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A Better Alternative 

I think most ophthalmologists agree that 9-0 Prolene is preferable to 10-0 because of the problem of long-term suture breakage in scleral IOL fixation cases. I am communicating this to those who, like me, want to switch from 10-0 to 9-0 Prolene for scleral suture IOL fixation but are unable to find a product that is readily available and is not cost prohibitive.

Early last year, I researched the various manufacturers producing 9-0 Prolene and only found two: Ethicon and Sharpoint. Unfortunately, I found that Sharpoint had discontinued the item due to lack of demand.

I appealed to Sharpoint to resume production of 9-0 Prolene on a SL15 needle (one-eighth circle side cutting, similar to Ethicon CIF-4). To their credit, they agreed to resume production, and it became available for delivery in July 2006. The price is very attractive (about one-third the price of Ethicon’s 9-0 Prolene). I have since switched from 10-0 to 9-0 exclusively for my scleral suture-fixated IOL cases and have been very satisfied with the Sharpoint suture performance. However, since its relaunch, demand for the 9-0 Sharpoint suture has been soft. I suspect this is due to lack of awareness. We need to generate interest in the ophthalmic community for this important niche product to ensure its continued availability.

If you are interested in purchasing polypropylene sutures from Sharpoint, the company’s phone number is 800-523-3332 and their Web site is www.sharpoint.com.

Richard A. Erdey, MD
Columbus, Ohio

Note: Dr. Erdey reports no financial interest in the above-mentioned products.


An Ex-Surgeon’s Discontent 

I can imagine nothing worse than spending a medical career performing surgery that is neither professionally enjoyed nor competently rendered (Guest Opinion, May). Perhaps the only thing worse would be for talented surgeons not to be able to make a living plying their skills. The devaluation and deprecation of surgery is fast becoming a fait accompli.

Before becoming an ophthalmic surgeon, I spent two years as a general practitioner. Then I had a busy surgical practice for 30 years; for the last six years I have been a medical ophthalmologist. I have the unique perspective of both surgeon and nonsurgeon. I am amazed and disconcerted at the contention of some physicians and almost all third party payers that surgeons are “proceduralists” and monetarily overcompensated. Physically and emotionally, surgery is exponentially more difficult and intellectually it is every bit as challenging as nonsurgical medicine.

In spite of this, surgical reimbursement is experiencing draconian reductions. In 1986, I was paid $2,160 for a cataract–intraocular implant surgery; today our practice receives $635.03 for an operation that is more complex, uses equipment that is more expensive, done on patients with higher expectations and in an environment that is more litigious. Further reductions are inevitable. By comparison, dentists in Kansas City get $1,000 for crowning a tooth.

When surgeons lose money performing surgery vs. the revenue they might have generated spending all their time in medical ophthalmology, then the future of ophthalmic surgery is very much in doubt.

These bleak trends can only be reversed by surgeons making generous donations of their time and money to the national and state political processes. Our indifference and aloofness are our worst enemies. Begin now with a four-figure donation to the Academy’s OphthPAC.

John C. Hagan III, MD, FACS
Kansas City, Mo.


Your Profession Needs You 

I have been attending Congressional Advocacy Day and the Mid-Year Forum every year for the last four years, since my second year in ophthalmology residency. Each year has been a rewarding and worthwhile experience. Aside from the collegiality and networking with ophthalmologists, I enjoy meeting with members of Congress to advocate for our profession and educate decision-makers about issues that affect patient care and the way we practice medicine. The Mid-Year Forum, which coincides with Advocacy Day, provides an in-depth look at issues of importance to ophthalmology now and into the future.

Repeal of the sustainable growth rate (SGR) payment formula, our top legislative priority, faces even greater challenges this year because of the growing price tag to fix the problem and the increasing federal deficit. Because of the SGR, ophthalmology faces an anticipated 10 percent reduction in Medicare payments scheduled for January 2008, our profession’s most difficult challenge in years. This devastating reduction must be stopped, which is why it was heartening to see a record-breaking 314 Academy members at this April’s Congressional Advocacy Day.

The SGR was also a key topic during the Mid-Year Forum’s kick-off session on financing of physician services. Other important topics included: ambulatory surgery, electronic medical records, helping the public and media understand the role and qualifications of ophthalmologists, preparing young ophthalmologists for the profession, and more.

If you were unable to attend Advocacy Day, then there are several ways to voice your support and help protect patient care and our profession.

First, every ophthalmologist should contribute to OphthPAC every year. Financial support ensures that there are staff members to fight the fights we care about and to win political battles important to our profession. You can contribute online and find more information about OphthPAC by visiting www.aao.org/advocacy/ophthpac. Second, you can write letters to members of Congress using the following tool: www.capwiz.com/aao/home. Third, recruit your colleagues to become involved as advocates on both the national level and the state level with your state ophthalmological society. Fourth, mark your calendar for next year’s Congressional Advocacy Day, April 9 and 10, and/ or the Mid-Year Forum from April 9 to 12.

Being involved in Congressional Advocacy Day is fun and allows us to shape our future and preserve the best care for our patients. Remember, if you ask for nothing, you shall receive nothing. Therefore, please join me as an advocate and fight for our patients, profession and future!

Andrew P. Doan, MD, PhD
Member, Academy’s Congressional Advocacy Committee and Young Ophthalmologist Committee
San Diego

Correction

The diabetic retinopathy feature that ran in the March issue of EyeNet inadvertently confused the titles of Abdhish R. Bhavsar, MD. “Director of clinical research” should refer to Dr. Bhavsar’s work in private practice at the Retina Center in Minneapolis, and is independent of his position at the University of Minnesota, where he is adjunct assistant professor of ophthalmology. Dr. Bhavsar is also chairman of the Diabetes Eye Exam Initiative in Minnesota. EyeNet regrets the error.
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