Monday, December 15, 2008

The sky is not falling - ophthalmology will survive

The Obama feel-good factor was not shared by all of those attending the joint meeting of the American Academy of Ophthalmology (AAO) and the European Society of Ophthalmology (SOE) in Atlanta, Georgia, US.

Big drops in the share price of the leading ophthalmic companies and reports from individual doctors of a reduction of more than 40 per cent in LASIK procedures in the last three months have put a dampener on the post-election celebrations for some doctors.

The global economic meltdown is showing up on the bottom line of finance companies specialising in LASIK and other discretionary medical procedures. Capital One and Care Credit both reported a slowdown in business in the past two months. Tightening credit standards mean it’s getting harder to qualify some patients for loans and default rates on outstanding commitments are climbing.

But every cloud has a silver lining and one of the biggest growth areas in the next 12 months will be the market for practice management consultants and practice management seminars.
Ophthalmologists in the desperate search for a bang for their buck can expect to be bombarded with literature inviting them to pay top dollar for seminars on topics including, "Good news in a depression" and "The sky is not falling".

But ophthalmology, like other medical disciplines, should not be just about money and while doctors should also listen to the advice of practice management experts and other economic consultants, they should also set themselves standards that they will strive to achieve in good times and bad times.

This point was emphasised at the Meet the Masters presentation, sponsored by AMO, where residents attending the AAO/SOE meeting were invited to hear pearls of wisdom from Dr Michael Colvard (pictured above), Dr Bobby Osher and Dr Ralph Chu.

We won't go into a speaker-by-speaker check list of the individual messages from the masters but below are some of the pearls of wisdom they offered to the young doctors attending the meeting.

* Never ridicule anyone's new idea.
* People will forget everything you tell them but they will never forget how you make them feel.
* It's a very small world. Be honest when you speak.
* Always ask yourself what do you like doing and be passionate about what you do.
* It's not always about economic gain.
* Don't allow yourself get stale.
* Treat your patients like you would treat your families.
* You can't always cure but you can always comfort.
* Nobody can train you how to develop emotionally as a doctor.
* Never get cocky about your surgical skills.

Ophthalmology in the new Europe

This month EuroTimes looks at ophthalmology in the new Europe. Among those featured is Levon Barseghyan, MD, professor and head of the Ophthalmology Department of the National Institute of Health in Armenia.

Dr Barseghyan (pictured above) says his country faced a lot of difficulties after the break-up of the Soviet Union, but ophthalmologists have continued contacts with the major centres in Moscow and Ukraine.

Dr Barseghyan, who studied at the Filatov Eye Institute in Odessa, Ukraine and in Moscow, says that while contacts among Russian-speaking ophthalmologists are not as frequent as before, they continue. And that is why the Fyodorov meeting is so important, he says.

Other major influences on Armenian ophthalmology come from outside the region. One such influence is Roger Ohanesian, MD, the founder of the Armenian EyeCare Project. Dr Barseghyan explains that Dr Ohanesian has brought doctors to Armenia from abroad, helped to train Armenian doctors in the US, and donated such equipment as phaco machines. “He has also brought a mobile hospital to Armenia, which is very well equipped,” Dr Barseghyan adds.

While older ophthalmologists continue to promote ophthalmology in their countries, the future of the specialty lies with a new generation of young Armenian ophthalmologists, Dr Barseghyan says.

“There are better opportunities for our young ophthalmologists than there was in my time,” he says. “They can travel to international conferences, they can gather information from the Internet. By getting more knowledge, they can become better doctors.”

Ophthalmologists are never at war

Political tensions may continue to cast a shadow over relations between Russia and some of the other countries that were once part of the Soviet Union. Despite such clouds, the clear message from the delegates attending the recent IXth International Congress of the Russian Society of Ophthalmologists is that the international brotherhood and sisterhood of ophthalmology is, if anything, growing stronger.

This point is strongly borne out by Merab Dvali, MD, professor and chief of the Eye Department at the Tbilisi State Medical University Ophthalmology Department in Georgia.

“Years ago we were one big country with a common education, the same teachers and the centre of ophthalmology in the Soviet Union was Moscow,” Dr Dvali remembers during a break in the congress at the Fyodorov Complex in Moscow.

“I worked in Moscow for 19 years, and it continues to be a very important centre. Unfortunately, over the last 12 months, we have had political differences with Russia but I think the doctors in both of our countries have stayed friends. We were, and will be, brothers and sisters. We have no borders. Ophthalmologists never war. I hope our governments will take the same approach."

Dr Dvali says for Georgian ophthalmologists it is very important to have close links both with Russia and other European countries.
“It is very difficult for our patients to go abroad and get treatment. We are a small country and we do not have enough eye surgeons, but we are doing our best and we try to use the latest technologies.”

While state-funded clinics in Georgia often struggle for funds, an increasing number of private clinics are being developed, says Dr Dvali. Young ophthalmologists in Georgia are also being encouraged to travel overseas for training. “We are supporting one young doctor who we have sent to India to get training in vitreo-retinal surgery. He knows the theory, but he needs practical experience and in India he will get that experience. Another doctor has gone to Spain to study keratoplasty surgery.”

So what should be the model for developing ophthalmology in Georgia? While Dr Dvali is full of admiration for the work done at the Fyodorov Complex, he does not think that a complex of that size should be replicated in his country.
“It is my opinion that eye clinics should not be as big as Fyodorov. Under the old socialist system it was possible to build a big clinic like Fyodorov, but I do not think it is necessary to have a complex of that size,” he says. “For example, my own clinic is a 200-square-metre outpatient clinic. We do laser, we do phaco, and we do all surgery in this clinic. The most important thing is good equipment and good doctors.”

In 1999, Prof Dvali bought the first excimer laser into his clinic. “It was very difficult to raise the money,” he recalls. “But I was able to raise the finance with the help of five friends who were not ophthalmologists. They believed in me and they supported me and that was very important.”

Because of the lack of resources in government clinics – like the one he runs – Dr Dvali is using his private clinic to train his residents.
He notes that in many western European countries, ophthalmologists are concerned about the growth of the private ophthalmology sector at the expense of the public sector. In Georgia, however, private clinics are essential for the development of ophthalmology, he says.

“Public and private patients get the same treatment,” he says. “We also have a mobile clinic that allows us to go to small villages and carry out surgery. If a patient does not have money, he does not get a poor service.”

* A full report on Ophthalmology in the new Europe will be published in December EuroTimes. You can also visit our website at