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.