Caring For Your Eyes
Services
"As with any relationship, you have to feel trust towards your physician. You have to feel that your physician is personally interested in you" says Dr. David Feil. He adds: "You want to have someone who is personally connected to you and is working hard to address your concerns.”
The Visalia Eye Center provides the following services:
Comprehensive Eye Care
Modern, No-Stitch/No-Shot Cataract and Lens Implant Surgery
Laser Vision Correction (LASIK, PRK)
Cornea Transplant and Other Corneal Surgery, including DSEK*
Glaucoma Surgery
Laser Retina Surgery
Optical Services (glasses, contact lenses and sunglasses)
Contact Lens Fitting, including fitting for challenging corneal problems
DSEK
For decades, full-thickness cornea transplantation has been the gold standard for managing corneal disease. Now an exciting new treatment option for endothelial diseases (conditions involving just the back surface of the cornea) has been developed that reduces many of the complications and frustrations with traditional full-thickness cornea transplants. Over the past nine years, techniques have been refined and developed into the latest technique known as DSEK (Descemets stripping endothelial keratoplasty).
With DSEK, the diseased endothelium and Descemets membrane are “stripped” from the patient’s cornea, and replaced with a thin posterior lenticule (disc) cut from the back surface of a donor cornea. Basically, the endothelium, Descemets membrane, and a thin portion of posterior stroma from the donor make up the lenticule.
Advantages of DSEK over traditional full-thickness transplants include: Faster recovery of vision (a few months, as opposed to a year or more), minimal change in post-operative refractive error (no “surprise” post-op refractions, high or irregular astigmatism, etc), minimal effect on the integral strength of the eye, no suture issues at the graft-host junction, and much higher patient satisfaction. Also, the visual reduction from corneal edema dosen’t need to be as severe when considering DSEK as compared to penetrating keratoplasty. Patients with 20/40 vision and significant guttata are very happy with their post-operative vision once guttata and corneal edema has resolved.
The risk of transplant rejection still exists and patients need regular and careful follow-up and management, but the advantages over a full thickness transplant are significant. The best candidates for this procedure are patients with endothelial cornea disease, who have already had their cataract removed. Patients are able to return to the referring doctor within months for regular follow up care.
As a fellowship trained cornea specialist, Stan Feil, M.D., is pleased to be able to offer this procedure to the appropriate patients, and is seeing result comparable
to those surgeons who pioneered the technique.
Understanding the difference between medical eye exams and vision eye exams
The field of eye care is unique in the sense that two different kinds of insurance coverage exist to provide for eye examinations. Although there is some overlap, they each provide distinctive services. It is important to determine which insurance is going to be used for each individual visit.
Vision eye exams
These exams are for the evaluation of the need for glasses or contacts. Being tested for glasses (a refraction) is included in these examinations. A number of screening tests are also done, and the eyes are evaluated for possible medical problems. Insurances that cover vision eye exams do not cover any additional tests that might be identified as necessary during the screening examination.
Medical eye exams
These exams are primarily for the evaluation and management of medical eye problems, such as cataract, glaucoma, macular degeneration, and diabetes. Most insurances that cover these services do not cover being checked for glasses (a refraction). They do, however, cover testing and procedures required in the management of any medical problems that might be identified.
The dilemma
Often patients would like to have both a vision exam as well as a medical exam at the same visit. They may not want to pay the fee for a refraction which is not covered by their medical insurance, because they have vision insurance coverage. However, they may have a medical condition that they would like evaluate as well. There are two ways to solve this dilemma.
1. Have either the vision exam or the medical exam on one day and come back another day for the other exam. This is often inconvenient to the patient so another option is now available.
2. Have both exams (Vision eye exam and medical eye exam) on the same day. While this may be more convenient, it often will involve co-pays for both vision and medical insurances. It may also require the patient to remain in the office for a longer period of time, since two different exams are being performed.
Our Ophthalmologists, David Feil, MD & Stan Feil, MD, are both eye physicians. They focus primarily on medical eye exams, and deal mainly with medical and surgical eye diseases. They are often assisted for the initial portion of the exam by their associates, Michael Baumann, OD, and Matthew Oblad, OD. Both doctors also see patients independently for vision eye exams, and screening medical exams.