• Advertising and Medicine Don’t Mix
• Don’t Undermine Ophthalmology
• Imaging of Choice
• Optometry Won’t Stop, Neither Can We

Advertising and Medicine Don’t Mix


I read with great interest your Opinion article, “Presbyopic IOLs: Another Feeding Frenzy?” (September) and agree wholeheartedly with your thoughts.

Although I partake as much as possible in the technological advances to help produce good outcomes for my patients, I strongly believe that advertising and promotion in medicine is unethical. Deregulation by the FCC in the 1970s was a mistake, and I feel that the general public is too easily misled regarding the abilities of our profession.

I know that advertising in medicine will continue despite my opinion, but it’s nice to hear someone else with a voice of reason.

Julian P. Alexander, MD
Red Bluff, Calif. 

Don’t Undermine Ophthalmology

Optometrists are professionals, and they deserve more respect than we usually give them. I don’t believe we are fighting the mainstream optometrist, who is not interested in doing surgery; we are fighting an extremist sect in the optometry world, which doesn’t represent the main body of optometrists. 

I was dining with a group of optometrists recently. One of them stated that a significant issue adding to our surgery problem is the ophthalmologist who delegates YAG laser and other minor procedures to their employed optometrists. I personally don’t know of any ophthalmologists who delegate surgery to optometrists, but I have no difficulty believing that the practice exists. After all, there was an ophthalmologist who, in the extracapsular surgery days, used to delegate wound closure to surgical technicians in his effort to do more and more cases. A YAG laser capsulotomy is far easier than the microsurgical closure of an 11-millimeter limbal wound.

It is a serious problem for the Academy when we push our Surgery by Surgeons agenda but make no effort to police our member surgeons who may be undermining our efforts by promoting the exact behavior we are fighting against. Even worse, someday we may be confronted in a state legislature with optometrists claiming that they were actually taught to do surgery by members of our organization.

Through the course of my career, I can think of countless instances in which we have been undermined by members of our profession pushing their personal interest over what was in the best interest of ophthalmology. This may be yet another example. 

George A. Stern, MD
Missoula, Mont.

Imaging of Choice

In “The Case of Colored Lights and Fleeting Vision” (Morning Rounds, October), I felt that there was some information missing. 

A CT scan is not the imaging technology of choice for papilledema. I think the article should have stressed that MRI and MRV (magnetic resonance venography) are the best studies to rule out cerebral venous thrombosis, as well as mass lesions. 

Starting acetazolamide (Diamox) in a patient with venous thrombosis can cause relative dehydration and worsen the thrombosis, and there have been reports of this exact scenario. Much less importantly, optic nerve head drusen can cause these symptoms.

I suspect that if I am given this case during my oral boards, and I do not specifically rule out venous thrombosis, I will be paying another $1,500 the following year.

Derrick W. Shindler, MD
Easton, Md.

Optometry Won’t Stop, Neither Can We

Last year, I worked with some of our profession’s most outstanding members in the fight against surgical scope expansion by optometrists in Oklahoma. We not only held our ground, but also made incredible progress. As I write this in December 2005, we are preparing for the next round when the Oklahoma legislature convenes in January. We are optimistic about our chances for success, knowing that we have the resources of the Surgical Scope Fund behind us.

Optometry will not stop its campaign to expand surgical scope of practice across the country. We must, therefore, be prepared to continue this fight wherever it arises. We must have a strong Surgical Scope Fund—immediately and at all times in the future.

I ask all of my colleagues in ophthalmology to give generously to the Surgical Scope Fund in 2006.

Cynthia Ann Bradford, MD
Oklahoma City

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Ed: For more information, visit www.aao.org/ssf.

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