We Do Not Have the Means
A Hidden Gem
I enjoyed Phacomania: A New Phenomenon (Letters, March). I would offer the companion mania phacoenvy.
Phacoenvy is a syndrome that afflicts older eye surgeons. Many of these victims were trained when the experience of cataract surgery was as much a catastrophe as a blessing for the patient. They were introduced to cataract surgery during the times of intracapsular or manual extracapsular surgery. Surgical techniques were plagued with vitreous loss, vitreous wick syndromes, aphakia, prolonged and slow-healing postop courses, retinal detachment and induced astigmatism.
They came to consider cataract surgery a last-ditch intervention for patients nearly ripe for functional blindness. A case that would be considered to be a modern disaster (e.g., vitreous loss, aphakia) was then the best standard of care.
As with shingles, phacoenvy manifests with symptoms decades later. Phacoenvyists say that any surgeon who does more cases than they do is performing too many cases. Any surgeon who has quicker OR times cares for nothing but speed. As reimbursement for all medical care and surgery is being slowly ratcheted down, the young surgeons are killing the goose that laid the golden egg.
The cure for phacoenvy is nothing more than thoughtful introspection. The victim needs to realize and accept that the standards of care have changed almost uniformly for the better. Blindness is no longer a prerequisite for cataract surgery. In fact, there are many eye surgeons who practice with the best and most ethical standards, put their patients needs first, and perform quick and efficient surgery with excellent outcomes. Excellence should not be considered a marker for a lack of ethics.
We haven't killed any golden egg-laying geese. In fact, we are delivering the golden egg to our thankful patients every day.
Mark A. Johnson, MD, FACS
We Do Not Have the Means
In New Tonometry: The Search for True IOP (Clinical Update, May), it was refreshing to hear Joel S. Schuman, MD, and Brian A. Francis, MD, comment that judgment should be reserved regarding the accuracy of the Pascal dynamic contour tonometer (DCT) and the Reichert Ocular Response Analyzer (ORA) technology until further study.
With the DCT device, the manometric studies were done with corneas that were de-epithialized and dehydrated. Corneas altered in this fashion do not represent a normal biomechanical model. So it would not be scientifically valid to conclude that the DCT is not affected by corneal biomechanics by using such studies. It is also difficult to make conclusions based on LASIK studies because of normal diurnal IOP fluctuation.
With the ORA device we do not know what the relationship is between hysteresis and corneal biomechanics. Without the science, it is not valid to say that this device is not affected by corneal biomechanics.
What this points to is that we do not have a means of accurately measuring the biomechanical properties of the eye, the same issue that Jonas S. Freidenwald, MD, struggled with some 60 years ago.
Frank Y. Falck Jr., MD, PhD, MS
A Hidden Gem
It's been my privilege and pleasure to have served as president and chairman of the board of directors of the Academy's Foundation. During the years of my membership, I have watched the growth of a hidden gem: the Foundation's Museum of Vision.
The museum has the big job of preserving the history of the Academy and teaching people of all ages about the importance of eye care. It has a collection of more than 10,000 items including artifacts, rare books and the Academy's historical items; it distributes educational materials to schools; and it sends its vision-related exhibits all over the United States.
I established an endowment to help the museum accomplish this important work. I would like to encourage all Academy members to support the museum in order to preserve our ophthalmic heritage and translate it into an educational resource for use by members, medical historians, researchers and the public. It is a rewarding experience.
Stanley M. Truhlsen, MD
Ed: For more information on the Museum of Vision, visit www.faao.org.
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