Academy News Atlanta 2008

Friday & Saturday

SUBSPECIALTY FOCUS : CORNEA, GLAUCOMA, PEDS, REFRACTIVE, RETINA, UVEITIS

S C I E N T I F I C H I G H L I G H T S O F A T L A N T A 2 0 0 8EyeNet

M A G A Z I N E

e y e n e t ’ s a c a d e m y n e w s 3

IN THIS ISSUE: This edition of Academy Newsfocuses on Subspecialty Day.Program directors tell what’snew at their meetings, OMIC

lists the biggest malpractice claims, and MD pioneerslook back at excimer laser milestones.

Highlights of Subspecialty Day . . . . . . . . .4–7

Alan C. Bird, 2008 Academy Laureate . . . . . .8

25 years with the excimer laser . . . . . . . .9–10

OMIC and indemnity payments . . . . . . .11–13

Atlanta aquarium . . . . . . . . . . . . . . . . .17–18

Meet the honorary lecturers . . . . . . . . . .19–22

TABLE OF CONTENTS

ON THE COVERHemangioblastoma

Photo by Matt Raeber

Barnes Retina Institute

FROM THE EDITOR

Subspecialty Dayis here, and youhave questions.What is the defin-itive approach toretinal vasculitis?Does eye musclesurgery improvevision in kidswith nystagmus?Can cornealinlays solve presbyopia? What’s thenews from glaucoma studies?

You might find intriguing answers to those questions in this year’s Sub-specialty Day programs. And this year, in particular, we will be treated to abumper crop of offerings, from specialtracks in cornea, uveitis and pediatricsto the perennial pillars of glaucoma,retina and refractive surgery.

The presentations begin Friday with“Refractive Surgery 2008: The DangerZone,” and “Retina 2008: Vistas andViewpoints.”

Saturday is even busier, with theaddition of “Cornea 2008: EmergingTrends: Evolution or Revolution?” “Glau-coma 2008: The Pendulum Swings,””Pediatric Ophthalmology 2008: Basicsand Breakthroughs in Managing Strabis-mus and Pediatric Eye Disease,” and“Uveitis 2008: How Should We Diag-nose and Treat Our Patients?”

Welcome to Atlanta, and please joinyour colleagues for the best researchand clinical updates of the year.

Richard P. Mills, MD, MPHChief Medical Editor, EyeNet Magazine

4 f r i d a y � s a t u r d a y e d i t i o n

SUBSPEC IALTIES

The six Subspecialty Day programsoffer so much in their packed agen-das that the biggest challenge will

be deciding which presentations you’llwant to attend. In order to help you betterplan your Subspecialty Day, EyeNet

approached some of the directors of theprograms to see what they consider thebig news in their fields and what might be of greatest interest to those in othersubspecialties. Even if you prefer to stickstrictly to your own subspecialty, this

brief will give you a sense of what’s goingon in other areas.

CORNEACornea Subspecialty Day opens on a his-torical note, with a talk about the evolutionof keratoplasty by Mark J. Mannis, MD,and concludes with experts predictingwhat’s in store over the next five or 10 yearsfor ophthalmology in general, and corneain particular. The audience can expect tohear “what’s current, what’s new and whatmay be new five years from now,” saidMichael W. Belin, MD, one of the CorneaSubspecialty Day program codirectors.

NEWS IN CORNEA. The agenda includesupdates on surgical techniques for DSEK,full-thickness penetrating keratoplasty,anterior segment reconstruction andlamellar replacement. “Each procedurehas its benefits and limitations,” Dr. Belinsaid, adding that the presenters will conveyhow to find the best procedure for eachpatient.

“We used to do full-thickness cornealtransplants. We still do. They’re still effec-tive,” Dr. Belin said. But now, wheneverpossible, rather than replacing the entirecornea, doctors try to selectively replacelayers, he said. “Maybe in the future, we’llbe able to replace a single cell layer. Thisselective approach to corneal replacement,still in its infancy, is what’s really new,what’s revolutionary.”

Also, experts will take opposing view-points on applications in corneal and ante-rior segment imaging technologies, whichhave undergone changes in the last fewyears. And you can expect new informa-tion on infectious keratitis, with high-lights on treatment modalities and newand emerging drugs.

OF INTEREST TO THE NONSPECIALIST. Whilesurgery dominates the agenda, this year’sprogram offers a topic of widespreadinterest—pigmented lesions, tumors andnodules of the anterior segment. “We’vegathered a panel of international expertsto make sense out of what is, for almosteveryone—the general ophthalmologistand the subspecialist—a confusing topic,”Dr. Belin said.

The final section, which is titled “YouMay Think I’m Crazy, But . . .,” promisesto be a fitting ending to an ambitiousagenda, Dr. Belin said. “We tried to put a program together where each sectionrelates to the others and gels at the end.”

Cornea Subspecialty Day takes place onSaturday in the Thomas B. Murphy Ball-room 3/4.

GLAUCOMAThe pendulum swings.

Example: Fifty years ago, blood flowwas regarded as the culprit in glaucoma.That theory was superseded by intraocularpressure. Today, the notion that damage to the optic nerve results from an insuffi-ciency of blood flow is in resurgence, saidHenry D. Jampel, MD, MHS, a codirectorof the Glaucoma Subspecialty Day pro-gram. Or consider the role of centralcorneal thickness in calculating IOP. Forthe past six or seven years, the importanceof corneal thickness “got taken to sort ofan extreme,” Dr. Jampel said. “Now there’s a swinging back to thinking that cornealthickness is a little bit important, but notcritical.”

Such swings provide the focus for thisyear’s Glaucoma Subspecialty Day.“There’san initial enthusiasm, followed by an over-reaction, then a reassessment of wherethings really are,” Dr. Jampel said. “Topicsgo in and out of vogue.”

Even the American Glaucoma SocietySubspecialty Day Lecture by Paul P. Lee,MD, JD, about caring for glaucomapatients has a revisionist ring to it—“Back to the Future.”

NEWS IN GLAUCOMA. On the late-breakingnews front, the three-year results of theTube vs. Trabeculectomy study will beannounced. And in response to populardemand, an expanded surgery section willprovide an overview of what Dr. Jampelcalled “a bewildering array of surgicaltechniques,” as well as newer surgicalapproaches.

OF INTEREST TO THE NONSPECIALIST. Doyou have an OCT in your office? Are youthinking of buying one, or some otherdiagnostic device? Speakers will share

FROM CORNEA TO UVEITIS

Highlights of the Subspecialty Day Programsby miriam karmel, contributing writer

TRABECULECTOMY OR TUBE? The three-year results of the Tube vs. Trabeculec-tomy study are to be announced atGlaucoma Subspecialty Day.

OP

HTH

AL

MIC

IM

AG

ES

CD

, V

ER

SIO

N 3

.0

This publication was printed in advance of the Joint Meeting. Check the TicketSales area in Hall A-2 for cancellations or changes in meeting times.

T I M E C H A N G E S & C A N C E L L A T I O N S

Subspecialties, continued on page 6


SUBSPEC IALTIES

their diagnostic testing experiences. Youcan expect to hear: “This is how I use theOCT clinically for glaucoma,” said Dr.Jampel.

Finally, fireworks are likely when PaulR. Lichter, MD, and Paul F. Palmberg,MD, PhD, debate the prickly question ofwhether the pharmaceutical industry is,or is not, beneficial to patients. The “Indus-try Relations” section, new this year, should

have widespread appeal, as glaucoma isn’tthe only subspecialty confronting industryinfluence, Dr. Jampel said.

Glaucoma Subspecialty Day takes placeon Saturday in the Sidney J. Marcus Audi-torium.

PEDIATRIC OPHTHALMOLOGYAfter a three-year hiatus, the pediatricophthalmologists are back, with an arrayof topics. “Not just strabismus,” promisedR. Michael Siatkowski, MD, a program

codirector for Pediatrics Subspecialty Day.To be sure, strabismus is on the agenda.

The Saturday afternoon session, geared tothe subspecialist, will cover “the higher-order concepts in strabismus—for exam-ple, when is strabismus a neurologic prob-lem?” Dr. Siatkowski said.

Also, strabismus surgery will be high-lighted in this program’s Keynote Address,when Joseph L. Derner, MD, PhD, wholaid the groundwork for understandingthe anatomy of extraocular muscles, dis-cusses the implications of pulley systemsfor modern strabismus surgery. “He’ll dis-cuss how that anatomy affects the surgerywe perform and when surgery on the pul-leys is appropriate,” said Dr. Siatkowski,adding that a goal of the session is to getdoctors to start incorporating pulley sys-tems into their surgery planning.

NEWS IN PEDIATRIC OPHTHALMOLOGY. Ontap, in the final “Hot Topics” segment, willbe debates on three of the most controver-sial topics in pediatrics today. In a point-counterpoint format, experts will considerphotoscreening and whether it’s ready for widespread implementation. They’llalso discuss whether eye muscle surgerycan improve vision in children with nys-tagmus. And finally, they’ll talk aboutwhether IOLs are appropriate in childrenyounger than 12 months. “IOLs are nowwell accepted for kids older than 1,” Dr.Siatkowski said. “But are we ready to usethem in infants?”

On the late-breaking front, there willbe updates on refractive surgery andretinopathy of prematurity as it relates to changing NICU practices.

OF INTEREST TO THE NONSPECIALIST. Themorning session will provide a forum foreducating comprehensive ophthalmolo-gists who deal with children and who treatadult strabismus. “They’re going to get aprotocol to follow, including a tool kit forhow to measure vision in children, as wellas the state-of-the-art treatment foramblyopia,” Dr. Siatkowski said. “We wantthe comprehensive ophthalmologist to feelcomfortable examining and evaluatingkids with a variety of problems that don’trequire the subspecialist level of care.”

Pediatric Ophthalmology SubspecialtyDay takes place on Saturday in RoomA412.

REFRACTIVE SURGERYWhy does one post-LASIK patient com-plain about dry eyes and the other doesnot? Who are the unhappy LASIK patients?Is there a way to prevent their dissatisfac-tion? In one of the three Keynote Address-es at Refractive Surgery Subspecialty Day,Jennifer Morse, MD, a psychiatrist whostudies patient response to surgery, willshed light on what makes patients tick.

Dr. Morse was among those whoaddressed the FDA’s ophthalmic devicegroup last spring at a meeting that madethe headlines in the wake of reports fromdisgruntled LASIK patients. Malvina B.Eydelman, MD, director of that FDAgroup, will speak about her agency’sLASIK concerns.

NEWS IN REFRACTIVE SURGERY. In responseto a question from Refractive Surgery Sub-specialty Day codirector Steven C. Schall-horn, MD, seven prominent surgeons willreveal their “No. 1 pearl.” Said Dr. Schall-horn, “They’ve got to decide what thatone thing is.”

A session titled “Refractive Surgery inUnique Patients” covers refractive surgeryin aviators, pilots and children, as well asin patients with autoimmune disease, nys-tagmus or handicaps. Also on the agenda,experts will address the question: “Whathave I done differently this year?” Thissession promises to touch on everythingfrom new techniques to managing theimpact of the economic slowdown on thebusiness of refractive surgery.

OF INTEREST TO THE NONSPECIALIST. Dur-ing the “Business Strategies” session, the“experience economy” will receive specialcoverage, Dr. Schallhorn said. The nextstep beyond the service economy is theexperience economy, in which businesscreates a memorable experience for thecustomer, and Shareef Mahdavi, an expertin this area, will talk about his field as itrelates to refractive surgery. In ophthal-mology, for example, the tendency is tothink that the next level of care is betterphaco machines, better LASIK, betterimaging devices, Dr. Schallhorn explained.Dr. Mahdavi will discuss why that’s onlypartly true. “The real game is improvingthe patient’s experience,” Dr. Schallhornsaid, drawing an analogy to Starbucks,which offers aroma and ambience alongwith its coffee. “It’s a real shift in offeringcare,” Dr. Schallhorn said.

Refractive Surgery Subspecialty Daytakes place on Friday and Saturday in theThomas B. Murphy Ballroom 1/2.

RETINAFor two days, retina specialists are beingtreated to the latest information on every-thing from gene therapy for inherited dis-eases to new instruments and innovationsfor management of vitreoretinal diseases.But if any one topic stands out, it is age-related macular degeneration, which dom-inates most of the first day’s agenda. “Agreat deal of this meeting will be devotedto discussions of treatments of exudativeas well as nonexudative macular degener-ation,” said M. Gilbert Grand, MD, a Reti-na Subspecialty Day program codirector.

THE EDITORS’ CHOICES SYMPOSIUMMONDAY

Time: 10:15 a.m. to 12:15 p.m.Room: Thomas B. Murphy Ballroom 4Fee: No charge

The line-up is as follows:

Preventing Surgical Confusions in Ophthal-mologyPresenter: John W. Simon, MD Discussant: Joe R. McFarlane Jr., MD

Ten-Year Follow-up of Laser In Situ Ker-atomileusis for High Myopia Presenter: Jorge L. Alió, MD, PhD Discussant: Jay S. Pepose, MD, PhD

A Modified Technique for Descemet-Strip-ping Automated Endothelial Keratoplasty toMinimize Endothelial Cell LossPresenter: Massimo Busin, MDDiscussant: Edward J. Holland, MD

Rosiglitazone May Delay Onset of Prolifera-tive Diabetic RetinopathyPresenter: Lloyd P. Aiello, MD, PhDDiscussant: Susan B. Bressler, MD

Early Bevacizumab Treatment of CentralRetinal Vein OcclusionPresenter: Richard F. Spaide, MDDiscussant: Travis A. Meredith, MD

Three-Dimensional Spectral-Domain OpticalCoherence Tomography Images of the Retinain the Presence of Epiretinal Membranes Presenter: Carmen A. Puliafito, MD, MBADiscussant: Richard F. Spaide, MD

CFH and LOC387715/ARMS2 Genotypes andTreatment With Antioxidants and Zinc forAge-Related Macular DegenerationPresenter: Michael L. Klein, MDDiscussant: Paul Sternberg Jr., MD

Vision Function in HIV-Infected IndividualsWithout Retinitis: Report of the Studies ofOcular Complications of AIDS ResearchGroup

Presenter: William R. Freeman, MDDiscussant: Janet L. Davis, MD

Mechanism of Action of Bimatoprost,Latanoprost, and Travoprost in Healthy Subjects: A Crossover StudyPresenter: K. Sheng Lim, MDDiscussant: Douglas R. Anderson, MD

Prevalence of Plateau Iris in Primary AngleClosure Suspects: An Ultrasound Biomi-croscopy StudyPresenter: Tin Aung, PhDDiscussant: Jeffrey M. Liebmann, MD

Systematic Internet-Based Review of Com-plementary and Alternative Medicine forGlaucomaPresenter: Daniel G. Ezra, MBBSDiscussant: Lloyd Hildebrand, MD

Does Pre-Verbal Photoscreening for Amblyo-genic Factors Affect Outcomes in AmblyopiaTreatment? Early Objective Screening YieldsGood AcuitiesPresenter: Robert W. Arnold, MDDiscussant: Elias I. Traboulsi, MD

Keep up with AJO, Archives and Ophthalmol-ogy by reading EyeNet Magazine, whereselected summaries from these publica-tions are featured in the Journal High-lights section.

Full access to both AJO and Ophthal-mology is available to Academy membersvia the O.N.E. Network www.aao.org/one.

EyeNet is the clinical newsmagazine ofthe Academy and is mailed to all domes-tic members. Access to the online versionis available to all members, domestic andinternational, at www.eyenetmagazine.org.International members who pay a shippingand handling fee of $76/year receive theprint version of EyeNet.

The EyeNet Web site and the O.N.E.Network are available to Academy mem-bers with their Academy username andpassword.

T H E Y E A R I N R E V I E W : J o i n t h e E d i t o r s o fA J O , A r c h i v e s a n d O p h t h a l m o l o g y

Amid the demands of practice, the busy clinician doesn’t always find time to keepup with the peer-reviewed journals. The editors of the American Journal of Oph-thalmology, Archives of Ophthalmology and Ophthalmology invite you to a review

of interesting research published during the last year that has had immediate clinicalrelevance to the profession.

The main criteria for selection by the editors include clinical relevance, interest tocomprehensive ophthalmologists, and a contribution that 1) warrants consideration of a change in recommended clinical practice, 2) appears to prove or disprove somethingthat ophthalmologists have been doing previously but based on less solid evidence or3) gives better insight into a disease.

LATE-BREAKING TOPIC. During PediatricOphthalmology Subspecialty Day, therewill be an update on retinopathy ofprematurity care in the neonatal ICU.

Subspecialties, continued from page 4

OP

HTH

AL

MIC

IM

AG

ES

CD

, V

ER

SIO

N 3

.0

He added that much of the AMD discus-sion will focus on new methods for man-aging AMD, particularly pharmacologictherapy, which has provided dramaticimprovement in achieving stability andsometimes even visual improvement.

NEWS IN RETINA. Among the highlightsare presentations on the use of ciliaryneurotrophic factor to treat a number ofretinal diseases. Also in the lineup are pre-sentations of the results of studies usinggene therapies to manage inherited retinaldiseases, such as Leber’s congenital amau-rosis. “Those are critically importantpapers,” Dr. Grand said.

The agenda also includes retinal imag-ing, as well as a comprehensive review ofmanagement of choroidal melanomas andretinoblastoma.

OF INTEREST TO THE NONSPECIALIST.“While the program is really designed forthe retina specialist,” said Dr. Grand, “theSaturday afternoon session on uveitispromises to have universal appeal.”

And for those interested in the historyof ophthalmology, Harvey A. Lincoff, MD,a pioneer in the management of retinaldetachment, will give a personal accountof the evolution of retinal surgery, when hedelivers the first annual Charles L. Schep-ens, MD, Lecture early Friday morning.

“A great deal of effort has been made toinclude presentations that are clinicallysignificant and on the cutting edge,” saidDr. Grand, adding that the hope is to pre-sent the most recent data regarding thecurrent management of vitreoretinal dis-eases, including macular degeneration,hereditary retinal disorders, vascularocclusion, pediatric retinal abnormalities,diabetic retinopathy, uveitis and tumors.”

Retina Subspecialty Day takes place onFriday and Saturday in the Hall A-3 Ses-sion Room.

UVEIT ISMaybe this year will be different. Maybethis year the message will sink in. The keymessage that C. Stephen Foster, MD, oneof the directors of Uveitis SubspecialtyDay hopes to deliver: “When treating idio-pathic or autoimmune-related uveitis,there’s a lot more out there than steroids.”

Despite texts emphasizing the impor-tance of moving beyond corticosteroids,and courses given at the Academy on thePreferred Practice Patterns for treating

uveitis, and in spite of all the publicationsin peer-reviewed literature over the past25 years, “The vast majority of ophthal-mologists around the world are stuck withjust one string on the guitar—and that’scorticosteroids,” Dr. Foster said.

The consequence of not heeding pre-ferred practices has led to needless disabil-ity and blindness, which will be covered inthe talk “Prevalence of Visual Disabilityand Blindness: It’s a Disgrace!”

NEWS IN UVEITIS. “Steroids are wonder-ful,” Dr. Foster added. “They put the fire

out quickly.” But they guarantee side effects,so in the many instances in which theuveitis is stubborn, the preferred practiceis to move beyond corticosteroids. Expertswill discuss those practices. Also on theagenda is a report on new drugs, includingintravitreal fluocinolone and an updateon the Systemic ImmunosuppressiveTherapy for Eye Diseases (SITE) study.

Quan Dong Nguyen, MD, codirector ofthe event, will review drugs in the pipeline.There also will be an update on surgicalcare of patients with uveitis.

OF INTEREST TO THE NONSPECIALIST. Muchof the program is geared to the nonspe-cialist, said Dr. Foster, who hopes that byday’s end the audience will understandthat the uveitis armamentarium containsmore than steroids. By early referral to anocular immunologist or chemotherapisttrained to deliver novel treatments, or byteaming up with a specialist, we can reducethe “shockingly disgraceful” prevalence ofblindness from uveitis, he said.

Uveitis Subspecialty Day takes place onSaturday in Room A411.


SUBSPEC IALTIES

AMD TAKES THE DAY. Age-related macu-lar degeneration will command a largeportion of the Friday agenda duringRetina Subspecialty Day.

RIC

HA

RD

E. H

AC

KE

L, C

RA

, F

OP

S


THE LAUREATE

The Academy takes special pride inhonoring Alan C. Bird, MD—aworld-renowned expert on the

treatment of retinal vascular disease andgenetic and degenerative retinal disorders—as recipient of the 2008 Laureate Recog-nition Award.

Professor Bird has been one of the mostprolific and innovative minds of the past40 years in the field of medical retina. Hisresearch has included the clinical andgenetic documentation of families withretinal disorders and the identification ofthe genes responsible for those patholo-gies. This research has also led to thedevelopment of new technology to defineboth the clinical characteristics of retinaldisease and the correlation of abnormalgene expression with metabolic dysfunc-tion at the cellular level.

Born in London, Professor Bird receivedhis medical degree from Guys Hospital,University of London, where he trained inboth neurology and neurosurgery beforehis ophthalmic residency at MoorfieldsEye Hospital. He then had a one-yearfellowship in neuro-ophthalmology at theBascom Palmer Eye Institute in Miamiand spent a brief period at the Universityof California, San Francisco.

Professor Bird returned to London in1969 and was appointed to the staff at theInstitute of Ophthalmology (IO) andMoorfields Eye Hospital, where he hasremained ever since. In the late 1970s, heestablished one of the first clinics in theworld for inherited retinal disease. In col-

laboration with IO Professor Shomi Bhat-tacharya, the team identified numerouseye disease genes and cemented the stand-ing of the IO (which became a school ofUniversity College, London) and Moor-fields Eye Hospital as one of the top eyeresearch and care centers worldwide.

Over the years, Professor Bird developeda multidisciplinary and talented researchteam for studying monogenic retinal dis-orders and age-related macular disease.Investigative techniques have includedmolecular genetics, electrophysiology,psychophysics, specialized imaging andmorphology. “In part because of thetremendous clinical load and in partbecause of the sophisticated level of sci-ence,” said Professor Bird, “the clinical and research activity at Moorfields andthe IO has attracted gifted post-residencyfellows from all over the world, many ofwhom have made major contributions tothe field.”

With the help of two of his fellows fromGermany, Professor Bird’s team was thefirst to demonstrate that the accumulationof lipids in Bruch’s membrane was an inte-gral part of AMD.“This was a concept thatderived originally from Dr. Dean Bok atUCLA,” Professor Bird said. Along withthe assistance of one of his fellows andIO’s Professor Frederick Fitzke, ProfessorBird also developed a novel technique todocument autofluorescence in the retinalpigment epithelium for monitoring itshealth along with the health of photore-ceptor cells. “For the first time, we record-ed changes in disease involving the pig-ment epithelium, something we had notbeen able to do prior to that time, at leastnot accurately,” said Professor Bird. “Wecould not only look at drusen changes atthe level of Bruch’s membrane, but wecould also start observing changes in thepigment epithelium, an integral aspect ofAMD.”

When asked what he feels is his greatestcontribution to ophthalmology, ProfessorBird doesn’t hesitate: “The most impor-tant thing I’ve ever done was in riverblindness.” In the 1970s, he traveled toAfrica to help a clinical team in Cameroonwith research. “The most notable findingwas the identification that retinal andoptic nerve disease was the main cause ofblindness rather than corneal scarring,and that the standard treatment of thattime—diethylcarbamazine—acceleratedvisual loss,” Professor Bird said. “This gaverise to the introduction of ivermectin asthe new treatment for onchocerciasis.” Asa direct result, river blindness, which atthe time was classified as one of the majorcauses of blindness in the world, is now afar smaller problem.

Another key achievement in ProfessorBird’s career focused on sickle cell retinopa-

thy. He has worked in Jamaica recordingthe retinal changes in sickle cell diseaseover a 21-year period using a rigorouscohort generated by hematologist GrahamSerjeant. Together, the team has docu-mented the relatively benign nature ofsickle cell, thus obviating the need forprophylaxis.

Today, Professor Bird is involved in anumber of important clinical trials. Mostrecently, he chaired the Independent DataSafety and Monitoring Committee for thepegaptanib (Macugen) trial for AMD.“The development of biological treatmentfor choroidal neovascularization has beenextremely exciting to watch,” he remarked.

In addition to having worked with the U.K.’s Medical Research Council andWellcome Trust, the U.S.’s National EyeInstitute, France’s INSERM and Germany’sDeutsche Forschungsgemeinschaft, Pro-fessor Bird is involved in advising industryfrom a clinical perspective. Professor Birdhas earned the Duke-Elder, Doyne andBowman medals in the United Kingdomand the Prix Chauvin in France. He hasgiven numerous eponymous lecturesthroughout Europe and North Americaand has received the Alcon ResearchAward, the Helen Keller Prize, the PaulKayser Award and the Jules FrançoisMedal. In 2006, he was honored by theMacula Society with a lifetime achieve-ment award.

“The essence of my career has beencooperative research between myself as a clinician and talented colleagues in thelaboratory who have been very generousin supporting clinically driven research,”said Professor Bird. “I have been so fortu-nate to receive constant and crucial support

from my colleagues at Moorfields and thenumerous fellows who were attracted tothe Institute of Ophthalmology in Londonfrom countries around the world.”

In October 2005, Professor Bird retiredfrom full-time clinical practice and wasappointed emeritus professor of medicalophthalmology at London University andhonorary consultant at Moorfields EyeHospital. He and his wife, Sarah, have twosons and one grandson, all of whom livein England. Professor Bird enjoys gardeningand playing golf when he can find timeand is an avid Rugby Union fan, rootingfor the London Wasps. He would want usto mention that the Wasps recently wonthe 2008 Guinness Premiership Final.

THE ACADEMY HONORS A PIONEER IN RETINAL RESEARCH, TEACHING AND CLINICAL MEDICINE

Alan C. Bird, MD, Named 2008 Laureateby gabrielle weiner, contributing writer

PROFESSOR BIRD is an internationallyrecognized expert on the treatment ofretinal vascular disease and geneticand degenerative retinal disorders.

Iworked for Alan Bird in the early1990s and have always felt it was the most exciting year of my entire

ophthalmic training. One of the things that made Professor

Bird special was his gift as both a clini-cian and a basic research scientist. With adetailed knowledge of basic retinal physi-ology and molecular biology, he can speakthe language of the basic scientist whileproviding critical analysis of findings fromthe perspective of an astute and observantclinician. He has thus influenced thedirection of research in retinal disorders,collaborating with some of the most influ-ential retinal scientists of his time.

Moorfields Eye Hospital has providedhim with a volume and variety of clinicalpathology that few other institutions havehad, and Professor Bird has not squan-dered that opportunity, serving as a bridge

between basic retinal science and theclinic, and greatly enhancing our knowl-edge of retinal disease and therapies.

Professor Bird is a caring and compas-sionate physician who is wonderful withpatients, never taking away hope from the many patients with blinding retinaldiseases that have no treatment.

As my teacher, “Prof” Bird—as we allcalled him—was downright fun to workwith and was always eager to share hisknowledge and passion for his work. Andas a person, he’s simply a great guy, easyto relax and enjoy a good laugh with.

I’m very proud that I had the chance to spend one of my most formative yearswith Prof Bird. The 2008 Laureate Awardis truly deserved.

Jack Wells, MDPalmetto Retina Center,

Columbia, S.C.

W O R D S F R O M A F O R M E R F E L L O W

Every year, ophthalmologists distin-guish themselves and the professionby making exceptional scientific con-tributions toward preventing blindnessand restoring sight worldwide. Theboard of trustees of the Academy rec-ognize these extraordinary contributionswith its Laureate Award, the Academy’ssingle, highest honor.

2007Claes H. Dohlman, MD

2006Lorenz E. Zimmerman, MD

2005Arnall Patz, MD

2004Daniéle S. Aron Rosa, MD, PhD

J. Donald M. Gass, MDMarshall M. Parks, MD

2003Charles D. Kelman, MDRobert Machemer, MD

Charles L. Schepens, MD

P A S T A W A R D E E S


TECHNOLOGY

More than 800,000 Americans underwentLASIK surgery in 2007, according to astory published last April 24 in the Inter-national Herald Tribune. That number wasan increase over 2006, although, as an elec-tive procedure, refractive surgery is subjectto the whims of a poor economy, and theTribune story predicted a 17 percent dropin patients this year, describing LASIK as a barometer for economic recession.

FROM INKLING TO INNOVATIONA RUSSIAN REVOLUTION. Scientists in Moscowwere credited with the design of the excimer

laser in the mid-1970s. But its potentialfor ophthalmic applications would waituntil 1983, when Stephen L. Trokel, MD,paid a propitious visit to photochemistRangaswamy Srinivasan, PhD, who wasusing the excimer laser for microetchingcomputer chips at IBM’s Thomas J. Wat-son Research Center in Yorktown Heights,N.Y. Dr. Trokel had also previously notedthe work of John Taboada, PhD, who wasperforming military safety testing of thelaser at low energy levels. Dr. Trokel subse-quently oversaw a series of experimentson freshly enucleated bovine eyes, using

ablative photodecomposition to removecorneal tissue.

ULTRAVIOLET WORKS ITS MAGIC. Recogniz-ing its significance, Dr. Trokel reported inthe December 1983 American Journal ofOphthalmology, “The excimer laser, whichproduces light in the far-ultraviolet portionof the spectrum, allows precise removal ofcorneal tissue through a photochemicallaser-tissue interaction. This interaction isnot thermal and does not involve opticalbreakdown; rather, it directly breaksorganic molecular bonds without tissueheating.”

The 193-nm, argon-fluorine excimerlaser energy was well absorbed by thecornea, breaking organic bonds and eject-ing molecular fragments at supersonicspeed. This ability was striking.

But what the laser didn’t do wouldmake it revolutionary: It did not causesignificant mechanical or thermal injury to the cornea. “The experiments becameprogressively more sophisticated as wesystematically explored the laser tissueinteraction across the UV spectrum,” saidDr. Trokel. “I had met with Dirk Bastingsin August 1983 after a series of experi-ments.” (Mr. Bastings was then CEO ofLambda Physik, the manufacturer of theexcimer lasers.) “It was my intention to

beg, borrow or buy a laser system fromhim for further studies,” Dr. Trokel said.Very soon, he and others would be doingthose studies. Animal experiments hadbegun in Berlin in December 1983 andwould start shortly thereafter in the United States in the lab of Marguerite B. McDonald, MD, who was then atLouisiana State University.

IDEAS FOR INITIAL APPLICATIONS. “Theearliest reports were to make cuts in thecornea to resemble RK,” said W. BruceJackson, MD, commenting on the work of Thomas F. Neuhann, MD, and others.“And the second was to use it for thera-peutic applications—such as for cornealscars and even corneal infections,” headded. “Then the concept came that youcould sculpt the cornea, actually take tis-sue off to correct myopia. That was reallythe beginning.” Dr. Jackson is professorand chairman of ophthalmology at theUniversity of Ottawa.

HE DID THE MATH. Charles Munnerlyn,PhD, was curious about large-area abla-tions and sought to do such experimentson rabbit eyes in 1984 with Dr. Trokel andCarmen A. Puliafito, MD, MBA. Then, Dr.Munnerlyn started a project that resultedin construction of the first clinical proto-type photorefractive keratotomy (PRK)

SUCCESS STORY. The excimer laser has found broad applications

in many markets, from micromachining to medical uses. And no discipline has

been more dramatically altered by its advent than refractive surgery. Over

time, improvements in performance and reliability, combined with a host of

complementary techniques and innovations, have turned excimer refractive

surgery into the most popular elective surgical procedure worldwide.

Birthday for a Beam of Light

A Quarter Century of the ExcimerLaser

1975Early Russian develop-ment of excimer lasertechnology.

1983Rangaswamy Srinivasanuses excimer laser forprecise cuts in organicmaterials.

1983Stephen Trokeldescribes use ofexcimer laser to removecorneal tissue (left).

1986Theo Seiler creates linear and arcuatekeratectomies for astigmatism.

1987Theo Seiler performsfirst excimer treatmenton a human eye.

1988Marguerite McDonaldperforms first excimerPRK on a sightedhuman eye (right).

1991Stephen Brint performsfirst LASIK procedure.

by annie stuart, contributing writer

THE EXCIMER TIMELINE

Happy 25!

Light micrographs, above, published by Dr. Trokel and colleagues 20 years ago in Oph-thalmology, depict “a transversely sectioned cornea whose anterior surface has beeneroded to form a series of steps by exposure to an excimer laser through a progressivelyopening aperture.”

system. He worked out mathematicallythe depth of ablation, diameter and edgeangles, later cofounding Visx with Dr.Trokel and Terry Clapham in 1986.

The ferment spilled over with the firstexcimer treatment on a human eye by Ger-man ophthalmologist Theo Seiler, MD,PhD, in 1987 and excimer PRK on a sight-ed human eye in 1988 by Dr. McDonald,who maintains the longest follow-up inthe world.

EARLY OBSTACLESAs with any new technology, all did not gosmoothly at first. Two major challenges:controlling the laser’s beam and managingsurgical complications.

NEEDED: BEAM CONTROL. The initialpulse was delivered as a broad, rectangularbeam of irregular energy. To obtain con-sistent clinical results, beam homogeniza-tion and shaping were attempted throughvarious means. “It was difficult to controlthe size of the beam with the machine,”said Ioannis G. Pallikaris, MD, director ofthe Institute of Vision and Optics at theUniversity of Crete in Greece. “So it washelpful to use a masking procedure madeof apertures so we could ablate more inthe center of the cornea and less in theperiphery.”

To accommodate the need for expand-ing refractive indications, the masks usedto shape the broad beam laser deliverywere changed, said Yaron S. Rabinowitz,MD, director of ophthalmology researchat Cedars-Sinai Medical Center in LosAngeles.

“For example, the axicon was used to rotate a decentered beam to correcthyperopia,” he said, “which made thatapplication possible.” Over time, flying-spot excimer lasers replaced broad-beam

lasers, enabling greater accuracy of treat-ment and correction of higher-order opti-cal distortions. “This made it possible tocreate smooth, contoured ablations andcustomized patterns,” said Dr. Rabinowitz.

HALOS, HAZE AND GLARE. Optical sideeffects such as glare, halo and contrastsensitivity, and physical complicationswere also challenging. Severe scarring orhaze indicated aggressive wound healing—either from epithelial healing over theablated area or new collagen synthesis inthe superficial stroma—leading to regres-sion of effect.

Correcting optical problems was easierthan addressing healing, noted Dr. Pal-likaris. “We were not familiar with thehealing process of the cornea, so it took a lot of time to observe and understandthe reason why we had so much haze andregression of myopia,” he said. “My initialcontribution in excimer laser history waswhen I studied in the rabbit model nerveregeneration with gold chloride in orderto understand the healing process.” Mito-mycin C later came to the forefront as away to manage scar and haze formationfollowing surface ablation.

ADVANCING TO FLAPS. Dr. Pallikaris playedanother key role in mitigating the healingchallenges by developing the idea for laserin-situ keratomileusis (LASIK) in the late’80s. “In 1990, I designed a prototypemicrokeratome in order to generate thefirst corneal flap on a blind eye,” said Dr.Pallikaris. Making precise flaps was a challenge, he said, until automated micro-keratomes came along to generate morereliable flaps. FDA approval for LASIKoccurred in 1999, four years following theapproval of the eximer laser for PRK cor-rection of myopia in the range of 1.0 to7.75 D.

CONTINUING CUSTOMIZATIONA new generation of lasers allowed forsmoother surfaces, wider ablations andbetter transition zones, all of whichimproved corneal healing responses withboth PRK and LASIK, said Dr. Pallikaris.It was possible to design almost any shapeof ablation profile of the cornea, includingaspheric ablation profiles, first introducedby Dr. Seiler in 1994.

“Initially, we had no concept of howhigh a correction could be done or howdeep you could go in the cornea,” said Dr.Jackson.“We tended to use multizone-typetreatments, but they were small in diameterand often the patients ended up with moreglare, halos and other optical symptoms.”But with automation, increased laser speedand larger treatment diameters, patientsatisfaction started to go up,” said Dr.Jackson.

NEW TECHNIQUES HOP ON BOARD. To pre-serve the epithelium, and reduce haze andpain, two other techniques evolved: laserin-situ epithelial keratomileusis (LASEK),introduced by Dimitri T. Azar, MD, in1996, and a newer variation called epipolislaser in situ keratomileusis (epiLASIK),an innovation of Dr. Pallikaris in 2004.

PATIENT, FIXATE THYSELF. Handheld fixa-tion devices were replaced by self-fixation,then, later, by a variety of pupil and limbustracking devices. This allowed the excimersystem to compensate for saccadic move-ment and torsion, and brought an addedlevel of confidence to the patient experi-ence, said Dr. Jackson.

WAVEFRONT MAKES A BEACHHEAD. InMarch 1999, Dr. Seiler tried the first wave-front-guided PRK. Dr. Jackson describedthis as a leap forward. “All of a sudden wewere looking at patients who were 20/20or 20/15, and even down to 20/10. In theold days, those would be numbers wewouldn’t even think of.”

Treating without pupil centroid shift,and employing torsional tracking—thisall improved up results even more, addedDr. Jackson.

Today, most refractive surgeons usewavefront systems, and, along with com-puterized topography and aberrometry,wavefront-guided and optimized systemshave provided new assurance with higher-order and induced aberrations, said Dr.Rabinowitz. “There was a huge jump in

my practice when wavefront was intro-duced—maybe 30 to 40 percent—andanother huge jump with femtosecondlaser. These two improvements reallyresulted in a much larger segment ofthe population being willing to do lasersurgery.”

THE LASER’S LONG REACHThe future holds still more innovation forthis laser: greater automated calibration,improved beam profile, better trackersand online pachymetry, to name a few.And consensus about where to focus thetreatment—the visual axis or the pupil-lary axis—may come at some point, aswell as how best to integrate topographywith wavefront.

What’s clear, however, is that theknowledge accumulated because of theexcimer laser has not only changed theworld of refractive surgery, said Dr. Jack-son, but had an amazing ripple effect inmany areas of ophthalmology.

Knowledge gained about how to man-age dry eyes, ectasia or corneal scars allhad roots with the excimer experience.“And when we got into aberrometry andhigher-order aberrations, this turnedcataract surgery around overnight.” Evenspectacles and contact lenses are affected,he said. “So it’s far-reaching in all our optical corrections.”

Dr. Jackson is a consultant for AMO/Visx. Dr.

Pallikaris reports no financial interests. Dr. Rabi-

nowitz is a consultant for AMO and Wavelight.


THE EXCIMER TIMELINE CONTINUED1995FDA approves excimerlaser to correct myopiawith or without astig-matism.

1996Dimitri Azar introduceslaser in-situ epithelialkeratomileusis(LASEK).

1999FDA approves excimerlaser for LASIK surgery.

2000FDA approves excimerlaser for LASIK to cor-rect hyperopia.

2002FDA approves wave-front-guided LASIK.

2002FDA approves IntraLasefor laser-assisted cre-ation of corneal flap.

2004Ioannis Pallikaris intro-duces epipolis laser insitu keratomileusis(epiLASIK).

A Symposium to celebrate the 25th anniversary of the excimer laser will be held Sunday,from 10:45 a.m. to 12:15 p.m. in the Hall A-3 Session Room. For a schedule of speakers,search the Online Program for event code “Sym04,” or check your Final Program.

This Symposium will conclude with the 2008 Barraquer Lecture, “Corneal Surgery IsRefractive Surgery,” delivered by Roger F. Steinert, MD. “We have made great strides inreplacing cloudy corneas with clear corneas,” said Dr. Steinert. “Yet our ability toachieve optically excellent corneas comparable to natural corneas has lagged seriouslybehind this anatomic success. Meeting patients’ vision needs will involve borrowing thetools of refractive surgery, such as LASIK and PRK.”

This is a combined meeting with ISRS/AAO and the European Society of Cataractand Refractive Surgery. Check your Final Program for many more presentations on thenewest developments in corneal and refractive surgery.

Cheers for a Quarter-Century of Argon-Fluorine Sculpting

Dr. Trokel included this illustration in an essay he authored, “Evolution of excimer lasercorneal surgery,” published in the Journal of Cataract and Refractive Surgery, July 1989.

Schematic offered in a brief report on“Ophthalmic Excimer Laser for CornealSurgery,” published in March 1987, inthe American Journal of Ophthalmology.

TECHNOLOGY


RISK MANAGEMENT

Recently, OMIC reviewed its claims for the six subspecialties that are includedin this year’s Subspecialty Day to find the nine cases involving the biggest pay-ments, which ranged from $3,375,000 to$800,000. Only one of these subspecial-ties, uveitis, is not represented below. Ithad a top payment of $500,000 (for a caseof endophthalmitis that resulted from adropped lens during cataract surgery).By reviewing cases such as these, as

well as keeping an eye on trends withinophthalmology, OMIC is able to developvery specific risk management recommen -dations. (Many of these recommendationscan be found on OMIC’s Web site, www.omic.com.)

PEDIATRIC OPHTHALMOLOGY :$3,375,000—failure to diagnoseretinopathy of prematurity. The patientwas born via cesarean section on March23, 2003, at 26 weeks of gestation with abirth weight of 960 g. An ROP exam wasnot done until May 7, at which point thebaby was 6 weeks old and weighed 1,585 g.The ophthalmologist found no ROP, andthe plan was to follow up with anotherophthalmologist on Nov. 6.However, before the follow-up appoint -

ment, the parents became concerned thattheir child was not tracking well, and thepatient was seen on Aug. 19 by the insured.The ophthalmologist noted stage 4A ROPOS > OD. The dilated fundu scopic examshowed retinal detachment and fibrosis in

both eyes and definite signs of macularvessel stretching in the right eye. On June 20, 2005, the insured declared

that the patient was legally blind.ALLEGATION: Failure to diagnose ROP.DAMAGES: 20/370 in the right eye at 1

foot and no light perception in the left eye.EXPERT REVIEW: The defense and plain-

tiff experts felt that the ophthalmologistshould have followed up with the patientmuch sooner than six months; he shouldhave had the patient return in two orthree weeks. There was an indemnity payment of $3,375,000.

RISK MANAGEMENT ISSUES: The physiciandid not follow standard of care for exami-nation and treatment of ROP. In addition,the hospital and the physician’s office didn’tuse a tracking system to ensure that thechild was examined within the propertime intervals.

OMIC RESOURCES: Menke, A. M. ROPCreating a Safety Net. (Available at www.omic.com.)

GLAUCOMA : $1,800,000—failure todiagnose open-angle glaucoma. A 3-month-old boy was diagnosed withmicrophthalmia and bilateral cataracts.Cataract surgery was performed. Theophthalmologist continued to treat thepatient for eight years but did not mea-sure intraocular pressure every six monthsas is recommended for microphthalmic,cataractous patients. (Such patients have a 15 to 20 percent increased risk of glau-

coma.) Instead, the ophthalmologist occa-sionally monitored the cup-to-disc ratio.Vision loss continued between 5.6 and 8.2years, but this was thought to be due toexotropia. When the patient finally complained of

total vision loss, he was referred to a retinaspecialist who found 100 percent cup-to-disc ratio with an atrophied optic nerve(total vision loss) in the left eye and 65percent cup-to-disc in the right eye. Thepatient is now on glaucoma medications.

ALLEGATION: Failure to diagnose open-angle glaucoma in a 3-month-old microph -thalmic infant after cataract surgery.

DAMAGES: Total vision loss (no light per -ception) in the left eye; 65 percent loss ofvision in the right eye.

EXPERT REVIEW: The experts for boththe plaintiff and the defendant found thatthe physician fell below the standard ofcare. IOPs should have been checkedevery six months. Following the cup-to-disc ratio would only reveal whether dam-age already had occurred, and not all cup-to-disc mea surements were documentedin the file. Also, the retina specialist whosaw the patient on referral from the origi-nal physi cian diagnosed marked glauco-matous cupping of the patient’s left eyeand stated that the vision loss in this eyewas a result of chronic, long-term open-angle glaucoma. The case was settled for$1.8 million.

RISK MANAGEMENT ISSUES: The physician’sdiagnostic thought process failed toinclude a differential diagnosis for thispatient. Both plaintiff and defense expertspointed out that there is a 15 to 20 percentincreased risk of glaucoma in microph-thalmic, cataractous patients. The physi-cian may have avoided this misdiagnosisof open-angle glaucoma if he recognizedthe signs of a misdiagnosis:1. Diagnosis did not account for all symp -toms and findings.

2. Decision-making process did not ruleout the worst-case scenario.3. Patient was not responding to treatment.4. Recurring complaint.5. New or evolving complaint.6. Repeat visits or phone calls.7. Phone calls to multiple providers.

OMIC RESOURCES:Menke, A. M. RiskManagement Issues in Failure to DiagnoseCases. This article discusses the diagnosticprocess that was described above. (Avail-able at www.omic.com.)

RETINA : $1,500,000—failure to diag-nose choroidal melanoma. A 46-year-old man presented to an ophthalmologygroup practice in January 1996 for a routine eye exam and he was seen by anoptom etrist employed by the practice.The optometrist identified a nevus on thepatient’s right eye during that exam. Thenevus was described as nonsuspicious, flat and about two discs in diameter. Theoptom etrist maintained that a photo wastaken of the nevus on this date, but nophoto (or order to take one) was found inthe medical record. The patient was askedto return in one year for follow-up.Almost one year later, the patient returnedto the office complaining of an inability to focus his right eye. He was seen by anophthalmologist in the group who sus-pected retinal detachment and referredthe patient to a retina specialist. The spe-cialist diagnosed a malignant melanomawith overlying retinal detachment. Thepatient was referred for treatment, butdied in August 1999.

ALLEGATION: Failure to diagnosechoroidal melanoma.

DAMAGES: Death.EXPERT REVIEW: The defense experts felt

the optometrist met the standard of careboth in the follow-up duration (one year)and in not needing a photo for a nevus ofthis description. The plaintiff experts felt

RISK EXPERTS. The Ophthalmic Mutual Insurance Company has

been defending Eye M.D.s for 21 years. During this time, its indemnity

payments have tended to be significantly lower than those of other multi -

specialty carriers. This is due, in no small part, to OMIC’s governance by

ophthalmologists who understand the risks and worth of each case.

Lessons Learned From Million-Dollar Payouts by hans bruhn, mhs, senior risk management

specialist, omic

at workThe courts, the cases, the verdictsOMIC

that the supervision of the optometristwas inadequate; they argued that a consultwith an ophthalmologist should have beendone when the nevus was first detected.The case was settled for $1,500,000. Theoptometrist and the group were separatelyinsured; the group paid $500,000 due toits vicarious liability as the employer.

RISK MANAGEMENT ISSUES: It would havebeen prudent for the optometrist to referthe patient to the ophthalmologist whenthe nevus was first detected. Consideradvising employed optometrists to referpatients with a new finding of nevus for aconsultation with the ophthalmologist.Owing to the vicarious liability that thegroup practice has (and its easy referralcapability), protocols should have beendeveloped requiring referral in cases suchas this.

OMIC RESOURCES: Menke, A. M. Coman -agement of Ophthalmic Patients. (Avail-able at www.omic.com.)

CORNEA/ EMERGENCY MEDICINE :$1,000,000—failure to treat cornealulcer. In March 1994, a 2-year-old malepatient fell into an “oily, dry matter” onhis family’s driveway. Shortly thereafter,the patient complained of something inthe right eye, and his mother noted drain -age. The patient went to a local emergencyroom for treatment that same day. The ER doctor called the ophthalmologist todiscuss the case. The ER notes indicatecorneal abrasion with acute inflammatoryresponse. A patch was placed on the eyewith ointment, and instructions were

given to follow up the next day with theophthalmologist. However, the patientwas not able to set up a follow-up appoint -ment due to a miscommunication. Theophthalmologist’s office had a policy notto treat patients on public assistance,except if they are ER follow-up patients.The ophthalmologist failed to instruct hisoffice that this patient should be sched-uled for an appointment, nor did heinstruct the patient to mention this excep-tion to the group’s scheduling staff. Threedays later, treatment for a corneal ulcerwas provided by other providers. Thepatient had serious opacity in the righteye and the possible need for a cornealtransplant.

ALLEGATION: Failure to treat a cornealulcer.

DAMAGES: The patient’s eyesight in hisright eye has been measured 20/40 or bet-ter, but ongoing treatment indicates thepossibility that his eyesight may worsenand a transplant may be needed. His lefteye is unaffected.

EXPERT REVIEW: Although the treatingophthalmologist followed the standard ofcare for this patient, defense experts feltthe group’s practice of not seeing publicassistance patients would not reflect wellon a jury should the case go to trial. Thecase was settled for $1,000,000.

RISK MANAGEMENT ISSUES: The ophthal-mologist did not properly document thetreatment that he phoned in to the ERphysician. He should have made a note ofthe patient’s name and the fact that he wason public aid and also alerted his staff not

to turn the patient away but rather toschedule the patient for an exam (becausehe was an ER patient). Poor follow-up onthis patient contributed to the damagesand settlement of this case.

OMIC RESOURCES:Menke, A. M. TheOphthalmologist’s Role in Emergency Care:On-Call and Follow-up Duties underEMTALA. (Available at www.omic.com.)

GLAUCOMA : $1,000,000—failure todiagnose and treat glaucoma.An optom -etrist treated a 39-year-old woman for 10years. The patient regularly complained of decreasing, blurry vision. Nonetheless,the optometrist did not perform any diag-nostic tests and never referred the patientto an ophthalmologist. The only responsewas to change the contact lens prescription.Indeed, the prescription appeared to be thesole focus of the yearly visits.

ALLEGATION: Failure to diagnose andtreat glaucoma in a 39-year-old woman.

DAMAGES: The patient ended up with100 percent cupping in both eyes with lit-tle optic nerve tissue remaining.

EXPERT REVIEW: The optometrist failedto conduct the required tests on thispatient, and thus failed to meet the stan-dard of care. The ophthalmology practicealso was named in this claim because itemployed the optometrist. Two insurancecompanies eventually settled the case,with each company paying $500,000.

RISK MANAGEMENT ISSUES: The primaryrisk in this case is that the optometristfailed to diagnose glaucoma. When exam-ining and treating this patient, he didn’tuse a diagnostic process to rule out theworst possible diagnosis. The optometristfailed to consult with others in the prac-tice to determine the cause of the patient’sloss of vision. The secondary risk here isthat the employer (the group practice)may not have properly supervised theoptometrist.

REFRACTIVE SURGERY : $983,000—negligent LASIK. On Dec. 5, 2001, a 48-year-old woman had bilateral LASIK. Onday 1 postop, her visual acuity was 20/25in the right eye, 20/30 in the left. Onemonth later, the patient’s visual acuity was 20/50 in both eyes.On June 19, 2002, a retreatment on her

right eye was performed, followed by aretreatment on her left eye on July 18. Itshould be noted that the insured did dis-cuss with the patient the increased risksdue to her thin corneas. Four monthslater, the physicians referred the patient to another ophthalmologist for a secondopinion since the patient continued to bedissatisfied with her results. In May 2003,after a diagnosis of keratoconus and ecta-sia, this physician did a corneal transplanton the patient’s left eye. He stated that onOct. 28, he was planning to proceed with acorneal transplant on the right eye.

ALLEGATION: Negligent LASIK.DAMAGES: The patient was making

$250,000 a year before her surgery and$90,000 a year afterward. She had 15 years

of additional work life left with a decreasein earnings of approximately $150,000 peryear. Also, past and future medicalexpenses were estimated at $100,000.

EXPERT REVIEW: The plaintiff ’s expertsstated that the residual stromal bed neededto be 250 µm or greater. The originalphysician fell below standard of care byfailing to leave a margin of safety in thispatient with borderline findings, bothbefore LASIK and again when a retreat-ment was performed. This led to ectasia,requiring a corneal transplant. However, it was conceded that no surgeon in 2001reasonably could have predicted that thepatient would suffer from ectasia as aresult of the LASIK. Defense experts could not support

the care rendered. They opined that thepatient had keratoconus and there wereproblems with the retreatment on the sec-ond eye because of what appeared to bethe first signs of ectasia. They also felt thatthe patient had progressive ectasia beforethe retreatment, increasing the likelihoodshe would need a corneal transplant in thesecond eye. Regardless, it was felt that acorneal transplant should be able to bringthe patient back to visual acuity in the20/20 range.The case went to trial and the jury found

for the plaintiff 11-1. They awarded theplaintiff a total of $944,420 before pre-judgment interest.

RISK MANAGEMENT ISSUES: The ophthal-mologist fell below standard of care withthis patient by performing the LASIK pro-cedure despite contraindications for theprocedure.

REFRACTIVE SURGERY : $900,000—contraindicated LASIK. On Dec. 1, 2003,the ophthalmologist first saw a 47-year-old woman who expressed interest inLASIK. She had a history of myopia withastigmatism. She was also presbyopic andhad been wearing contact lenses for manyyears, and monovision contact lensesmore recently to treat her presbyopia. Her previous prescriptions for glasses wastwo years old. Visual acuity with correction was

noted as 20/40 in both eyes. Pachymetryreadings taken by staff were 485 µm and462 µm in the right eye, and 462 µm and471 µm in the left. Pupil size was 6 mm inboth eyes. The ophthalmologist discussedthe risks and benefits of LASIK and PRK.The patient elected to have LASIK.On Dec. 4, the procedure was per-

formed on both eyes. Postoperatively, the patient complained of headaches andcontinued blurriness. Two weeks later, the ophthalmologist refloated the flap.Afterward, the patient complained of star-bursts and ghosting. Visual acuity afterthe refloat was recorded as 20/40 + 3 and20/50 in the right and left eyes, respec-tively. The physician recommended aretreatment procedure, which the oph-thalmologist performed nine monthslater. The patient then complained offoggy vision and ghosting, especially in

12 f r i d a y ● s a t u r d a y e d i t i o n

VISIT THE ACADEMY/OMIC INSURANCE CENTER. Chat with insurance experts who arefamiliar with the full line of Academy-sponsored insurance programs.Where. Hall B-4, Booth #3432.

OMIC ANNUAL MEMBERS MEETING. Timothy J. Padovese, president and CEO of OMIC,will report on the company’s latest financial results. Plus, election of OMIC’s directorsand other business.When. Sunday, Nov. 9, 11:30 a.m. to noon, Room A304. Free.

OMIC FORUM: WRONG PATIENT—WRONG SITE—WRONG IOL. An in-depths review of OMICclaims will illustrate the faulty systems and practices that can cause surgical mistakes.When. Sunday, Nov. 9, 1 to 3:30 p.m., Thomas B. Murphy Ballroom 1–3. Free.

ULTIMATE CHART AUDIT. The AAOE’s “savvy coder” Sue Vichrilli, COT, OCS, and OMIC’srisk manager Anne Menke, RN, PhD, will explain how improved documentation canhelp you avoid both malpractice lawsuits and billing audits.When. Monday, Nov. 10, 9 to 11:15 a.m. A ticket for AAOE Instruction Course #358costs $70 at Ticket Sales in Hall A-2.

RISK MANAGEMENT

Atlanta: Booth and Special Events

the left eye, and continued to have prob-lems with astigmatism. A toric lens wasprescribed. In June 2006, the patientexpressed concerns about LASIK anddecrease of vision in both eyes. The oph-thalmologist noted in the medical record,“corneal ectasia OU s/p LASIK OU andenhancements OU.” The patient wasreferred to another ophthalmologist whodiagnosed ectasia, noting a pattern thatwas consistent with pellucid marginaldegeneration. He recommended that thepatient try a post refractive surgery reversegeometry lens. The physician reportedback to the referring ophthalmologist thathe “discussed with her the possibility that acorneal trans plant may be necessary if shefeels that her vision is inadequate withglasses and if she does not tolerate contactlenses.” He found visual acuity with herexisting glasses to be 20/60 in the right eye and 20/50 in the left. An OMIC review of the claim found

the LASIK procedure was contraindicateddue to abnormal topography as evidencedby asymmetrical inferior steepening andabnormal corneal irregularity measure-ment on the Humphrey greater than 1.0.In addition, the patient’s corneal thicknesswas 0.480 OD and 0.460 OS, which is alsoabnormal. The patient did not do wellpostoperatively, and the insured com-pounded the problem by doing bilateralretreatments even though topography was even more abnormal and refractionshowed loss of BCVA.

ALLEGATION: Contraindicated LASIK inthe right eye.

DAMAGES: Lost wages claim of approxi-mately $400,000 and a potential for higheraward due to significant medical issueswith the physician.

EXPERT REVIEW: The defense expert wasnot able to support the case. He opinedthat the preoperative corneal topography,showed inferior nasal steepening andoblique astigmatism, indicating formfruste keratoconus. In addition, thepatient had thin corneas. Retreatmentmade her ectasia worse. The case was settled for $900,000. RISK MANAGEMENT ISSUES: The ophthal-

mologist’s preoperative assessment of thispatient was incorrect. Topography findingsand the patient’s thin corneas should havestrongly ruled out LASIK.

REFRACTIVE SURGERY : $850,000—contraindicated PRK. On May 23, 2005,the patient was evaluated by one ophthal-mologist in the practice and was noted tobe a good candidate for LASIK. Pachyme-try revealed a corneal thickness of 474 µmin both eyes. The patient had a correctedvisual acuity of 20/30 but could not becorrected to 20/20 with glasses. Topogra-phy was done, but the medical recordshows no interpretation.On Aug. 3, the patient returned and

was seen by another ophthalmologist, and it was this second physician who wasnamed in the case. During this visit, thecorneal thickness was noted as 473 µm in the right eye and 442 µm in the left.Topography was repeated without anycomment on the findings. Uncorrectedvisual acuity was 20/400 in the right eyeand 20/200 in the left. The patient signeda LASIK consent form at that time. Thepatient was warned of the risks of operat-ing on both eyes at the same time, but heclearly expressed a desire to have both eyesdone at the same time.On Aug. 12, the ophthalmologist sug-

gested the patient undergo PRK instead ofLASIK due to pachymetry and topography.No specific PRK consent form was signed.The ophthalmologist signed off on theLASIK consent and proceeded with PRK.On Aug. 13 (day 1 postop), the patient

was doing well with UCVA of 20/100 inboth eyes. However, by Aug. 15 (day 3 post -op), UCVA was 20/50 and the patientcomplained of blurry vision, which wasworse in the right eye than the left. On Aug. 19, UCVA decreased to 20/200.

The ophthalmologist noted corneal haze,greater in the right eye than in the left.When seen on Aug. 23 and 25, the patientwas doing better but UCVA had notimproved. On Aug. 29, the insured wrote a letter to the patient’s disability insurancecarrier that stated the patient had under-gone an uneventful PRK procedure but

had experienced a severe complicationknown as corneal ectasia. The resultingdecrease in visual acuity made it impossiblefor the patient to drive or work, and theophthalmologist stated that the patientwas totally disabled. On Sept. 6 and 7, theophthalmol ogist fitted the patient withspecial lenses to combat the weakenedcornea. On Sept. 14, the ophthalmologistdocumented corrected vision of 20/60 inthe right eye and 20/50 in the left. Howeverthe patient could not tolerate the contactlenses in spite of trying several pairsspecifically ordered to deal with ectasia.On Dec. 28, when the patient visited theophthalmologist for the last time, visualacuity with contact lenses was 20/200.

ALLEGATION: PRK contraindicated bytopography. Improper informed consent.

DAMAGES: Loss of future earnings, whichis reflected in the settlement of $850,000.

EXPERT REVIEW: The plaintiff ’s expertalso was the subsequent treater and hadconsiderable credibility as a witness. Heopined that the patient had keratoconusin the left eye and form fruste keratoconusin the right eye. He believed the ophthal-mologist violated the standard of care forPRK on the left eye, but he conceded formfruste keratoconus is not an absolute con-traindication to PRK. He also said that thepatient never should have undergone PRKin both eyes simultaneously. The defense experts could not support

the physician’s decision to proceed withsurgery in the face of the topography.Also, they believed that it would be diffi-cult to defend the informed consent issue.

RISK MANAGEMENT ISSUES: If there is achange in procedure, the patient’s informedconsent process must be redone and doc-umented. Also, the topography skills ofthe surgeon must be current.

OMIC RESOURCES: Menke, A. M. Obtain-ing and Verifying Informed Consent. (Avail -able at www.omic.com.)

RETINA : $800,000—negligent resusci-tation. A 45-year-old male patient wasscheduled to undergo a panretinal photo-

coagulation in his left eye with indirectlaser and pars plana vitrectomy with endo -laser in his right eye. Prior to surgery, theophthalmologist noted proliferative dia-betic retinopathy with vitreous hemor-rhage in both eyes. The patient underwentperibulbar injection in the right eye andintravenous sedation. However, both pro-cedures were interrupted by a cardio -pulmonary event. Intravenous sedationwas given by the anesthesia staff (CRNA),who used 4 mg of midazolam and 100 µgof fentanyl. The patient became unrespon-sive. While 911 was called, the CRNA intu-bated the patient with an endotrachealtube and maintained respiration with anambubag with oxygen at the maximumlevel. A stetho scope was used to confirmthe endotracheal intubation. EMS arrivedand took charge of cardiopulmonaryresuscitation, later noting that the initialintubation was not successful (the tubewas in the esophagus). The patient waseventually admitted to the hospital, wherehe was diagnosed with anoxic encephal -opathy with second ary myoclonic jerking.The patient died two months later.

ALLEGATION: Vitrectomy, negligentresuscitation resulting in death.

DAMAGES: DeathEXPERT REVIEW: Experts for both the

plaintiff and the defense felt that the negligence in this case centered on theanesthesia care as well as response to thecardiopulmonary event. The case was ulti-mately settled for $800,000 because it wasthought that there was less than a 50 per-cent chance of a defense verdict for theophthalmologist.

RISK MANAGEMENT ISSUES: During cre-dentialing, ensure that the CRNAs havecurrent competency in situations withoutbackup. Consider calling 911 if a patient’scondition deteriorates. And ensure thatthe physician and staff have current train-ing in Basic Life Support for health careproviders.

OMIC RESOURCES: Menke, A. M. Anes-thesia Liability. (Available at www.omic.com.)


RISK MANAGEMENT

Physicians have experienced arespite from rising malpracticeinsurance costs in recent years with

premiums falling in many regions of thecountry. Most industry experts expect thegood news for doctors will continue foranother year or two as insurance carriers’balance sheets remain relatively strongdue to better underwriting results.Although claims related to retinopathy

of prematurity have emerged as a concerndue to the potential for large losses, oph-thalmology is, in many instances, faringbetter than other specialties. The largest carrier in ophthalmology,

OMIC, implemented large policyholderdividend returns totaling more than 35percent over the past three years in addi-tion to significant rate decreases varying

by state and averaging nearly 22 percentduring the same three-year period. Since 2000, OMIC has outperformed

multispecialty carriers, and it credits thisto two factors: the favorable risk profile ofophthalmologists compared with physi-cians in other specialties plus its focusedunderwriting and risk management philos-ophy. OMIC has been at or near the top ofthe list of physician-owned carriers in theUnited States when measuring combinedand operating performance ratios. Someobservers opine that OMIC’s strong resultsduring the difficult market conditions afew years ago prompted the shift frommultispecialty programs.

Learn more about OMIC. Talk to OMICrepresentatives at the Academy/OMICInsurance Center (Hall B-4, Booth #3432).

Malpractice Rates Continue Falling

OMIC provides a rich array of resourcesfor physicians at www.omic.com.These include risk management

recommendations that feature detailedanalysis of many important liability risksfaced by practicing ophthalmologists.This information minimizes the risk ofpatient harm and reduces the likelihoodof allegations of professional liability. Physicians can browse the OMIC publi-

cation archives, which feature dozens ofarticles in the following 11 categories:ophthalmic clinical risk management;closed claims studies; policy issues; gen-eral office risk management; litigationand claims handling; informed consent;

comanagement; documentation and recordkeeping; patient relations; managed care;and advertising and marketing.The OMIC Web site also provides many

subspecialty-specific consent forms (includ -ing some in Spanish) as well as patientsafety advisories for use in a physician’smedical office.OMIC also offers an array of online risk

management courses for ophthalmologistswho are unable to attend live seminarsand audioconferences. These interactivecourses allow physicians an alternativemethod to earn CME credits and an OMICrisk management premium discount ontheir professional liability policy.

More Online

INVEST IN YOUR FUTURE TODAY

VISIT THE ACADEMY

Resource Center

ACADEMY STOREEnjoy a 10 percent discount when youplace an order of $250 or more at TheAcademy Store. Most products are avail-able to be picked up today, or you can haveyour order shipped back to your office.

ADVOCACYThe Federal Affairs & OphthPAC deskis the place to be to send a letter to yourmembers of Congress on issues of impor-tance to ophthalmology. You also can speakto experts on Medicare reimbursementand regulatory issues, and you can make a donation to OphthPAC.

Go to the State & Subspecialty Relationsdesk to find out how the Academy is work-ing with state and subspecialty societies.Ask about optometric scope of practiceand the Surgical Scope Fund.

CLINICAL EDUCATION: CD-ROMS ANDDVDSView the Academy’s latest clinical educationdigital media:� BCSC. The CD-ROM set includesBCSC Sections 1–13. You can search, writenotes, highlight text, bookmark importantsections and link to PubMed references.Special discounts are available for CD-ROM/print combination orders. BCSC

Online is also available. You can access all 13 sections from any computer with an Internet connection. This online for-mat confers password-protected access,enhanced search capabilities and user-friendly features.� Front Row View: Video Collections ofEye Surgery. Watch up-to-date video clipsof surgical procedures.� Clinical Skills Video Series. Take a lookat demonstrations of the clinical skillsneeded across several disciplines of oph-thalmology.� The Video Atlas of Eye Surgery Series—Phacoemulsification: 3. Complications,Discs 1, 2 and 3. Browse the latest volumesof this video-based training program. Top-ics include local anesthesia, capsulorhexis,hydrodissection, wound burn and cham-ber-shallowing techniques. Surgicalvideos are supplemented with custom-built graphics and 3-D animations. Eachvolume is sold separately and is availablefor purchase online as streaming video.� LEO Clinical Update Course. Clickthrough DVDs in the Lifelong Educationfor the Ophthalmologist Clinical UpdateCourse series, including the latest titles,Orbit and Ophthalmic Plastic Surgery andPediatric Ophthalmology and Strabismus.� Eye Care Skills CD-ROM. Check out

this tool for giving educational and train-ing presentations to nonophthalmic physi-cians and health care professionals. TheCD-ROM also features a library of clinicalimages, text slides and speaker notes.

CLINICAL EDUCATION : O.N.E.Check out the Ophthalmic News & Edu-cation (O.N.E.) Network, the Academy’scomprehensive online educational portal,which enhances your ability to access rele-vant clinical information from an extensiveknowledge base. O.N.E. saves you time bycombining a suite of educational toolswith aggregated clinical content from avariety of trusted sources.

CLINICAL EDUCATION: PRINTView the Academy’s latest clinical educa-tion print media:� BCSC. The 13 volumes of this year’sBasic and Clinical Science Course includefour major revisions—Section 10: Glau-coma; Section 11: Lens and Cataract; Sec-tion 12: Retina and Vitreous and Section13: Refractive Surgery.� Focal Points. Stay up to date with asubscription to Focal Points: ClinicalModules for Ophthalmologists. Availablein online and print versions.� ProVision: Preferred Responses in Ophthalmology. Assess your ophthalmicknowledge and stay current on a range ofclinical issues with a two-volume set thatcontains 450 questions and discussions innine subspecialty areas, including therapidly changing field of keratorefractivesurgery. Featuring the same content as theprint series, the online version offers thecapability to access the self-assessmentquestions and discussions online.� Color Atlas of Gonioscopy. Browsethrough the second edition of the textdesigned for clinicians wishing to be pro-

ficient in examining the anterior segment.The book also includes a DVD of videoclips demonstrating basic and advancedgonioscopic techniques.

CME REPORTING To report your Atlanta CME, either type it inat a CME Reporting/Proof of Attendancekiosk or fill out your Final Program’s CMEform, which you can drop off at the Mem-ber Services desk or mail to the Academy.

ETHICSVisit the Maintenance of Certificationkiosk to see a live demo of the Academy’sthree free online ethics courses and todownload MP3s of the same courses.Information about other ethics programofferings will be available at the MemberServices desk where staff are available toanswer questions.

EYESMART AND COMMUNICATIONSCheck out the EyeSmart desk to catch upon the Academy’s public awareness cam-paign and other media-related activities.� EyeSmart. This year’s focus is prevent-ing eye injuries. Learn more about thecampaign’s efforts at the EyeSmart deskand ask how you can get involved. Sign up to receive free educational materials(available to U.S. members) and pick up a free EyeSmart gift.� Media Relations. View a tape of the topophthalmology stories in the mainstreamnews from the past year featuring yourcolleagues, and sign up to become a clini-cal correspondent yourself.

MAINTENANCE OF CERTIFICATIONThe MOC Exam Study Kit is availableonline through the O.N.E. The kit—anAcademy member benefit—includes com-prehensive study outlines, study questions


FIND IT FASTThe Academy Resource Center (Hall B-4, Booth #3532) is designed so that

you can swiftly find what you need. Kiosks are clearly labeled (see map),

and Academy staff are on hand at the Information desk and throughout the

exhibit to help you zero in on the resources that will be most useful for your

practice. If you only have a couple of minutes to spare, head straight for the

New Products display.

RESOURCES

Are you taking advantage of the Academy’s array of

resources? The Academy Resource Center will help

you build and maintain a flourishing practice.


and timed exams for 10 practice emphasisareas and Core Ophthalmic Knowledge (arequired DOCK exam module). Ask to seea live demo at the Maintenance of Certifi-cation (MOC) kiosk.

MEMBER SERVICESVisit the Member Services desk to perusethe 2008–2009 Member Directory; dropoff your CME form; pay dues; updateyour phone, fax, address, e-mail or bio-graphical information; pick up an appli-cation form for ISRS/AAO or AAOE; andget information on the awards program.

PATIENT EDUCATIONExplore the latest Academy’s patient edu-cation materials:� Patient Education DVDs. Check outthe updated Understanding Age-RelatedMacular Degeneration DVD, whichexplains nonproliferative and proliferativediabetic retinopathy from both the physi-cian’s and patient’s perspectives. Alsoperuse the revised Understanding DiabeticRetinopathy DVD featuring real AMDpatients discussing their experiences withthe disease and physicians discussing diag-nosis and treatment options. Both DVDsinclude a Spanish-language option.� Patient Education print media. Take alook at the latest offerings, including theEndothelial Keratoplasty (EK) and LaserTrabeculoplasty brochures, the EnhancedLens Options for Cataract Surgery bookletand the BPH Medications and Eye Surgeryeye fact sheet.� DVD Personalization Booth. Add yourown on-camera introduction to an Acade-my DVD.� Digital-Eyes Ophthalmic Animationsfor Patients and Personal-Eyes CD-ROMSet. Check out the Academy’s Digital-EyesOphthalmic Animations for Patients CD-ROM, featuring a collection of more than40 high-quality animated segments show-ing and discussing a wide variety of eyeanatomy and treatment topics. Also seethe Personal-Eyes CD-ROM, featuringmore than 200 customizable patient edu-cation handouts.� PowerPoint. See the Academy’s patienteducation PowerPoint collections, designedto help you make complete presentationsto patients, community groups, nonoph-thalmic medical professionals and others.

PERIODICALSVisit the Academy Periodicals desk tolearn about the Academy’s informationalresources.� Academy Express. This e-newsletteroffers highlights from peer-reviewed clini-cal journals, opinions from leading expertsin the field, as well as news from the Acad-emy and your regional ophthalmic society.Academy Express is e-mailed to ophthal-mologists around the globe every week.� Ophthalmology and EyeNet. Check out the Academy’s highly esteemed peer-reviewed journal and news and clinicalupdate magazine.� The Web site. Drop by and offer yourfeedback on www.aao.org.

PRACTICE MANAGEMENT/AAOEWant to know what reference and trainingresources are available? Have your ques-tions answered at the following kiosks andhelp desks:� AAOE Practice Management Center.Get advice from practice managementexperts (appointments are recommend-ed) and browse through the entire prod-uct line of the AAOE.� Coding & Reimbursement desk.Browse the ICD-9 for Ophthalmology;ICD-9 Quick Reference Cards; the CPTStandard and Professional Editions; theHCPCS manual; the CPT Pocket Guide forOphthalmology; as well as Code This Caseand the Ophthalmic Coding Coach bookand CD-ROM. Find out about the latestmodules in the Ophthalmic Coding Seriesand the Ophthalmic Coding SpecialistExam Flash Cards.� A+ Marketing: Proven Tactics for Suc-cess. Learn how to identify cost-effectivemarketing opportunities for you practice.This book contains ideas, action plans andexamples from successful practices.� Dispensing for Ophthalmologists—What MDs and Administrators Need to

Know to Operate a Profitable Dispensary.Discover the practical aspects of openingan optical dispensary and operating it atpeak profitability.

QUALITY OF CARE & KNOWLEDGE BASEBrowse through the Academy’s PreferredPractice Patterns and Summary Bench-marks. You can download the Bench-marks onto your PDA at the Quality ofCare & Knowledge Base desk and theTechnology Pavilion (where it is alsoavailable in a BlackBerry format).Remember to ask about the new Oph-thalmic Technology Assessments: Anti-VEGF Pharmacotherapy for AMD; Safetyof Overnight Orthokeratology for Myopia;Wavefront-Guided LASIK for the Correc-tion of Primary Myopia and Astigmatism;Aqueous Shunts for Glaucoma; andOrbital Radiation for Graves Ophthal-mopathy, as well as newly revised PPPs:Age-Related Macular Degeneration; Bac-terial Keratitis; Blepharitis; Conjunctivitis;Diabetic Retinopathy; Dry Eye Syndrome;Idiopathic Macular Hole; and PosteriorVitreous Detachment, Retinal Breaks, andLattice Degeneration.

THE ACADEMY RESOURCE CENTERHALL B-4, BOOTH #3532

AND WHILE YOU’RE HERE...Take a moment to visit the neighbor-ing exhibits:

Foundation of the American Academyof Ophthalmology (BOOTH #3440)This public service foundation is dedi-cated to reducing avoidable blindnessand severe visual impairment.

Museum of Vision (BOOTH #3440)Visit “Eye Seeing Eye: Art and Ophthal-mology” to explore the crossroads of artand medicine. The exhibit showcasesthe museum’s unique collection ofworks specifically devoted to ophthal-mology and sight. It also explores howart movements have influenced thedesign of diagnostic and surgical instru-ments, inviting viewers to appreciatethese artifacts like works of fine art.

The Academy/OMIC Insurance Center (BOOTH #3432)Consult with insurance experts familiarwith the full line of Academy-sponsoredinsurance programs specially designedfor ophthalmologists.


AQUATIC EYES

IN THE GEORGIA EXPLORER GALLERY—possi-bly the oldest extant compound eye. Thehorseshoe crab has been with us for morethan 500 million years and has changedlittle during that time. It boasts the largestommatidia (individual eye facets) of anyanimal, and it has approximately 1,000 ofthese ommatidia in each of the two lateraleyes. Look for the two visible median eyesat the front of the carapace. Now look forthe small eyes immediately behind the lat-eral eyes; these “extra” eyes are for circadi-an rhythm. The horseshoe crab has a totalof 10 eyes if you count the eyes on theventral surface! It even has photoreceptorslining its tail.

The species has helped researchersunderstand visual processing. Because ithas very large nerves transmitting imagesfrom those very large ommatidia, it wasan early subject in the study of vision.

IN THE RIVER SCOUT GALLERY—eyes withelectric cataracts. Electric eels use theirshocks to subdue prey, but with each dis-

charge of direct current their lenses devel-op just a bit more cataractous change.Older eels will have dense cataracts fromthese repeated shocks. However, thesecataracts won’t diminish an eel’s huntingskills because it relies mostly on sensorymechanisms other than vision.

IN THE COLD WATER QUEST GALLERY—eyes that could put the retina surgeon out of business. If you get a chance, go seethe octopus. There are many intriguing

A WORLD OF WONDER. During the opening hour of Sunday’s

Orbital Gala you’ll have the chance to explore Atlanta’s spectacular aquarium,

the largest in the United States. You’ll find animals—some common, some

not-so-common—that must interact with the world visually. And as ophthal-

mologists, we are prone to wonder, “Just how do these animals see?”

The aquarium is divided into five galleries: Georgia Explorer, River Scout,

Cold Water Quest, Ocean Voyager and Tropical Diver. All of these are filled with

wonderful surprises, with each specimen having its own interesting story.

Here are just a few examples.

Join Your Colleagues for Some Visual SurprisesAt the

Aquarium

THE ACADEMY FOUNDATION’S ORBITAL GALA takes place on Sunday, from 5 p.m. ’til late at theGeorgia Aquarium. Enjoy a private viewing of the aquarium’s specimens until 6 p.m., when themain exhibits area will close. At 6 p.m., head upstairs to the ballroom for dining, dancing and—new this year—a silent auction. Need tickets? Tickets cost $300 each, and a limited numbermay still be available on a first-come, first-served basis. To check availability, visit the Estateand Planned Giving Office in Room A406-407 of the Convention Center on Saturday (8 a.m. to 2 p.m.) or Sunday (8 a.m. to 1 p.m.).

by ivan r. schwab, md

GE

OR

GIA

AQ

UA

RIU

M

The Horseshoe Crab witnessed the riseand fall of the dinosaurs. You can get tac-tile with this living fossil at the aquarium’stouch pools (Georgia Explorer gallery).

Five Galleries and 500 Different Species

aspects to this fascinating species. Think,for instance, about their visual system.They have an odd horizontal pupil thatcan close virtually completely, like windowblinds. The retina is everted, meaning thatthe photoreceptors point toward the lens.There are no intervening amacrine, hori-zontal or ganglion cells. Hence, there is no blind spot and no chance of a retinaldetachment.

But the really intriguing aspect of anoctopus’ vision is this: Octopi can changecolors in response to threats or whenhunting but, surprisingly, they are colorblind and have only one visual pigmentwith peak absorption at approximately475 nm. How does this work? No oneknows.

IN THE OCEAN VOYAGER GALLERY—thenose that knows. Sharks are invariablyamong the most popular exhibits at anaquarium, and the hammerhead sharkarouses an additional fascination due tothe peculiar shape of its head. What evo-lutionary advantage did this give it?

The hammerhead family emerged asan evolutionary anomaly more than 24million years ago. The unusual shape of itshead allows for improved electroreceptionand stereo-olfaction. Hammerheads cancompare an odor from one side of its headto the other, and as they swim you’ll seethem swing their heads from side to sideto make the most of this ability. They alsohave among the largest olfactory bulb-to-brain ratios of any species and can detect

blood in sea water at concentrations aslow as one part per 25 million.

For ophthalmologists, an interestingfootnote to the unusual morphology of itshead is that the optic nerves extend a footor more from the eye to the brain.

IN THE TROPICAL DIVER GALLERY—eye of a predator. Depth perception is criticalwhen hunting prey, but how do fish achieveadequate stereopsis if their eyes are posi-tioned on the sides of their head? Someintriguing evolutionary adaptations havesolved this problem, as illustrated by theKoran angelfish. Like most predatory fish,it has a horizontally oval pupil. This pupilis pear-shaped, with the apex of the “pear”pointing toward the nose. When examin-ing these fish, you will see the edge of thelens in the pupil’s periphery. The spaceanterior to the edge of the lens is knownas the aphakic space. Now, if you lookhead-on at that fish, you can see that theaphakic space permits the image to tra-verse the lens to the periphery of the reti-na where the fovea resides. If the pupilwere round, the edge of the pupil wouldinterfere with the transmission of light tothe fovea. In other words, the aphakicspace permits this fish to be stereoscopic.

Note that this eye continues to growthroughout life and that should move thefovea toward the posterior pole. But thatdoesn’t happen because there are retinalstem cells at the periphery of the retina.These stem cells continually supply theeye with enough photoreceptors to permitthe retina to continue to grow, keeping thefovea in the same topographical location.

Bright shades of gray. The coral reefexhibit can be mesmerizing, with sleekcolorful fish and beautiful corals. But didyou ever wonder why the fish are so color-ful? Wouldn’t it be counterproductive andeven dangerous to call attention to oneselfwith all these colors? Many of these fishare bathed in complementary colors.When viewed at close range, these brightcolors are important for communicationand mating. But when viewed from a“patrolling” distance—as when, forinstance, a shark is cruising the reef—these colors come together in a receptive

field of vision, and what the shark per-ceives is gray. The colorful fish simplyblend into the background. If the fishwere a single color, they would stand outagainst the reef, but “gray” fish blend in.

NOT GOING TO THE ORBITAL GALA? If you’renot able to attend the Foundation’s OrbitalGala but still want to visit the GeorgiaAquarium, you can go online at www.georgiaaquarium.org for current hours ofoperation and to book tickets. You alsocan purchase tickets by calling 404-581-4444. This popular attraction is some-times filled to capacity, so advanced book-ing is highly recommended.

The Georgia Aquarium is located indowntown Atlanta at 225 Baker St. NW,across from Centennial Olympic Park.

If you don’t have a chance to chat with Dr. Schwab during Sunday’s Orbital Gala, youcan attend one of his Instruction Courses.

Evolution’s Witness takes place on Monday from 9 to 10 a.m. Although visual devel-opment probably began in the Precambrian period, it was the Cambrian explosion thatspawned an incredible variety of ocular systems. Some are merely curiosities, while oth-ers offer the finest visual potential packed into a small space, limited only by the lawsof diffraction or physiological optics. We should be so lucky. (Event Code 338; ticketscost $35 each.)

A Natural Festival of Light and Color takes place on Tuesday from 11:30 a.m. to 12:30p.m. The subtle splendor of the green flash, the thrill of the rainbow, Alexander’s phe-nomenon, the lunar corona, the Specter of the Brocken, the fog bow and the surrealfata morgana are examples of refraction, diffraction and reflection. These and othernatural events will be revealed, explained and admired (Event Code 587; $35).

Dr. Schwab is a professor and director of cornea and external disease at the Univer-sity of California, Davis. He is the proud recipient of the 2006 Ig Noble award inornithology and his forthcoming book, Evolution’s Witness, will be published by OxfordUniversity Press in February 2010.

Meet the Expert


The Electric Eel’s unusual hunting technique can have shocking repercussions forits visual health (River Scout gallery).

The Giant Pacific Octopus employs asharp visual acuity, along with remark-able intelligence, when hunting its prey(Cold Water Quest gallery).

AQUATIC EYES

The Koran Angelfish enjoys binocularvision despite its eyes being on the sideof its head (Tropical Diver gallery).

OP

HTH

AL

MIC

IM

AG

ES

CD

, V

ER

SIO

N 2

.0

Time Management for ManagersEvent Code 216, $35, Sunday, 2 to 3 p.m.

Using RVUs to Manage Your PracticeEvent Code 217, $35, Sunday, 2 to 3 p.m.

Conquering Patient Flow ProblemsEvent Code 250, $70, Sunday, 3:15 to4:15 p.m.

Spotlight on Practice Efficiency: Preparingfor the BoomersEvent Code Sp01, no ticket required,Sunday, 3:45 to 5 p.m., in Room #A411.

Efficient Ambulatory Surgery Center Management PracticesEvent Code 341, $35, Monday, 9 to 10 a.m.

Using Benchmarks to Improve Your PracticeEvent Code Spe26, no ticket required,

Monday, 10:15 to 11:15 a.m., in Room#B303.

Physician Productivity: Maximizing It WithSystems and StaffingEvent Code 461, $35, Monday, 4:30 to5:30 p.m.

Staff Training for EfficiencyEvent Code 462, $35, Monday, 4:30 to5:30 p.m.

Retina-Specific Patient FlowEvent Code 538, $70, Tuesday, 9 to 10 a.m.

Designing Medical Office Space: How toCreate Efficient, Effective, and Patient-Friendly Office SpaceEvent Code 575, $70, Tuesday, 10:15a.m. to 12:30 p.m.

It’s a reality that 80 million Baby Boomerswill begin to retire over the next fewyears. Since many eye diseases are relat-

ed to aging, ophthalmologists will play aparticularly important role in the health careof this population. And yet the number ofophthalmologists is not expected to increaseover the next 20 years. The combination ofthese facts points to heavier patient loadsfor ophthalmologists in the near future.

A higher patient-to-provider ratio can bea blessing for those physicians who run veryefficient practices. While it takes some fore-thought and commitment to develop and implement a plan for improving practice effi-ciency, it is well worth the effort for Eye M.D.s and the patients they serve. At the JointMeeting, there are 10 sessions to get you started thinking about how to ramp up yourpractice’s efficiency:

For more practice management sessions, see your Pocket Guide or Final Program.

I M P R O V E Y O U R P R A C T I C E ’ S E F F I C I E N C Y


HONORARY LECTURES

Named for highly respected figures inophthalmology, most honorary lec-tures take place during a Sympo-

sium and they often serve as the corner-stone for the session. If you can’t attendthe entire Symposium, consider makingtime in your schedule to hear the hon-orary lecturer’s presentation.

The newest honorary lecture at theAcademy is the Charles L. Schepens MDLecture, which takes place today (Friday)during the Retina Subspecialty Day meet-ing. The other lectures below will be pre-sented on Sunday and are all free; no ticketis required.

CHARLES L. SCHEPENS MD LECTUREHarvey A. Lincoff, MD, will present TheEvolution of Retinal Surgery: A PersonalStory (9:54 to 10:14 a.m.) on Friday duringRetina Subspecialty Day. This combinedmeeting with the American Society of Reti-na Specialists, Macula Society, Retina Soci-ety and Club Jules Gonin takes place onFriday and Saturday in Hall A-3 SessionRoom.

ABOUT THE LECTURE. Harvey A. Lincoff,MD, has a passion for the retina that hasnot been diminished by age or time. ToDr. Lincoff, it feels like yesterday when hetraveled as a senior resident in 1954 from

Bellevue Hospital in New York City to the Massachu-setts Eye and EarInfirmary to meetCharles L. Schepens,and saw firsthandthe wonders of thehands-free indirectbinocular ophthal-moscope that Dr.Schepens haddesigned. With it Dr.

Schepens would make a meticulous draw-ing of the detached retina and the retinalbreak preoperatively. With the drawing ondisplay in the operating room, he foundand sealed the break and reattached theretina with remarkable frequency. “WhenI returned to New York,” Dr. Lincoff said,“I began with the Schepens scope to attachretinas and have been doing so ever since.”

While Dr. Lincoff had the greatest admi-ration for Dr. Schepens, they were notwithout their differences. “When I intro-duced cryopexy for retinal detachment,Dr. Schepens stood by the hot diathermyneedle approach; we would debate the twotechniques at society meetings. Our peerswould introduce us as Drs. Hot and Cold.”

During his lecture, Dr. Lincoff will sharesimilar stories and give the audience a rarepersonal glimpse at the dynamic historyof Dr. Schepens and retinal surgery.

ABOUT THE SPEAKER. Dr. Lincoff is pro-fessor of ophthalmology, Newhouse Clini-

cal Scholar and attending surgeon at theNew York–Presbyterian Hospital WeillCornell Medical Center in New York City.In addition to introducing cryopexy forretinal detachment, he pioneered the useof the straight chain perfluorocarbon

gases for the treatment of complicateddetachments. He authored the classic 1971paper “Finding the Retinal Hole,” whichstill retains relevance.

RESEARCH OPPORTUNITIES. Dr. Lincoffsaid that while scleral buckling may be

becoming a “lost art,” advances are beingmade in the vitrectomy technique to attachthe retina. Research continues into thedevelopment of smaller and finer instru-mentation. The ultimate research oppor-tunity is retina transplantation, where the

MAKE TIME FOR THESE PRESENTATIONS

Five Leaders Discuss History, Today’s Issues by lori baker schena, contributing writer

See retina historythrough Dr. Lincoff’seyes.


peripheral retina would be transplantedinto the central retinal region and func-tion there. —L.B.S.

Some history about Dr. Schepens andhow his eponymous lecture came aboutcan be found at the end of the honorarylecture previews on page 22.

JACKSON MEMORIAL LECTUREFrederick L. Ferris III, MD, will presentClinical Trials: More Than an Assessmentof Treatment Effect (9:32 to 9:57 a.m.)during the Sunday Opening Session (8:30to 10 a.m.), which takes place in Hall A-3Session Room.

ABOUT THE LECTURE. No one can disputethat clinical trials are expensive to run.Yet the value of this research extends waybeyond the treatment effects, noted Fred-erick L. Ferris III, MD. “We gather vitaldata beyond the scope of the original trial,and the worth of these data cannot beunderestimated.”

In his lecture, Dr.Ferris will give a his-torical perspectiveof clinical trials andthe National EyeInstitute, and he willprovide severalexamples of thevalue of clinical tri-als over time. “Forexample, I thinkpeople forget howmuch ridicule washurled early on at the idea of scatter pho-tocoagulation for diabetic retinopathy,”Dr. Ferris said. “Scatter photocoagulationmade about as much sense then as did thepattern bombing in North Vietnam.”Yetfindings from the Diabetic RetinopathyStudy Research Group dramatically iden-tified high-risk proliferative diabeticretinopathy and definitively demonstrat-ed that the benefits of photocoagulationoutweighed the risks.

Dr. Ferris cited other studies, includingthose from the Diabetes Control and Com-plications Trial Research Group, whichfocused on blood glucose control, andfrom the Retinopathy of PrematurityResearch Group, which dramaticallyexpanded ophthalmology’s understandingof the risk factors for ROP that currentlyare in daily use in our neonatal nurseries.

ABOUT THE SPEAKER. Dr. Ferris is NEIclinical director and director of the Divisionof Epidemiology and Clinical Researchthere. He joined the NEI in 1973. He waschairman of the Age-Related Eye DiseaseStudy starting in 1992 and cochairman ofthe Early Treatment Diabetic Study, whichbegan in 1980.

RESEARCH OPPORTUNITIES. “The mostchallenging and interesting new researchopportunity is the development of moreeffective approaches to slowing or stoppingthe progression of age-related maculardegeneration before it reaches the neovas-cular stage,” said Dr. Ferris, and he added,“Accumulating evidence points to newimmunologic pathways and possible new

treatment approaches for AMD.”CHALLENGES AHEAD. In terms of research,

it is a challenge to get continued fundingfor clinical trials from government andindustry.“The costs, along with the bureau-cratic burden, including IRB and privacyprotocols, are creating more and more ofa challenge to good clinical research,” Dr.Ferris said. —L.B.S.

BARRAQUER LECTURERoger F. Steinert, MD, will present CornealSurgery Is Refractive Surgery (11:50 a.m.to 12:10 p.m.) during the Sunday Sympo-sium titled 25th Anniversary of theExcimer Laser (10:45 a.m. to 12:15 p.m.).This combined meeting with the Interna-tional Society of Refractive Surgery of theAmerican Academy of Ophthalmology and the European Society of Cataract andRefractive Surgeons takes place in Hall A-3Session Room.

ABOUT THE LECTURE. Roger F. Steinert,MD, observes that ophthalmology hasmade great strides in improving opticalperformance through refractive surgery,and more recently, cataract surgery.“Indeed,” he said, “cataract surgery is notjust an anatomical procedure but also arefractive procedure in which we recog-nize and meet a patient’s vision needs—whether that involves making limbalrelaxing incisions or implanting a pres-byopia-correcting IOL.”

According to Dr. Steinert, the time has come to take a similar approach tocorneal transplantation surgery. “We havemade great strides in replacing cloudycorneas with clear corneas,” he said. “Yetour ability to achieve optically excellentcorneas comparable to natural corneashas lagged seriously behind this anatomicsuccess.”

His lecture willfocus on recognizingthat corneal surgeryis refractive surgery.While half the job isachieving an anatom-ically clear cornea,the profession nowmust focus on theother half—givingpatients the optimaloptical performance,he said. This includesborrowing the toolsof refractive surgery such as LASIK andPRK once the corneal transplant hashealed, and using the femtosecond laser toobtain better healing and optical contour.

ABOUT THE SPEAKER. Dr. Steinert is pro-fessor and vice chairman of clinical oph-thalmology at the University of California,Irvine. He has authored or coauthoredfour textbooks, including the definitivetext, Cataract Surgery, now in its secondedition, and he has published more than120 peer-reviewed journal articles and 60book chapters.

Dr. Steinert served on the HarvardUniversity Medical School faculty from1981 until he was recruited to the Univer-

HONORARY LECTURES

Dr. Ferris offers in-sight into the valueof clinical trials.

The bar must beraised for cornealsurgery outcomes,says Dr. Steinert.


sity of California, Irvine in 2004.RESEARCH OPPORTUNITIES. There are two

hot areas in research, and they intersect.These are the development of the ultimateendothelium transplant, and the develop-ment of femtosecond laser incision tech-niques to create better incisions and mini-mize distortion, Dr. Steinert said.

CHALLENGES AHEAD. “Throughout all ofmedicine, we have an aging populationthat is living longer, so these people areexperiencing more degenerative disease.Yet they have high expectations of retain-ing bodily function and not quietly slip-ping into infirmity,” Dr. Steinert said.

“This ongoing disconnect betweendemand and expectation will place enor-mous economic pressure on the system.So far, the general public does not haveany sense of that conflict nor any percep-tion that this is an unavoidable issue.”—L.B.S.

WHITNEY G. SAMPSON LECTUREGeorge A. Stern, MD, will present CornealInfections in Contact Lens Wearers: WhatHave We Learned? (3 to 3:25 p.m.) duringthe Sunday Symposium titled Ectatic Dis-eases of the Cornea: Treatment With Con-tact Lenses or Surgery (2 to 3:30 p.m.).This combined meeting with the ContactLens Association of Ophthalmologists takesplace in Room A411.

ABOUT THE LECTURE. As long as therehave been soft contact lenses, there have

been corneal infec-tions. “Theorieshave evolved overtime about whythese infectionsoccur,” said GeorgeA. Stern, MD.“Three years ago—just when wethought we kneweverything—aworldwide fungusinfection epidemicoccurred that hadnever been seenbefore, along with asurge of amoebic

infections that had died out but returned.Both were related to contact lens disinfec-tion and disinfecting solutions.”

In his lecture, Dr. Stern will discuss thehistory of infections in contact lens wear-ers, the reasons for the resurgences, andwhat the scientific community has learnedfrom the latest round of infections. “Wenow know that contact lens disinfectionmust be taken more seriously,” Dr. Sternsaid. “Patients often don’t think aboutwhat is best for their eyes; they only wantconvenience. And the companies feed intothis attitude, making disinfection as sim-ple as possible. But we must make disin-fection more of a priority, focusing onwhat is most important for the patients’eyes, not the patients’ convenience.”

Dr. Stern also will review FDA proto-cols on disinfecting solutions, and he willdiscuss whether the rules and guidelines

are rigorous enough.ABOUT THE SPEAKER. Dr. Stern has been

in private medical practice since 1997 atthe Three Rivers Eye Care Center in Mis-soula, Mont.

Prior to moving to Montana, Dr. Sternwas a professor of ophthalmology foralmost two decades at the University ofFlorida in Gainesville. In 2004, he receivedthe Honor Award from the Contact LensAssociation of Ophthalmologists.

RESEARCH OPPORTUNITIES. “We need to

look for disinfecting solutions that are lesstoxic and more effective, and to improvecontact lens materials that will inhibitattachment of bacteria to the lenses,” Dr.Stern said.

CHALLENGES AHEAD. “The politicianspushing universal health care are focusedon getting people insured to provide accessto care. Quality of care is a distant second,”he said.“Not a lot of consideration is beinggiven to what is happening to the doctorsand hospitals. Physicians are just pawns in

our current system. Issues that affect thephysician’s ability to practice effectivelyneed to be considered, not just gettingpeople care and paying for it. That is achallenge, and it will be for a long time.”

—L.B.S.

RUEDEMANN LECTURE Kevin V. Kelley, BCO, FASO, will presentThe ASO, 1957–2007: Fifty Years ofAdvancements (3:08 to 3:28 p.m.) duringthe Sunday Symposium titled Put the

Contact lens disin-fection must takepriority over con-sumer conve-nience, says Dr.Stern.

HONORARY LECTURES


Patient First! Ethics for the Ocularist andthe Ophthalmologist (2 to 3:30 p.m.). Thiscombined meeting with the American Soci-ety of Ocularists takes place in the ThomasB. Murphy Ballroom 4.

ABOUT THE LECTURE. For 50 years, theAmerican Society of Ocularists (ASO) has

been dedicated to athreefold purpose:to improve and pro-mote research in thedevelopment ofophthalmic pros-thetics, to advancethe methods, tech-niques and skills ofits ocularist mem-bership, and to pro-vide the public withcontinual improve-ments in the field.According to Kevin

V. Kelley, BCO, FASO, this mission hasserved as the foundation for the advancesin ocular prosthetics—helping both tostandardize training and to provide cus-tom artificial eyes of the highest quality.

“We have experienced a number ofmilestones in the past 50 years,” Mr. Kelleysaid. These include the creation of a train-ing program by the ASO in 1973 and 1974

that formalized the education of ocular-ists and set the requirements necessary to receive a diploma from the ASO, and in 1980 the establishment of a separateNational Examining Board of Ocularists(NEBO) that produced and administeredthe first certification exam for ocularists.

In his lecture, Mr. Kelley will discussthese milestones, including the ASO’s col-laboration with the Academy, as well asfuture challenges for the profession.

ABOUT THE SPEAKER. Mr. Kelley joinedthe ASO in 1978 when he began hisapprenticeship training under his father,John J. Kelley Sr.

The younger Mr. Kelley, who wasNEBO certified in 1983, and awarded fellow designation by the ASO in 1986,has served in a number of high posts withthe ASO, including chairman of the Edu-cation Committee for more than 10 years.Mr. Kelley has also served as chairman ofthe Written Exam Committee for theNEBO, and as an examiner for the NEBOpractical exam.

In 1992, Mr. Kelley received two U.S.patents and a Canadian patent for theinvention of the SLP self-lubricating prosthesis, which addresses the problemof inadequate lubrication on the surface of the prosthesis.

RESEARCH OPPORTUNITIES. “The devel-opment of porous motility implants thatcan be ‘pegged’ in order to impart moremovement to the prosthesis has revolu-tionized artificial eyes,” Mr. Kelley said.“The field continues to search for simplerand improved pegging systems that allowfor even better movement. Newer and bet-ter prosthesis materials are always an areaof research, and ocularists will continueto search for a method to incorporate amissing aspect into an ocular prosthesis:

a simple, realistic and workable dilatingpupil.”

CHALLENGES AHEAD. While the ASO has50 years under its belt, it continues toexperience some growing pains as a pro-fessional organization. “We want to con-tinue expanding membership in the ASOwithin our strict guidelines,” Mr. Kelleysaid. “Maintaining that professional quali-ty is one of our challenges as the largestteaching organization for ocularists in theworld.” —L.B.S.

HONORARY LECTURES

Take a look at thepast and future ofthe ASO with Mr.Kelley. Those words were the motto of Charles

L. Schepens, MD, a brilliant scien-tist, compassionate retina surgeon

and pioneer in the field of retinal eyecare. As well as inspiring others—hetrained 223 fellows who went on tobecome leading academicians and clini-cians—Dr. Schepens’ own life is a testa-ment to the power of single-minded dedi-cation to science, as well as courageousaction in the face of insurmountable odds.

The Academy hosts the inauguralCharles L. Schepens MD Lecture at Reti-na Subspecialty Day. A project of theSchepens International Society and theRetina Research Foundation of Houston,the lecture is intended to honor Dr.Schepens, recognize the outstanding workof retina scientists, and provide a step forward toward the goal of eradicatingblindness caused by vitreoretinal diseases,according to Alice McPherson, MD, a life-long friend of Dr. Schepens who worked to make the lectureship a reality.

Dr. McPherson, president of the RetinaResearch Foundation and professor ofophthalmology at Baylor College of Medi-cine, noted that Dr. Schepens’ all-absorb-ing commitment to science benefited bothclinicians and patients worldwide.

Dr. McPherson studied as a fellowunder Dr. Schepens at the MassachusettsEye and Ear Infirmary and, in fact, wasthe first woman he ever trained. “If itwere not for his support, I wouldn’t have a career today,” she said.

Known as the “Father of Modern Reti-na Surgery,” Dr. Schepens invented thehands-free binocular indirect ophthalmo-scope, cobbling it together from bits andpieces he found while living in Londonduring the aftermath of World War II. Healso performed the first scleral bucklingprocedure in the United States, intro-duced the encircling scleral buckle anddeveloped the laser Doppler flowmeterand the scanning laser ophthalmoscope,as well as writing more than 350 publica-tions, ranging from scientific studies tobooks.

A few days before Dr. Schepens died inMarch 2006, the consul general of Francepresented him with the French Legion ofHonor award for smuggling more than 100

people over the Pyrenees from France intoSpain during World War II—all the whilemasquerading as a Nazi collaborator.

A native of Belgium, Dr. Schepensbecame a part of the underground afterthe Nazis invaded. After being arrestedtwice, he fled to France and bought adilapidated lumber mill in the town ofMendive, France, using its tramway tosmuggle people and documents over theborder.

He eventually settled in the UnitedStates in 1947 and became the first direc-tor of the retina service at the Massachu-setts Eye and Ear Infirmary.

In 1950, Dr. Schepens founded theRetina Foundation. In 1967, he foundedthe Retina Society, which remains to thisday a forum for leaders in the field of reti-na. Then in 1974, his Retina Foundationwas renamed the Schepens Eye ResearchInstitute (SERI), which has publishedmore than 4,000 papers, trained over 600vision scientists and receives more fund-ing for eye research than any other eyeorganization in the United States. He alsofounded the Schepens International Soci-ety, which offers leadership opportunitiesand an award to individuals who havemade contributions to ophthalmology.

—Barbara Boughton, Contributing Writer

N E W L E C T U R E H O N O R S R E T I N A P I O N E E R

Never stop dreaming. What seemed impossible yesterday can become a reality tomorrow.—Charles L. Schepens, MD

MU

SE

UM

OF

VIS

ION

, A

ME

RIC

AN

AC

AD

EM

Y O

F O

PH

TH

AL

MO

LO

GY

DR. SCHEPENS. This morning (Friday) dur-ing Retina Subspecialty Day, the Academyhonors the memory of Dr. Schepens withits inaugural honorary lecture in his name.

Academy News Atlanta 2008

Health & Medicine

Transcript of Academy News Atlanta 2008