A Primary Care Obstacle
I read with interest the excellent article titled “Bleed and Clot Concerns in the Anticoagulated Patient” (Feature, February). Like most surgeons, I try not to disrupt a patient’s coagulation status so as to avoid a thrombotic event before they are re-anticoagulated in the postoperative period. The evolution of cataract surgery to clear corneal incisions and intracameral anesthetic has largely eliminated the need for patients to discontinue anticoagulants in routine phacoemulsification.
The surprising obstacle, however, is convincing our patients’ primary care doctors not to discontinue anticoagulants prior to cataract surgery. For this reason, when my partner and I converted to clear corneal incisions and topical/intracameral anesthesia some 12 years ago, we began sending letters to every primary care physician in our referral area, explaining that “. . . to avoid iatrogenic neurologic or cardiovascular events that can occur from stopping anticoagulation, for most cataract surgeries we ask that anticoagulants not be stopped prior to surgery.” This effort has helped to educate our primary care brethren about the technique we are using.
It might be helpful to consider correspondence to primary care colleagues in your area if this is your surgical technique.
Daniel C. Love, MD
The Complex Management of AMD
I was disappointed that the story “Community Eye M.D.s Tackle the Intravitreal Injection” (Feature, March) failed to adequately emphasize the complexities inherent in the contemporary management of neovascular AMD, a disease with a range of presentations and courses.
Management of this blinding disease is difficult, rapidly evolving and involves much more than simply following a “resident training protocol for intravitreal injections.” The judgments include de-termining which cases may actually benefit from therapy, exactly when to begin, end or restart therapy, whether and when to consider combination therapies, the frequency of therapy and the artful use of clinical examination, fluorescein angiography and optical coherence tomography to monitor the response to therapy.
As a fellowship-trained retina specialist with 18 years of full-time experience treating diseases of the retina, I find management of many of these cases to be highly complex and uncertain. How a non-retina-fellowship-trained ophthalmologist for whom retina disease may comprise only a small part of a larger medical practice can expect to provide optimal management is unclear to me.
David F. Williams, MD
Why Not to Hire an OD
I must disagree with the solution to the problems posed in the article “Boost Practice Efficiency, Part Three—When to Hire an OD” (Pract ice Perfect, April).
Ophthalmologists with full schedules who desire more time out of the office should only consider hiring another ophthalmologist. Only an ophthalmologist can provide service equal to that of another ophthalmologist and satisfy patients’ understandable demand for MD-level service. Scheduling a patient with an OD is like having the patient see a physician assistant or a nurse practitioner. And this misleads the patient into thinking that their services are interchangeable with those of an ophthalmologist.
If the ophthalmologist really wants to do more surgery with the current pitiful reimbursement, there is a supply of medical ophthalmologists both male and female available full- and part-time.
The professional relationship between an MD and an OD will be strained at best. The OD will feel used and disrespected, and the MD will feel like the OD is getting a favor. MDs and ODs work together best in large organizations where both groups are simply part of the provider panel.
As for the comment about the increasing number of female optometrists, this same phenomenon is occurring throughout medicine, including ophthalmology, as males gravitate toward more financially rewarding and less academically rigorous programs. Whether motherhood is actually a woman’s ultimate goal can be debated, but most younger physicians are looking for a balance between work, play, family and self that older physicians would never have even dared to dream of, much less require.
Rebecca J. Adams, MD
EyeRide for Sight
In early May, EyeCare America launched the EyeRide for Sight, a transcontinental bike ride to educate the public about both eye disease and EyeCare America’s free eye care programs, as well as raise funds to support the organization’s efforts to save sight.
The four-member EyeRide for Sight cycling team began their two and a half month journey at the Academy in San Francisco and have traveled approximately 3,000 miles across the United States, finishing in Washington, D.C. in July. The event allowed us to raise awareness about EyeCare America programming and has raised enough money for us to provide thousands more people across the country with free eye exams.
But, the need is still there and we know with your help we can provide vision-saving services for even more people. For every $25 donation, we can provide one patient with sight-saving eye care. I urge you to help us make a difference in the lives of those affected by eye disease. For more information, visit eyecareamerica.org.
B. Thomas Hutchinson, MD
Chairman of the Foundation of the American Academy of
Ophthalmology Advisory Board of Directors