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October 2008


Childhood Cataract Revisited 

Regarding “The Origins and Treatment of Childhood Cataract” (Clinical Update, May), there are other cataracts whose origin and treatment should be discussed, such as those associated with galactosemia, hypoparathyroidism, recovery from rickets and convulsions after birth or in early infancy. These conditions are treatable and preventable. Aminoaciduria and Lowe syndrome variants are also usually associated with cataract and, occasionally, with congenital or juvenile glaucoma. Most of these children also have renal rickets.

In my practice, IOLs are not the best correction to prevent amblyopia because of the imperfection of their measurement. It is easy to fit contact lenses and to train parents to insert them in the baby’s eye. In bilateral cataract, glasses are well accepted by infants.                                               

Heskel M. Haddad, MD
New York


MD/OD Practices Do Work 

I read the letter "Why Not to Hire an OD" in the June EyeNet and was concerned and confused by several of the author’s comments.

The issue of MD/OD practices remains an area of great conflict in both professions, and I have a concern when absolutes are used to describe and discuss the matter. There is no inherent, universal or qualitative difference between MDs and ODs and their exams. The difference is entirely based on training and skills and attitudes of the examining doctor. There are good and bad MDs as well as good and bad ODs.

Our combined goal should be to make both groups better. Working together in the same office is an excellent way to accomplish this ideal. We have nine MDs and two ODs in our office, and this is exactly the result we have experienced.

The author also says, “The OD will feel used and disrespected, and the MD will feel like the OD is getting a favor,” if the MD were to hire the OD. This might be her experience but it is not ours, and to make this exaggerated conclusion is specious. I am also confused about why she feels ODs in an office are bad, yet okay if part of a large organization.

At the end of her letter, she discusses the younger physicians’ desire for a balance of work, play, family and self. She notes that this is a balance “that older physicians would never have even dared to dream of, much less require.” I will give her the benefit of the doubt that this is hyperbole to make a point. As a 61-year-old MD, I have indeed not only dreamt such things but actually lived them.                                          

Douglas J. Carlson, MD
Stillwater, Minn.


Another Ophthalmic Theft 

Thank you, thank you, thank you! The May Opinion ("Greatest Unsolved Mysteries: Optical Division") was, as always, a pleasure to read. I have made this particular article required reading for my technicians at the office because they have accused me of being a kleptomaniac when it comes to my patients’ glasses.

In all the years of my accidental pilfering, I have only walked out of the room with a patient’s glasses on my nose on one occasion. Luckily, the prescription was not close to my refractive error, so I immediately noticed that something was awry. In spite of my noticing that I had the wrong prescription in front of my eyes, my technicians will never let me forget about this particular episode.

I can’t believe you had the courage to put this in print, but I am very grateful that you did so.                                          

Michael H. Cunningham, MD
Spokane, Wash.



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