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November/December 2006


Ophthalmology and the Political Scene

After attending my first Mid-Year Forum of our American Academy of Ophthalmology in Washington, D.C., I had a major change in my attitude toward politics. I suspect that like many ophthalmologists I thought I was too busy, and it was not something I needed to be engaged in.

Our Academy demonstrated to me that it is making great strides to further our best interests on the national and local political scene. I am persuaded that it has formed new and stronger working relationships with the AMA and the American College of Surgeons—larger voices for medicine with significant clout at national and local levels.

Members of the Senate and House of Representatives made it clear that they are responsive to messages from their constituents and to what is happening in the states they represent. This indicates that our interests are best served if we develop personal relationships with all our legislators and if we fund organizations that represent us. When I look at the big picture, I can find no excuse for not financially supporting my local Eye PAC and the Academy’s OphthPAC and Surgical Scope Fund.

It is embarrassing to me that only as I reach the age when many consider retiring from practice am I realizing the importance of supporting my state society and our Academy. Please very seriously consider joining me as a contributor to the safeguarding of our profession.

Maynard B. Wheeler, MD
Concord, N.H.


Pterygium Opinions

The following are in response to “Treating Pterygium: Innovation From Down Under” (Clinical Update, July/August).

Dr. Lawrence Hirst’s technique for pterygium surgery is definitely one that leads to great success. However, I believe others have been doing a similar technique for many years. Seven years ago, Dr. Scheffer Tseng enlightened me on the importance of removing Tenon’s from under the conjunctival edge of the dissection, after the pterygium has been removed, and before the graft is placed. Since incorporating this modification into my surgical technique, I have had results similar to those reported by Dr. Hirst.

This technique may not be known among most ophthalmologists simply because this surgery doesn’t have the glamour or reimbursement that refractive or cataract surgery has.

Stan H. Feil, MD
Visalia, Calif.

Dr. Hirst states that the size of transplanted tissue in traditional pterygium surgery is typically 4 or 5 mm x 3 to 4 mm. In his hands, an extensive resection with large graft technique (15 mm x 13 mm) eliminates recurrences, with excellent cosmesis. I am appreciative of Dr. Hirst’s contribution.

At the same time, I believe that other surgeons are obtaining similar outcomes with medium-sized grafts.1,2 Also, I have found excellent patient comfort and cosmesis with fibrin glue closure, as has Dr. Gabor Koranyi at St Erik’s Eye Hospital in Stockholm, who has shown better outcomes with fibrin glue than with absorbable sutures.3

Lawrence S. Stone, MD


1 Uy, H. S. et al. Ophthalmology 2005;112:667–671.
2 Marticorena, J. et al. Cornea 2006;25:34–36.
3 Koranyi, G. et al. Acta Ophthalmol Scand 2005;83:298–301.

The following is Dr. Hirst’s response to Drs. Feil and Stone.

I am pleased that others have found success with approaches similar to my “pterygium extended removal followed by extended conjunctival transplant.” I would encourage Dr. Feil to publish his results; the more peer-reviewed reports that highlight this method, the better. Perhaps, then, some of the more concerning methods of ptergyium removal, such as extensive use of mitomycin, amniotic membrane transplantation and others, may lose their attraction.

I also appreciate Dr. Stone’s observations on intermediate-sized grafts. I believe that the extensive Tenon’s removal is the crucial step in my surgery that virtually eliminates recurrences. However, the size of the graft is important in the final cosmetic result. The use of fibrin glue instead of sutures certainly brings with it the potential for less prolonged surgery and perhaps less postoperative pain.

Lawrence W. Hirst, MD
South Brisbane, Australia


Get Involved in Politics: Here's How

More than 10 years ago, a session was offered at the Academy’s Annual Meeting. The speakers at the session foresaw reduced reimbursements from Medicare, HMOs and private carriers, coupled with scope of practice expansion of optometry. The future they saw is reality now, as we all know.

Is anyone surprised that that meeting in the early 1990s was poorly attended? Unfortunately, our colleagues in ophthalmology and in all of medicine have been slow to respond to these types of challenges and are woefully underrepresented in the political arena. Our collective silence in the past has allowed the public to overlook us as the best our profession offers for medical and surgical eye care.

This year, in Las Vegas, there will be a timely and important session called “Crisis! How to Manage the Political Crisis in Our Profession,” the planning of which began 18 months ago in Washington, D.C., in response to a Council Advisory Recommendation to the Academy. The Academy’s board wanted at least a year to be devoted to planning this vital presentation, and it formed a committee composed of Academy members and Washington, D.C., Academy staff knowledgeable in state and federal legislation.

Now is the time for our members at the grassroots level to exert their legislative influence. Our voices are a potentially powerful, but barely tapped, resource.

Legislators do respond to constituents and campaign contributions. Reimbursement and scope of practice are based not only on state regulations, but also on federal regulations (e.g., Medicare and Veterans). Both state and national legislation must therefore be addressed.

Please attend “Crisis! How to Manage the Political Crisis in Our Profession,” Monday, Nov. 13, from 12:45 to 2:45 p.m., Venetian, Marcello 4405. The time has come to become proactive.

David S. Pao, MD
Southampton, Pa


Satellite Offices

Over the years, I have been repeatedly asked to open satellite offices. What was the advantage? Namely it was to get more patients from the area of the satellite location. Each time, I made a decision against this concept.

The reality of increasing income vs. a lifestyle change was most influential in my decision. In order to open another office, I would either have to take time from the primary office or add time when I might normally be free. I could never be convinced that this was advantageous. Life is busy enough.

Having multiple offices with additional ophthalmologists would be profitable, but at what cost?

Frank J. Weinstock, MD, FACS
Canton, Ohio


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