Friday, November 4, 2011

Strawberry Visual Fields Forever

In the wake of the untimely death of Apple computer founder Steve Jobs, Dale K Heuer MD, chairman and professor of ophthalmology at the Medical College of Wisconsin, Milwaukee, US, reported  on some of the firm’s contributions to medicine as well as a real breakthrough for ophthalmologists – the recent availability of classic Beatles songs on iTunes. Glaucoma specialists’ favorites include “Trabby Road,” “Strawberry Visual Fields Forever” and “Blue Eyes Yellow Submarine.”

Dr Heuer, speaking at the recent meeting of the American Academy of Ophthalmololgy in Orlando, Florida ended his tribute with a rendition of the immortal “Yesterday”:


Loss of vision seemed so far away

Then I had trabeculecto-may

Oh, how I long for Yesterday.


My vision’s half of what it used to be

There’s a shadow hanging over me

Oh vision loss came suddenly.

Why I needed more flow

I don’t know

She wouldn’t ne say

My field had something wrong

Now I long for yesterday.


Faking drops was such an easy game to play

Now my vision has all gone away.

Oh how I long for yesterday

It's all about the data for ophthalmologists

AAO is looking to national outcomes registries to defend the specialty from marauding insurance companies, politicians and optometrists.

“It’s all about the data,” AAO Executive Vice President and CEO David W Parke III MD told several thousand attendees of the opening session of this year’s annual meeting.

AAO has taken several steps to generate better information to document the complexity and value of care ophthalmologists provide. These include developing new ICD-9 diagnosis codes that more precisely describe ocular conditions, which were implemented by the Medicare program this year. Continued development of AAO’s Preferred Practice Patterns is also essential because they incorporate evidence-based care processes, said AAO President Richard L Abbott MD (pictured above)

 “Using clinical practice guidelines is not the same as ‘cookbook medicine,” he said. Rather, guidelines, including the AAO PPPs, provide a general pattern of practice which physicians must apply to individual patients using their professional judgment, clinical intuition and unique training. He pointed to the AAO’s analysis of the impact second-eye cataract surgery on patients’ quality of life, which led to a favorable national coverage decision, as an example of how good data can demonstrate the quality and value of the services ophthalmologists provide.

Dr Parke noted that other specialties in the US, notably cardiovascular surgeons, have successfully used national registries not only to improve care but to advocate for adequate reimbursement for services. This is a key issue for both preserving payments in the national Medicare system for older Americans, but also in private insurance companies. Many already profile physicians based on claims data, which do not take into account issues such as the difficulty of treating patients with advanced disease, multiple co-morbidities and other complications. As a result, some insurers have unilaterally lowered ophthalmology payments to levels reflecting uncomplicated routine care. Some states have even expanded the scope of practice for optometrists to include surgical procedures for which they are not trained.

Capturing the true level of service provided by individual ophthalmologists and the specialty as whole requires a national ophthalmology database that covers all subspecialties AAO President-Elect Ruth Williams said. Through its Hoskins research center, AAO is developing a guidelines-based database in collaboration with other ophthalmology societies.

Dr Williams envisions that the database will be linked to electronic medical records in ophthalmologists’ offices. These systems will also allow the integration of independent ophthalmic practices with larger risk-bearing delivery systems promoted by the US health reform bill passed last year, as well as by private insurance firms.

Thursday, October 6, 2011

Steve Jobs RIP

To some ophthalmologists, the name Steve Jobs won't mean a  lot. He died today aged 56 with pancreatic cancer.

So why should eye surgeons, or indeed any other health professionals, remember him?

Older ophthalmologists may find it hard to adapt to the new world order which has seen Apple's and Jobs's iPhones and iPads transform the way that we create and share information. But for young opthalmologists in training today, I would suspect that these products have become essential tools of their trade.

Recent research carried out by EuroTimes has shown that the majority of ophthalmologists still prefer to get the latest news on ophthalmology from the printed magazine. But there is a growing number of ophthalmologists  who are looking to Apps or other  applications, not only to share information, but also to help them in their day to day work.

Of course it should be pointed out that Steve Jobs alone wasn't responsible for this technological revolution,  but he became a cheerleader for a new generation that wanted and continues to want to look at new ways of seeing, hearing and speaking.

The Apple website simply states: "Apple has lost a visionary and creative genius and the world has lost an amazing human being. "

Steve Jobs, rest in peace.

Friday, September 16, 2011

Vienna or Bust

By Howard Larkin

Evidence of its imperial past, as well as the outsize personalities of its rulers, artists and warriors is never more than a short walk away in this eminently walk-able city of Vienna, site of the XXIX Congress of the ESCRS. There’s something for every interest. But watch out for horse-drawn fiacres on the narrow cobblestone lanes of the ancient city center.

Rising dramatically from the tunnel-like strasses of the city center is the Gothic cathedral Stephansdom. It’s hard to miss the gigantic Habsburg coat of arms emblazoned in green, white, red and black tiles on the roof. The foundations of this house of worship date back to the 12th Century. Since then friezes, frescos, alcoves, alters, pulpits, sarcophagi, and entire naves and towers have been added by a succession of patrons.

Many commemorate triumphs over evil in scenes mirroring Christ’s triumph over death in the resurrection. The Pulpit of Johannes Capistrano outside features a cherubim-bedecked gilt sunburst glorifying the enraptured Franciscan warrior standing over a writhing Turk. Nearby, a pious couple kneel beneath the risen Christ astride writhing demons. Inside, the master designer Pilgram looks out over his work, tools in hand.

Marble portraits of Kaisers past, including Mathias, Maximilian, Leopold I and Karls II & IV, along with Marie Antoinette, look over the crowds at the Kunsthistorisches Museum. Oil portratins and allegorical paintings by Reubens, Cranach the Edler, Rembrandt and more line the walls. The triumph of good over evil resonates throughout, from the allegorical Theseus defeating a centaur to the mythical St. George slaying the dragon to the literal Judith with the head of Holoferens.

On the campus of the University of Vienna, the Pathologisch-Anatomisches Museum chronicles the history of medicine. Samples of tubercular organs, venereal diseases and some of the oldest hip prostheses are on display. Domiciled in the former home of the psychiatric ward of the General Hospital, the barred windows and thick stone walls give further testimony to how far medicine has advanced in the past century.

And there’s Mozart and Strauss and Harry Lime. Get out and see it. Just a short walk.

Friday, September 9, 2011

There's eight days to go before the XXIX ESCRS Congress in Venice, Austria. Visit this blog for the latest news and views on this excitng event.

Wednesday, July 20, 2011

Ophthalmology - the next generation

Helen Tynan,  Head of Human Resources for Google Ireland  spoke recently at a "Commmerce and Cornflakes" breakfast , organised by the National College of Ireland and sponsored by cereal manufacturers Kellogs.

Ms Tynan told attendees at the breakfast that Google as a company has its pluses and minuses but there were things that worked for them that could be transferred to other companies.

What she didn't say, but what is true, that there are things that work for Google that could also work for ophthalmologists, particularly in the way they run and manage their practices.

 To get inside the mindsite of  Gen Y workers she asked the audience to think of teenagers aged 16 and 17 and young adults in the early 20s.

“They don’t sit, they land, they sprawl. When you are talking to them they are texting at the same time or checking their Facebook status or surfing the net. When they’re watching TV they have their laptops and they’re surfing at the same time. ake that and think about trying to put those people into a workforce and getting the best out of that generation.”

Google, said Ms Tynan, is a young company entering its teenage years and has grown up with Gen Y and the majority of its employees and managers are Gen Y so they don’t have the same challenges of assimilating this new generation of employees as older more established companies. Google was not set up as a traditional company and was never intended to become one.

So how does this philosophy transfer to the Google workforce. A typical Google workplace would include laptops everywhere,foosball, pool tables, volleyball courts, assorted video games, pianos, ping pong tables, and gyms that offer yoga and dance classes. Healthy lunches and dinners are provided for all staff at a variety of caf├ęs. and break rooms are packed with a variety of snacks and soft drinks to keep Googlers going.

But, said Ms Tynan, it’s not just fun for fun’s sake, it’s fun because it works and it encourages people to collaborate, get together and share ideas.

“It’s not all about beanbags and foosbol tables They work and they work fantastically well in a culture that has evolved around them,” she said. “Our intellectual property is our employees and from the very beginning part of the culture of Google was to take care of employees and to reward them for innovation and creativity.”

One area of particular interest, she said, is that in Google employees are allowed to spend 20 per cent of their time working on projects outside of their core working task. This is usually Google related which encourages them to come up with ideas for new products or improvements in existing products.
Gmail  was one of successful products to come out of this 20 per cent model.

Google spends a lot of its time on the hiring process and most employees will go through four or five interviews before they are recruited. They hire very bright people, said Ms Tynan, and provide them with an infrastructure to get the best out of them. “We don’t have a lot of formalities or policies. We try to let people get on with their jobs, improve their jobs and come up with new ideas. Every day we try to see what people are capable of and it’s amazing what people can do if you stay out of their way.”

So how can this translate to other companies? They should take risks with their employees and  not become overreliant on policies and procedures.  “Give employees freedom and give them trust and if it’s abused handle the cases individually . What we sometimes do in human resources is to legislate for five per cent of abuse rather than the 95 per cent of people who can be trusted.”

Good recruitment is also essential. “If you hold tough and hire the best people for your company and your culture you will reap the benefits of it,” said Ms Tynan. “This is not about academic brilliance, this is about someone who is going to demonstrate the values that are important to your culture and your team.” Even if you are desparate to fill a vacancy, she said, don’t hire someone who is not good enough and hold out for the best candidate for the job.

Openness is also important, she said, and staff should be briefed and consulted as often as possible and if they ask questions they are answered. “If you work for Google, you are trusted with information,” she said. “Confidential information is shared extensively internally.”