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October 2006


• The ER Call Dilemma
• Alpha-Blocker Usage by Cataract Patients
• Comment on Comanagement
• Another Happy Reader

The ER Call Dilemma

In the November/December 2001 EyeNet, I wrote an Opinion piece on the subject of the ER call in which I argued that Eye M.D.s have a moral responsibility to care for the emergency needs of those communities that provide their substantial incomes. At that time, a trend was developing that found a decreasing percentage of Eye M.D.s opting to participate in hospital coverage.

Nearly five years have passed and, not surprisingly, the trend has continued. Eye M.D.s in ever-greater numbers are opting out of hospital call arrangements. Before you jump on the bandwagon, though, think about what you might be giving up. Along with loss of sleep, you just might be giving up your livelihood.

Right now, organized optometry is looking for any way possible to crack open the door to ophthalmic surgery. With this ER call opening, they could gain all the experience they want in taking care of major eye trauma. “Too tough for them,” you say? Perhaps that is our point of view, but is it theirs? So the next time the question of opting out of an ER call comes up, perhaps you shouldn’t say “No!” Say instead, “I think I’ll hang on to my profession a while longer.”

William R. Penland, MD
Evansville, Ind.


Alpha-Blocker Usage by Cataract Patients

In the cataract community, there has been some concern about the numbers of patients with advancing cataracts who are being prescribed Flomax (tamsulosin) by their urologists. The FDA would like to share the following with EyeNet readers.

The floppy iris effect, also known as intraoperative floppy iris syndrome (IFIS), appears to occur with any of the alpha1 blockers, not just Flomax. We believe this is a class effect, and since the drugs in this class are effective for the treatment of the signs and symptoms of benign prostatic hyperplasia, they will be used widely in a population that is likely to have cataracts.

Ophthalmologists should be prepared for a potentially more complicated cataract extraction case with respect to maintaining pupillary dilation if the patient has been on any of the alpha1 blockers at any time in the past. In several patients, the effect on pupillary dilatation was reported to occur weeks to months after stopping alpha1 blockers, and it is not yet known whether the effect is permanent.

IFIS does not occur with every patient who uses Flomax or any other alpha1 blocker, only to a small percentage of them, but there is no way to predict which eyes will be affected.

Wiley A. Chambers, MD,
Deputy Division Director for Anti-Infective and Ophthalmology Products, FDA


Comment on Comanagement

I enjoyed Dr. John M. Haley’s “Comanagement: What Is Optometry’s Goal?” (Guest Opinion, April). In following the history of comanagement, it seems to me that Medicare originally allowed it because of rural physician complaints. In the rural setting, comanagement has at least a basis for justification (i.e., patients live in a community without ophthalmology services). However, it occurs much more frequently in nonrural settings.

Medicare recently made a ruling that rural ophthalmologists could be reimbursed 10 percent more if they lived within Medicare’s rural mapped communities. Why not lobby, persuade, insist or do whatever it takes to restrict comanagement to rural areas only? Medicare has already done all the work necessary to be able to identify and track rural physicians. Comanagement was originally allowed by Medicare to ensure appropriate care in the rural settings before they had the means to track whether or not a setting was rural. It’s just a matter of reminding Medicare.

Isaac J. Hearne, MD
Reno, Nev.


Another Happy Reader

I just finished a recent EyeNet, and I wanted to let you know how much I have enjoyed Dr. Richard Mills’ last few editorials. Well-written, thought- provoking and laced with humor. Keep up the good work.

Tamara R. Fountain, MD
Northbrook, Ill.



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