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Let’s Change the Emphasis
In “Danger of Oversimplification” (Letters, March), Dr. Christopher N. Ta urges surgeons to avoid inadvertently minimizing the perceived value of their surgery by emphasizing its brevity. I strongly agree—cataract surgery provides ample precedent.
During the 1980s, legislators frequently cited the claims of cataract surgeons to be able to perform their procedures in only a few minutes when justifying the reduction of cataract fees to one-third or even one-quarter of their previous level.
Patrick M. Dennis, MD
Regarding Epithelial Downgrowth
The article “A Post-DSAEK Danger: Epithelial Downgrowth” (Clinical Update, January) stated that when downgrowth involves an isolated membrane in only one area of the eye, several treatment options are available.
It did not mention curative block excision of epithelial downgrowth, which is possible if less than five hours of the circumference of the chamber angle are involved. The adjacent tissues of cornea, iris and ciliary body act as a scaffold and need to be excised, too. The defect in the globe is then closed by an eccentric corneoscleral tectonic graft. In 59 consecutive European patients diagnosed early with histologically proven epithelial ingrowth of various etiology, no recurrence was observed.1,2 In our experience, all other options are unsatisfactory.
Gottfried O. Naumann, MD
1 Naumann, G. and V. Rummelt. Arch Ophthalmol
2 Naumann, G. Applied Pathology for Ophthalmic Microsurgeons
(New York: Springer, 2008), 204–216.
Professionalism and Patient Care
We have all heard speakers at our ophthalmology meetings lamenting patients’ increasingly high expectations. This is especially true for LASIK and cataract surgery patients. When outcomes are not perfect, these patients can be vocal about their problems, even taking their complaints to the FDA.
The irony is that we are the ones primarily responsible for fueling these high expectations. Many surgeons have glitzy advertisements that promise wonderful vision and freedom from visual encumbrances. These ads often feature claims about the superior qualifications and experience of the advertising surgeon. The greed that fuels these advertisements disappoints the public as well as fellow physicians. Many of the problems that face us today both in our clinics and in the halls of government have been worsened by our own self-interested behavior.
We should choose to move again toward true professionalism with an attitude of genuine care for the patient. We should temper our approach to the business of ophthalmology with a dose of humility. We should view our fellow ophthalmologists as colleagues and not competitors. The Academy’s Code of Ethics should not be ignored to boost personal income or generate untoward relationships with referral sources.
If we improve our behavior as ophthalmologists, we will find ourselves less often on the wrong side of the patient’s ire and the FDA’s investigations. Further, our pleas in Congress for fair Medicare funding will more likely find a listening ear if we don’t advertise our greed on billboards. Most important, we will remember that a bloated bottom line can never produce the satisfaction that comes from providing excellent patient care.
Thomas D. Myers, MD
A Must for Older Patients
Thank you for “Ocular Shingles Raises Stroke Risk” (News in Review, January). All ophthalmologists should recommend to their patients over 50 that they have the Zostavax shingles vaccine. Although most patients will have to pay for it out of pocket (about $160), it is obviously well worth it.
Marietta Nelson, MD
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