About the Eye
MCOA Office Locations
We have five office locations to serve you. To schedule an appointment at one of our clinics please call:
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice describes the practices of our employees and staff as well as affiliated entities, entities associated with organized health care arrangements, or any other individuals or entities that will be following this notice. This notice applies to each of these individuals, entities, sites and locations. In addition, these individuals, entities, sites and locations may share medical information with each other for treatment, payment and health care operation purposes described in this notice.
INFORMATION COLLECTED ABOUT YOU
In the ordinary course of receiving treatment and health care services from us, you will be providing us with personal information such as:
Your name, address, and phone number.
In addition, we will gather certain medical information about you and will create a record of the care provided to you. Some information also may be provided to us by other individuals or organizations that are part of your “circle of care” – such as the referring physician, your other doctors, your health plan, and close friends or family members.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
We may use and disclose personal and identifiable health information about you for a variety of purposes. All of the types of uses and disclosures of information are described below, but not every use or disclosure in a category is listed.
Health information about you may also be disclosed when necessary to prevent a serious threat to your health and safety or the health and safety of others.
OTHER USES AND DISCLOSURES OF PERSONAL INFORMATION
We are required to obtain written authorization from you for any other uses and disclosures of medical information other than those described above. If you provide us with such permission, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose personal information about you for the reasons covered by your written authorization, except to the extent we have already relied on your original permission.
You have the right to ask for restrictions on the ways we use and disclose your health information for treatment, payment and health care operation purposes. You may request that we limit our disclosures to persons assisting your care or payment for your care. We will consider your request, but we are not required to accept it.
CHANGES TO THIS NOTICE
We reserve the right to make changes to this notice at any time. We reserve the right to make the revised notice effective for personal health information we have about you as well as any information we receive in the future. In the event there is a material change to this notice, the revised notice will be posted. In addition, you may request a copy of the revised notice at any time.
If you have any complaints concerning our privacy practices, you may contact the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W., Room 509F, HHH Building, Washington, D.C. 20201 (e-mail: ). You may also contact: Privacy Officer, Medical Center Ophthalmology Associates, 9157 Huebner Rd., San Antonio, TX 78240.
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Age-Related Macular Degeneration
Darren Bell, M.D.
Age-related macular degeneration (AMD) has been in the news a lot recently, primarily because of newly developed pharmacologic therapies. While certainly welcome news for patients, unless you or someone you know has been diagnosed with AMD, you may wonder why it has received so much attention.
What is Paragon CRT ® ?
Paragon CRT is a specially designed oxygen permeable therapeutic contact lens used in Corneal Refractive Therapy.
Specialized Diagnostic Services
Diagnostic services and laser treatment are provided for patients. The retina is the transparent tissue that lines the back inside wall of the eye. Early detection and treatment of retinal problems can often prevent further deterioration or loss of vision.
Eye Injury Prevention
More than one million people suffer from eye injuries each year in the United States. Ninety percent of these injuries could have been prevented if the individual had been wearing appropriate protective eyewear.
Approximately 20.5 million Americans age 40 and older have cataracts.
Cataracts are the clouding of the eye’s clear lens; like a window that is “fogged” with steam. When the lens becomes cloudy, light rays cannot pass through it easily and vision becomes blurry.
Children’s Eye Health & Safety
Vision problems affect one in twenty preschoolers and one in four school-aged children.
80 percent of the world’s blindness is avoidable.
World Blindness Awareness
Diabetic Eye Disease Awareness
Approximately 10.3 million Americans have diabetes. Over half of these individuals are at risk for vision loss and other health problems because they don’t know they have the disease.
Glaucoma is the second most common cause of blindness in the U.S.
Approximately 2.2 million Americans age forty and older have glaucoma and half are at risk of going blind because they do not know they have the disease. You could be one of them.
When Should Your Child Have an Eye Exam?
JEFFREY H. COHEN, M.D.
Great news for people with cataracts
Great news for people with cataracts: New lens implant technologies allow unprecedented flexibility of vision and freedom from glasses.
Sports Eye Health
From major league stadiums to small-town courts, America’s favorite pastimes make great memories for many. But for more than 40,000 athletes, those memories are ruined by eye injuries, the vast majority of which were preventable.
Facts on Firework Eye Safety
Fireworks are exciting, fun and spectacular, but decades of experience have taught us that they are dangerous and should be left to professional firework handlers.
Your eyewear should fit your lifestyle. At Medical Center Ophthalmology Associates you’ll get the eyewear you need for the way you live, work and play!
Contact Lens Department
Tired of Wearing Eyeglasses?
Did you know that the MCOA Contact Lens Department can assist you in seeing near and far with contact lenses and eliminate the need to wear eyeglasses? Rigid Gas Permeable (RGP) bifocal, soft bifocal contact lenses and all brands of disposable soft lenses are available and reasonably priced.
What is LASIK?
What are the risks with LASIK?
Can anyone have LASIK performed?
How long will I be off work?
Will I have to wear glasses or contact lenses after surgery?
If I don’t get full correction, can I be retreated?
Do I need to use eye drops after the procedure?
Are my eyes patched after surgery?
Will I feel any pain or discomfort during LASIK?
How long does the procedure take?
Do you treat both eyes on the same day or separately?
How long have MCOA surgeons been doing LASIK?
Has anyone ever gone blind?
What are the long term effects of LASIK?
Macular Degeneration Terms
Amsler Grid-Graph paper-like grid used in detecting central visual field distortions or defects.
Angiogenesis (Choroidal)- The growth of abnormal blood vessels.
Atrophic- Derived from atrophy. Refers to cells, Structures or organs that have wasted away and have lost their normal function.
Atrophy- Refers to cells, structures or organs that have wasted away and have lost their normal function.
Brunch’s membrane- Innermost layer of the choroid, lying directly under retinal pigment epithelium. When damaged by disease or aging is responsible for many bleeding disorders in the macular area.
Carotenoid- Any member of a group of red, orange or yellow pigmented lipids found in carrots, sweet potatoes, green leaves and some animal tissues.
Choroid- The layer of blood vessels and connective tissue between the sclera (white of the eye) and retina.
Drusen- Tiny, white, hyaline (clear, glassy like) deposits lying beneath the retinal pigment (RPE).
Endothelial- The lining of blood and lymph vessels.
Fibrovascular- Both fibrous and vascular.
Fluorescein Angiogram- Medical exam used for evaluating retinal, choroidal, and iris blood vessels; fluorescein dye is injected into an arm vein, then sequential photographs are taken of the eye as the dye circulates.
Indoyacine Green (ICG)- A newer dye, indocyanine green (ICG) used in an effective testing procedure for AMD called a fluorescein angiogram. ICG is a larger and more readily protein-bound molecule than fluorescein. Because of its light absorption properties, ICG dye permits better visualization.
Macula- Small, specialized central area of the retina, surrounding the fovea, which is responsible for acute central vision.
Metamorhopsia- Objects appear distorted in shape; usually caused by macular disturbances that disrupt the normal retinal position.
Neovascularization (Choroidal)- Abnormal formation of new blood vessels usually on or under the retina, usually seen in diabetic retinopathy, blockages of central retinal vision and macular degeneration.
Ophthalmoscopic Examination-Process of using a device for examination of the interior of the eye, especially the fundus.
Photocoagulation- Surgical procedure involving the application of intense light to burn or destroy selected intraocular structures such as abnormal blood vessels and tumors.
Photoreceptor- A nerve end- organ or receptor sensitive to light.
Retina- The innermost of the three tunics (coats) of the eyeball, surrounding the vitreous body and continuous posteriorly with the optic nerve.
Retinal Pigment Epithelium (RPE)- Pigment cell layer just outside the retina that nourishes retinal visual cells; is firmly attached to underlying choroid and overlying retinal visual cells- composed of one layer of cells that are densely packed with pigment granules.
Retinotomy- Removal of portion of the retina.
Thrombus- A solid mass formed by the condtituents of blood: a clot
Vitrectromy- Surgical procedure involving the removal of vitreous, blood and/or membranes from the eye; usually accomplished by entering through the pars plana with a needle-like rotary cutter that has fluid injection and suction capabilities.
Macular Degeneration Vision Loss
Vision Deterioration in Dry AMD
Vision loss in dry AMD is caused by atrophy or weakening of the retinal pigment epithelium (RPE) layer just outside the retina and the overlying photoreceptor cells. Vision loss with dry AMD is usually slow and gradual. A patient may begin to notice blank areas in their central vision. Over time, dry AMD can cause a large loss of detail vision; however, vision loss is generally not as severe compared to the wet form.
Development of Wet AMD
As previously discussed, dry AMD will often begin to convert to wet AMD, with the appearance of abnormal choroidal blood vessels - angiogenesis. The reason why angiogenesis occurs is unknown, however, it is believed that there is a link between angiogenesis and damage to Bruch’s membrane, which lies directly under the RPE, caused by the deposit of drusen. The drusen allows an angiogenic stimulant to promote the growth of underlying choroidal blood vessels into the subretinal space and retina. These tufts of blood vessels are fragile and have a propensity to leak and bleed, eventually forming scar tissue and resulting in irreversible vision loss.
Diagnosis of Macular Degeneration
Official diagnosis of AMD must be made by an ophthalmologist or optometrist. Early detection of AMD is important as treatments such as laser photocoagulation and Visudyne™ (a photodynamic therapy) may halt or slow progression of the disease only if detected at an early state. Unfortunately, it will usually not reverse existing retinal damage. Therefore, regular eye exams are crucial to detecting AMD in its early stages.
According to the American Academy of Ophthalmology (AAO), “asymptomatic individuals 40 to 64 years of age who have had a previously comprehensive examination, the recommended interval for interim evaluations is two to four years. For the age group of 65 or older, the AAO recommends an examination every one to two years, even in the absence of symptoms.” (AAO Policy Statement, September 15, 1990)
Methods of Detection
Decreased central visual acuity - the ability to see at various distances - is the classic symptom of age-related macular degeneration. The decreased visual acuity or image distortion is often termed metamorphopsia. Metamorphopsia can easily be detected with an Amsler Grid.
Since many patients with dry macular degeneration have no symptoms, an ophthalmoscopic examination is conducted. Ophthalmoscopic examination allows for detection of both early and late signs of macular degeneration.
Angiographic Diagnosis - The fluorescein angiogram is fundamental in diagnosis and treatment of choroidal neovascularization or the abnormal growth of blood vessels on or under the retina. It allows the retinal specialist to pinpoint the location and extent of neovascularization. It can also assist in guiding laser photocoagulation if indicated. However, only about 13% of angiograms show a treatable localized lesion (drusen) or classic choroidal neovascularization. The other 87% show diffused, poorly defined lesions that are not appropriate for laser photocoagulation or Visudyne therapy. These lesions are called occult choroidal neovascularization.
In this test, a special dye is injected intravenously and pictures are taken as the dye passes through the vessels in the retina. These photos identify leaking blood vessels or choroidal neovascularization. Improvements in this testing procedure have recently proven to be more effective at identifying poorly defined or occult choroidal neovascularization with a newer dye, indocyanine green (ICG) that permits better visualization.
The Amsler Grid is a chart that may be helpful in revealing signs of wet age-related macular degeneration (AMD); however, it is not a substitute for regularly scheduled eye exams/tests. The grid looks like a piece of paper with dark lines that form a square grid with one dot in the middle. To administer the test, hold the Amsler Grid at eye level at a comfortable reading distance. If you wear any type of reading lenses, wear them during the test. Cover one eye at a time, and focus on the center dot. If you notice any of the potential signs of AMD like wavy, broken or distorted lines or blurred or missing areas of vision, you should contact your eye care provider immediately. Remember that the Amsler Grid is not a substitute for regularly scheduled eye exams/tests, which should take place at least once every two years, especially after the age of 40.
To test yourself:
Print a copy of the Amsler Grid, and hang grid with the center dot at eye level on a bare wall in a well-lighted room. Wearing the glasses or contacts you normally wear for reading, stand 13 inches/33 cm from the wall. Cover one eye with your hand, then focus on the center dot with uncovered eye. You should see all four corners of the grid. Repeat with other eye. If you see wavy or fuzzy lines, you may be displaying symptoms of AMD. Click on the grid below for a printable version.
Please note that some people with AMD may not see distortions on the Amsler grid. Any noticeable change in your vision should be reported to your eye doctor immediately.
Types of Macular Degeneration
Age-Related Macular degeneration occurs as two distinct types, dry and wet. Most AMD starts with the dry form which may or may not develop into the wet form.
Dry AMD may also be called atrophic or non-neovascular macular degeneration. Dry AMD is the more common and milder form of AMD, accounting for 85% to 90% of all AMD. The key identifier for dry AMD are small, round, white-yellow lesions in the macula called drusen. Vision loss associated with dry AMD is far less dramatic than in the case of wet AMD. There is currently not a treatment available for dry AMD.
Wet AMD is less prevalent than the dry form representing 10% to 15% of AMD cases. The term wet denotes choroidal neovascularization (CNV), the development of abnormal blood vessels beneath the retinal pigment epithelium (RPE) layer of the retina. The potential for significant vision loss is much greater. Wet AMD is characterized by the development of abnormal choroidal angiogenesis which causes severe, and potentially rapid, visual deterioration. Laser treatment may be recommended if neovascularization exists.
Incidence and Risks
Incidence: In the US, it is estimated that between the ages of 43 to 86, approximately 1.2% of this population are affected by wet AMD, as opposed to 15.6% for dry AMD. (Source: Beaver Dam Eye Study). Based on this statistic, over 200,000 new cases of wet AMD, occur each year in North America.
Risks: Many studies have been done to identify risk factors for AMD.
Age-Related Macular Degeneration: Age-related macular degeneration (AMD) is a disease that affects your central vision. It is a common cause of vision loss among people over age of 60. Because only the center of your vision is usually affected, people rarely go blind from the disease. However, AMD can sometimes make it difficult to read, drive, or perform other daily activities that require fine, central vision.
Specialty Eye Surgery
Medical and surgical management is available for patients. This care includes the cornea or clear window of the eye, the conjunctiva or lining inside the eyelids, and the sclera or white covering of the eye.
A cataract is a cloudiness that develops in the normally clear lens of the eye. The lens, about the size of an aspirin, is the transparent fine focusing part of the eye located behind the pupil. It is comprised of a strong, transparent outer covering or capsule filled with a clear gel material. When the gel becomes cloudy, the incoming light rays are distorted or blocked before reaching the retina at the back of the eye. As the cataract develops, vision is increasingly reduced. Your family optometrist will usually discover developing cataracts in the course of routine eye exams. If you have cataracts that are causing visual difficulties, your doctor will usually recommend surgery, the only known cure for cataracts.
Laser Vision Correction
The eximer laser was FDA approved in 1995 and has since then treated millions of people to eliminate or reduce their dependence on glasses and contact lenses. Whether you suffer from nearsightedness, farsightedness, or astigmatism, we may be able to provide you with the potential to experience better vision than is possible with glasses or contact lenses.
NASA Approves Advanced LASIK For Use On Astronauts:
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Online Patient Surveys
Complete diagnostic, medical and surgical care is available for glaucoma patients. This specialty treats the condition of increased fluid pressure within the eye. If untreated, abnormally high eye pressure can damage the optic nerve leading to permanent loss of vision.
Family Eye Care
MCOA’s many physicians and staff are here for you and your family to assist with all your vision needs and emergencies.
Diabetic Eye Care
Diabetes affects over 14 million Americans. More than 8,000 Americans will become blind from diabetic retinopathy. Visual loss is a late symptom of diabetic retinopathy. There’s a lot you can do to take charge and prevent such problems. A recent study shows that keeping your blood glucose closer to normal can prevent or delay diabetic retinopathy.
Northwest Clinic (Main)
9157 Huebner Rd., San Antonio, Texas 78240
Stone Oak Clinic
109 Gallery Circle, Suite 139, San Antonio, Texas 78258
11900 Crownpoint Drive, Suite 140, San Antonio, Texas 78233
315 N. San Saba, Suite 970, San Antonio, Texas 78207
Del Rio Clinic
608 Bedell, Suite A, Del Rio,Tx 78440 • 830-775-7271
Steven J. Fisher, M.D.
Richard M. Evans, M.D.
Michael A. Singer, M.D.
Jason D. Burns, M.D.
Jeffrey H. Cohen, M.D., F.A.C.S.
Jorge A. De La Chapa, D.O.
Darren J. Bell, M.D.
Scott A. Thomas, M.D.
Ann-Marie Mora, O.D.
Michael A. Orozco, O.D.
Shayesteh M. Izaddoost, O.D.
Vision Correction is an excellent investment in an individual’s personal well being. Because of this, we believe financial considerations should not be an obstacle to benefiting from the lifetime of advantages that LASIK, or any other vision corrections, can provide. Being sensitive to the fact that different patients have different needs, we provide the following payment options:
24 Months Same As Cash!!
OTHER PAYMENT PLANS
Capital One Healthcare finance
Vision Fee Plan is a flexible monthly payment option offered through MCOA and specifically designed for refractive surgery with payments as low as $57 (one eye) or $74 (both eyes) per month.
You may apply quickly and securly online. Click the logo below to begin:
COMPANY FLEX PLANS
More Optical Illusions:
MCOA is dedicated to advancing the field of Ophthalmology through research, clinical studies and the development of new instruments and techniques. We are engaged in multiple clinical research trials of new therapies for various ophthalmological diseases. You will find information about some of these studies below.
News and Seminars
Currently, there are no seminars scheduled. We do offer free consultations for Laser Vision Correction. This consultation allows us to perform the correct testing and helps the doctor to determine the best option available for you and your lifestyle. Our doctors are present at each and every appointment, before, during and after surgery, to ensure that all of your questions and concerns have been answered.
To take your first step towards clearer vision, fill out the information below or call 210-697-2020.
Medical Center Ophthalmology Associates
Welcome to Medical Center Ophthalmology Associates, San Antonio's largest private group of eye care specialists.
From the very beginning of life-seeing premature infants in the NICU, to performing donor corneal transplants and all eye care needs in between-MCOA provides you and your family with caring physicians and staff using the latest technology to help diagnose and treat your condition.
Specializing In Your Eyes...