American Academy of Ophthalmology Web Site:
Original URL:

May 2005


Investing in Medicine

When Is a Picture Not a Picture?

Another Possible Etiology

Investing in Medicine

I read with great interest the EyeNet Opinion by Richard P. Mills, MD, MPH, about advocacy (“The Surgical Scope Fund: Have You Stepped Up to the Plate?”, February).

Even as a young ophthalmologist with significant student loan debt, I contribute routinely to my state’s ophthalmology political action committee, OphthPAC and the Academy’s Surgical Scope Fund. Such contributions are an investment in high-quality medicine, providing the very best for our patients and protecting our profession.

The Surgical Scope Fund is one of the most efficient ways in which ophthalmologists around the country can help colleagues in key battleground states. Central to the Surgical Scope Fund is advocacy on behalf of patients. Fund resources are used to educate legislators about the benefits of surgery by skilled surgeons and the dangers of allowing nonphysicians surgical privileges without proper training.

The Surgical Scope Fund was put to excellent use in the recent battle in my own state. The New Jersey Academy of Ophthalmology fought to protect patients from nonphysicians performing surgery. With the help of this fund, the American Academy of Ophthalmology was able to respond quickly to our urgent need for public relations, consultancy and advocacy resources.

Indeed, the fund can claim an incredible return on investment, as it has been used in a number of other state battles to advocate effectively for patient safety.

Scope of practice battles are primarily state issues—the recent fight over surgical privileges in the VA stemmed from our defeat in earlier patient protection battles in Oklahoma—and the profession needs such pooled funds to respond to legislative demands.

Ravi D. Goel, MD
Cherry Hill, N.J.

Ed: For more information, visit

When Is a Picture Not a Picture?

Donald J. Mirate, MD, FACS, MBA, wonders whether the Optos scanning laser technique can be billed as fundus photography in “Is It a Picture?” (Letters, April).

In an earlier article that I cowrote with Sue Vicchrilli, COT, OCS, we stated “there is no support for the suggestion that 92250 Fundus photography with interpretation and report can be used for ‘pictures’ obtained by scanning lasers” (Savvy Coder, November/December).

We based this statement on a precedent that was set by HCFA (now Centers for Medicare and Medicaid Services) years ago when the GDx and HRT devices first became available. We thought that it would be reasonable to bill for use of those devices using the fundus photography code, but the HCFA strongly disagreed. According to the feds, a scan is not a photograph, and they required that we get a new code, resulting in code 92135.

John M. Haley, MD
Academy Health Policy Committee
Garland, Texas

Another Possible Etiology

In “Acquired Ptosis: Evaluation and Management” (Ophthalmic Pearls, February), the authors neglected to discuss one possible etiology for ptosis that may actually have been significant for the patient presented.

In the before and after photos, the patient appears to be wearing rigid gas permeable contact lenses. Given her appearance and age, the RGP wearing history of this patient is probably two to three decades.

Contact lens wearers may develop ptosis from levator aponeurosis disinsertion, secondary to lid manipulation during contact lens insertion or ptosis associated with palpebral conjunctival inflammation due to papillary conjunctivitis. Contact lens discontinuation for a period of time prior to surgical correction of the ptosis may be of value in individual patients.

Finally, if the patient returns to contact lens wear, mast cell stabilization could be considered to possibly ameliorate or avoid post–ptosis-repair ocular surface inflammation, as well as rapid recurrence of ptosis.

Sam Omar, MD
Longwood, Fla.



In “Acquired Ptosis: Evaluation and Management” (Ophthalmic Pearls, February) on page 32 under “Anatomic Considerations,” the tarsal plate was incorrectly identified as a cartilaginous structure. The tarsal plate is made of dense connective tissue. EyeNet regrets the error.


We Want to Hear From You

Here's How: You can send your letters to us at EyeNet Magazine, e-mail