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EyeNet and Technologists

Let me say that, as a COMT, OSA, I really enjoy reading your entire magazine. I know the articles are geared for ophthalmologists, but reading all of the articles affords many technologists an opportunity to stay abreast of a lot of studies, etc. Thanks and kudos to the fine articles and photos.

Michelle Willis, COMT, OSA, COP 
Tallahassee, Fla.Obstetric Ophthalmology 

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Obstetric Ophthalmology

I thoroughly enjoyed the paper entitled “Ocular Changes During Pregnancy” in Ophthalmic Pearls (May)—a great read. I was surprised, however, to see no mention of a historical paper on this very topic from 1988 that in the opinion of many, myself included, is one of the classic review articles written in the field of ophthalmology. I am, of course, referring to the following:

Sunness JS. The Pregnant Woman’s Eye. Surv Ophthalmol. 1988;32(4):219-238.

When I was a resident, it was expected that everyone was familiar with this paper. Nearly 25 years after its publication, the passage of time seems to have taken this outstanding paper out of the “must-read” spotlight, and this is unfortunate. Because your recent EyeNet article was published in the Pearls section, in keeping with the spirit of passing on medical pearls to a newer generation of doctors, I would encourage all who have not already done so to read Dr. Sunness’ paper. It will certainly find its way to the pile of great papers that you secretly keep stashed on a corner shelf in your office.

Steven A. Nissman, MD 
Philadelphia 

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The Market Will Respond

I write in response to “Allocation of Medical Care: Is Rational Better Than Rationed?” (Opinion, April).

First of all, let me remind you that Academy members have been laboring under price controls under Medicare for many years. These members are certainly providing rational care today.

There is an implied threat in the Opinion’s conclusion that if, as a group of physicians, we do not allocate care better, the government will ration it. If this means that the government will not pay for certain services, I agree: That may well be coming our way. If the implied threat is that we will provide these services at a financial detriment to ourselves, this I would doubt. It may be that a number of Academy members would no longer accept Medicare as payment, or perhaps even private insurance, under those particular circumstances.

As for patients who are denied meaningful care in terms of insurance reimbursement: Many will either pay for it themselves aboveboard, or a black market will develop for the provision of these services; or people will become medical tourists and go to Singapore and India where the necessary care will be available.

The idea that Medicare will not pay for certain things: We will certainly face that. But the idea that there will be no market response to those changes is absurd. A large number of ophthalmologists under a rationed system will no longer accept Medicare or a national health insurance and will move outside that system. Where I practice, a large number of internists are simply no longer accepting Medicare. This is not concierge medicine; this is reverting to the days when there was no insurance.

I think that opinion pieces should provide greater in-depth consideration of the economic consequences of their positions.

William R. Stiles, MD, JD 
Northbrook, Ill. 

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EDITOR’S NOTE: Thanks to Dr. Stiles for facilitating a broader discussion of a topic that could not be covered in depth in a one-page Opinion article.

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Correction

In an advertisement in the September EyeNet, Genentech had an error in the brief summary of prescribing information for Lucentis (ranibizumab injection). Please see the corrected brief summary in this issue’s ad, or, to access the full prescribing information, visit www.lucentis.com/hcp.

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WRITE TO US Send your letters of 150 words or fewer to us at EyeNet Magazine, AAO, 655 Beach Street, San Francisco, CA 94109; e-mail eyenet@aao.org; or fax 415-561-8575. (EyeNet reserves the right to edit letters.)

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