• Lagophthalmos Treatment Option
• The Spectacle Samba . . .
• . . . and the Mortuary Mambo
• Are We Prepared?

Lagophthalmos Treatment Option 

One modality for the treatment of lagophthalmos not mentioned in “Lagophthalmos Evaluation and Treatment” (Ophthalmic Pearls, April) is a scleral implant placed between the conjunctiva and the orbicularis oculi. The implant is anchored into the inferior margin of the upper tarsus for upper lid lagophthalmos or to the superior margin of the lower tarsus for lower lid lagophthalmos.

Heskel M. Haddad, MD
New York

The Spectacle Samba . . . 

Once again you have brightened my day with “Greatest Unsolved Mysteries: Optical Division?” (Opinion, May).

I also take my glasses off for slit exams and maneuver the ocular with my brow, but I am –3.5 D, so I usually see well with my glasses off. However, in the dark I have picked up the wrong glasses (though it’s usually apparent that something is wrong right away, so I haven’t absconded with someone’s prescription).

Interestingly, at the age of 69, I have not as yet become presbyopic. I still see well with my distance prescription and don’t have a bifocal yet! I believe that is somewhat rare. My wife, Pat, sympathizes with you in that she couldn’t stand progressive lenses and loves her trifocals.

Thanks for your humor and keep up the good work.

Kenneth H. Musson, MD
Traverse City, Mich.

. . . and the Mortuary Mambo 

I smiled while reading “Greatest Unsolved Mysteries: Optical Division?” because you confirmed one of my personal rules: You’re never the only one.

I also learned to push the slit lamp around with my brow. However, I found that, after a while, there was an accumulation of skin oil on the oculars. Look, you do what you have to do.

And I too have switched my glasses with my patients, but invariably (so far at least) discovered the error immediately. One of my patients who watched such a switch was a mortician. He told me that a mortician colleague of his switched his glasses with those of one of his “clients” and didn’t discover the error until after the client was in the ground. Of course, he didn’t get his glasses back.

Benjamin H. Bloom, MD, FACS
Philadelphia

Are We Prepared? 

By 2030, the 65-and-over population is expected to reach 69.4 million, having doubled in just three decades.

Are we prepared for the deluge? Are we prepared for the increase in operating costs (more technicians, more square footage, more billers, more secretaries and more battles with insurers) that this will require? Are we as a specialty even aware that this looms in the future?

The answer is resoundingly no. However, the laws of supply and demand can provide a unique opportunity for ophthalmic surgeons. After all, the suppliers of surgical eye care will proportionally decrease as the patient pool steadily increases. We should use this to our advantage to ensure that reimbursements are higher and account for higher practice and malpractice costs. 

In 1980, the reimbursement for cataract surgery was $2,000. Using the consumer price index, the equivalent amount in 2008 is $4,894.39. No one thinks that this level of reimbursement is feasible, but I believe that the point is clear. How much longer can this specialty endure reductions in reimbursement? 

Now is the time for the ophthalmic community to start preparing for the future. This will be one of the rare opportunities to use the significant leverage we have to ensure a level playing field.

Dominick I. Golio, MD
Brooklyn, New York