentially a hole – from inside the eye to a bleb (a fluid-filled bump) on the ocular surface, and they can achieve profound pressure reduction. Alternate fluid pathways procedures continue to evolve year by year now. If patients undergo frequent eye exams as they grow older as recommended and when necessary, and we use the aforementioned treatments, we can hopefully prevent blindness from this terrible disease.

A cataract is formed as the lens of the eye becomes dense and opacified with age. Less light is able to enter the eye, causing diminished light perception, dulling of colors and blurry vision. Light becomes diffracted, resulting in glare. As the No. 1 cause of reversible vision loss worldwide, a great deal of time and effort has been spent on developing a safe, efficient and accurate surgical treatment.

The evolution of cataract surgery to become the operation it is today is one of the most interesting stories in all of medicine, and that journey is what the authors will share with you, taking you from ancient couching to incisional surgery where the entire cataract was removed.

The invention of intraocular implants allowed the “Coke bottle” glasses of your great grandparents to disappear. Techniques advanced allowing partial removal of the lens. Then ultrasonic dissolution and aspiration evolved to permit smaller and smaller incisions.

Very recently, a unique laser has enhanced and “simplified the surgical technique whereby the laser can make precise computer-designed incisions and dissolve the cataract. Incision size can be as small as 2mm (less than 1/10 inch), still large enough to remove the old cataract and insert a foldable lens implant substitute. Anesthesia has evolved from required general anesthesia to retrobulbar shots and now simply topical. That makes it infinitely safer for all patients.

While risks of surgery exist, this surgery offers very high levels of postoperative satisfaction. Astigmatism-correcting intraocular lenses (IOLs), refractive multifocal IOLs and presbyopia-correcting ones are available. Models have improved rapidly particularly over the past decade, and there is an excellent chance of finding a precise internal vision correction that makes the patient much less eyeglass-dependent. Essentially, a patient with healthy retina can request and choose crisp near vision or crisp distance vision. If that is not the desired endpoint, then there are multifocal IOL options that try to achieve a hybrid of both. The authors explain how cataract surgery of 2017 should preserve one’s active lifestyles like never before.

Diabetic retinopathy (DR) affects nearly one-third of all patients, and diabetes is the leading cause of blindness in our working-age population. This disease is epidemic, particularly here in Georgia.

A retina specialist will provide you with a succinct understanding of how this condition is managed. He emphasizes how all of us need to work collectively to get our patients motivated to not only achieve good A1c levels, but to address the other factors that accelerate this disease, particularly hyperlipidemia, hypertension and tobacco use.

All of us now know that what was considered an acceptable A1c of 8 in the past is not acceptable and the postponement of nephropathy, neuropathy and retinopathy depend on true tight control. Today he will report that compliant patients seldom end up blind, thanks to more tools in the retinal surgical tool box (small gauge surgery, improved pre-op pharmacology).

I recall during my fellowship and will never forget that one of my friends, in the midst of his neuroradiology fellowship, developed Type I diabetes mellitus. He diagnosed himself. It was ironic that he came down with this, given that his father, a professor of endocrinology, was also the president of the American Diabetes Association. Initially, he went into a deep depression concerned that he ultimately would lose the ability to read X-rays and catastrophizing how his life was doomed. Today such thinking hopefully is truly a thing of the past.

Age-related macular degeneration (AMD) is a very big deal because the aggressive forms of the disease lead to legal blindness (20/200 vision). This represents a severe handicap to our aging population who will lose the ability to drive, read or recognize faces.

Unless you are a pediatrician, you will encounter these visually handicapped patients. Now over 9 million people here in the U.S. have AMD, but 18 million people will have this condition by 2050. That is staggering! Knowing that QALY surveys find that people would rather have AIDS or advanced congestive heart failure than face the prospect of blindness, I am pleased to report that we have made great strides in managing this horrific condition, and a retinal specialist will share the good news with you and what we hope to achieve tomorrow.

No longer are ophthalmologists serving like psychiatrists trying to help these patients cope with their depression that such visual loss brings. Intravitreal injections of anti-VEGF drugs remain the standard of care for wet AMD. Yes, shots directly into the eye. Ninety percent of patients benefit, and of those, almost half experience some vision improvement. Considering 10 years ago when we relied on laser, we could only help 10 percent of patients, this is a revolutionary breakthrough. However, there is still room for improvement in AMD treatments since only the minority of patients experience significant visual gains and the treatment burden of frequent injections is high.

Breakthroughs for patients blinded by retinitis pigmentosa (RP) may include a retinal prosthetic device akin to a cochlear implant, called the Argus. In a different direction, we soon may be able to repopulate compromised/degenerated retinal cells using stem cell replacement, injected under the retina. 3-D printers using living cells placed on a substrate may even build networks of retinal cells that mimic the complex retinal hierarchal structure. Gene therapy provided by a viral vector (adeno-associated virus) has been recently used successfully in Leber’s Congenital Amaurosis (LCA), a blinding eye disease of children, and now may be modified to insert enhanced cells that may suppress natural VEGF production and allow our body to better defend against the onset of wet AMD.

As a consequence of the human genome project, each day more single-nucleotide polymorphisms (SNPs) of DNA are being investigated to find their relationship to eye disease. These discoveries will allow us to explore how we can synthesize protein inhibitors or promoters to prevent or cure disease.

Such research is robustly underway, including biotech company Spark Therapeutics, which is screening large populations to attack some rarer but devastating blinding eye disease such as choroideremia, RP and LCA. Enjoy the this eye edition.

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Shepherd Center Names, Dr. Michael Yochelson, New Chief Medical Officer

Wednesday, May 17th, 2017

Michael Yochelson, M.D., MBA, has been named chief medical officer of Shepherd Center. Dr. Yochelson’s tenure begins Sept. 6.

“Dr. Yochelson brings to Shepherd Center vast clinical and educational leadership experience,” said Sarah Morrison, PT, MBA, MHA, Shepherd Center’s president and CEO. “We believe his unique combination of skills, as well as his reputation as a leader, clinician and researcher make him an ideal fit for Shepherd Center.”

Since 2011, Dr. Yochelson has served as the vice president of medical affairs and chief medical officer at MedStar National Rehabilitation Network in Washington, D.C. In addition to being a board-certified neurologist and physiatrist, he also has served in an academic capacity as a professor and vice chair of clinical affairs in the department of rehabilitation medicine and professor of clinical neurology at Georgetown University. Additionally, he is the founding program director of the Brain Injury Medicine Fellowship, which he started at MedStar National Rehabilitation Hospital in 2009. Dr. Yochelson began his medical career in the United States Navy, where he served from 1995 to 2006.

Dr. Yochelson earned a bachelor’s degree in science from Duke University and his medical degree from George Washington University. He completed his residency training at the National Capital Consortium. Dr. Yochelson also holds a master’s in business administration from the R. H. Smith School of Business from the University of Maryland.

“Dr. Yochelson is a tremendous addition to Shepherd Center’s clinical staff and leadership team,” said Donald Peck Leslie, M.D., long-time Shepherd Center medical director. “His depth of knowledge, experience and passion for the patients we treat will be extremely beneficial for both Shepherd Center patients and staff.”

Dr. Yochelson assumes the role as Dr. Leslie retires after 31 years at Shepherd Center.

“I am honored to be joining the incredible team at Shepherd Center, which is leading rehabilitative care in spinal cord and brain injury and changing the lives of those they serve every day,” Dr. Yochelson says.

The Shepherd Center is a 152-bed private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions.

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Columbus Regional in Exclusive Negotiations with Piedmont Healthcare

Wednesday, May 17th, 2017

Columbus Regional Health and Piedmont Healthcare signed a Letter of Intent, initiating an exclusive negotiation period between the two organizations. Should the negotiations prove successful, Columbus Regional will become Piedmont’s regional “hub” for clinical services in Southwest Georgia.

Columbus Regional Health’s two hospitals – Midtown Medical Center and Northside Medical Center, as well as its John B. Amos Cancer Center, MyCare Urgent Care Centers and multiple physician practices – would be included in the partnership.

Piedmont Healthcare is a not-for-profit system of 7 hospitals, nearly 100 Piedmont-employed physician practice locations and a clinically integrated network of over 1,600 employed and independent physicians, caring for patients and communities across Georgia.

“Piedmont is committed to making a positive difference in every life we touch. We share a commitment to high-quality, patient-centered care with Columbus Regional and welcome this opportunity to increase access and enhance care across Southwest Georgia,” said Kevin Brown, president and CEO of Piedmont Healthcare. “Columbus Regional has a rich history of caring for its community and region, and we are thrilled to start working on a partnership with an organization that shares so many of our values.”

“Since last year when we made our initial announcement regarding a potential partnership or affiliation, we have maintained our position of strength financially and we continue to realize improvement across many areas of our health system. We believe that now is the time to combine our strengths through a strategic partnership. This will allow us to serve our patients and the community to the highest degree possible,” said Scott Hill, Columbus Regional Health president and CEO.

“This decision was made after a comprehensive, year-long process to evaluate the benefits for our patients, for our employees, our medical staff, and most importantly, for our community. Based on the core goals and objectives we laid out before we began our process, we are confident Piedmont is the right fit for us,” added Warren Steele, chairman of the Board of Directors of Columbus Regional Health.

“Piedmont Healthcare has proven experience integrating hospitals into its operations and capitalizing on the unique expertise of each organization, in concert with working to meet the needs of every community they serve in Georgia,” Steele added.

Columbus Regional Health’s Midtown Medical Center provides the region’s only advanced maternity services and neonatal intensive care unit (NICU); a Children’s Hospital, including a pediatric intensive care unit (PICU); comprehensive women’s services; a neuroscience center for spine and stroke care; emergency services – and the region’s only Level II trauma center and heliport.

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Georgia Urology physician, Dr. Andrew Kirsch, selected as speaker for 2017 American Urological Association Annual Meeting

Wednesday, May 17th, 2017

On May 14th, Georgia Urology’s Dr. Andrew Kirsch will be participating in the 2017 American Urological Association (AUA) Annual Meeting in Boston as a speaker for the Next Frontier Plenary Session. The conference expects to see over 10,000 urologists in attendance. Dr. Kirsch will be a part of the Point-Counterpoint Debate that focuses on the controversial use of antibiotics for vesicoureteral reflux in children. He will be arguing opposition by offering a more selective approach against the regular use of antibiotics.

The 2017 AUA Annual Meeting is the next chapter of more than a century worth of meetings. Each event showcases groundbreaking research, new guidelines, and the latest advances in urologic medicine to invited urology professionals from across the globe.

“I am thrilled to be able to participate in the 2017 AUA Annual Meeting,” said Dr. Kirsch. “Active participation and leadership in association events like this is crucial to staying abreast the latest developments and trends in urology.”

Dr. Kirsch’s education and experience reflects his ability to confidently speak about such complex issues. He earned his medical degree from SUNY Health Science Center in New York, and he completed a residency in both general surgery and urology at the Columbia University College of Physicians and Surgeons in New York. He fulfilled his fellowship in pediatric urology at the Children’s Hospital of Philadelphia at the University of Pennsylvania School of Medicine. Aside from speaking at the 2017 AUA meeting, Dr. Kirsch has also lectured throughout North America, South America, and Europe. He is an editor and a reviewer for numerous journals, including The Journal of Urology and The Journal of Pediatric Urology.

Dr. Kirsch created a surgical device and endoscopic technique to correct urinary reflux in children that later became the standard of care for children worldwide. Dr. Kirsch has received multiple awards and honors, including two NIH Research Fellowship Awards and The Best Doctors in America List. Currently, Dr. Kirsch is a partner at Georgia Urology as well as a Clinical Professor and Chief of Pediatric Urology at Emory University School of Medicine. He is also on staff at Children’s Healthcare of Atlanta where he serves on the Clinical Operations Committee, Clinical Research Oversight Committee, Operative Services Peer Review Subcommittee, and the Director of the Pediatric Robotic Surgery Program.

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Atlanta Association of Dermatology and Dermatologic Surgery – May CME Dinner Meeting

Tuesday, May 9th, 2017

May 9, 2017, Location TBD. For more information, visit Atlanta Association of Dermatology and Dermatologic Surgery

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Atlanta Association of Dermatology and Dermatologic Surgery – May CME Dinner

Tuesday, May 9th, 2017

May 9

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