NEWSLETTER - FALL 2003
| I. Howard Fine, MD, shares a laugh during the didactic lecture portion of the course.
On Saturday, August 23rd, Drs. Fine, Hoffman and Packer directed
the first course in the world concentrating on teaching surgeons
transitioning to bimanual micro-incision phacoemulsification. This
is a new method of doing cataract surgery through incisions about
one-half the size of the previous 2.5mm size incisions. The smaller
incisions lead to added safety and provide a very stable intraocular
environment during the removal of a cataract. This new technique
has been developed by many people, and Drs. Fine, Hoffman and Packer
have had a major impact on the evolution of the technique in terms
of refining phacoemulsification parameters on a variety of manufacturers’ machines,
and more importantly, in the development of instrumentation for use
within the eye during this process.
For this first course, we partnered
with Advanced Medical Optics (AMO), a major manufacturer of phacoemulsification
equipment and intraocular lenses, who sponsored the course. AMO
invited their high volume surgeons from throughout North America
and one from Paris, France, the professor and chairman of the department
at the University of Paris. About 25 surgeons took part in the
program, which included three hours of didactic lectures explaining
the evolution, development and current status of bimanual micro-incision
phaco, and also surveyed the future as intraocular lenses capable
of being implanted through these tiny incisions are continuing to
evolve. We then used videotaped cases to document and illustrate
the points of lecture. During the lecture, we also included an introduction
to the use of capsular tension rings, which are used to add safety
to patients in whom the connection of a cataract to the wall of
the eye is weakened.
|Mark Packer, M.D. answers questions after surgery.
completion of the didactic portion of the course, each of Drs.
Fine, Hoffman and Packer performed a live surgery conveyed via closed
circuit television to the optical shop of our clinic, which was turned
into an auditorium for this course. Afterward, each of the participants
had an opportunity to examine, under the slit lamp, the three immediate
post-operative patients, as well as six other patients who had
been operated in the past, each of whom represented a difficult and
unusual challenge at the time of surgery, which was best handled
by bimanual micro-incision phacoemulsification.
After a luncheon,
each of the 25 participants had an opportunity to perform this
surgical procedure using all of the instrumentation that we have
developed, which was brought for their use by the companies with
whom we worked in the development of these instruments. AMO provided
5 phacoemulsification machines for use in animals, and each surgeon
had an opportunity to practice all of the maneuvers involved in this
new procedure on animal eyes.
|Richard Hoffman, MD, assists a course member during the wet lab portion of the course.
At the completion of the course,
each of the participants were asked to evaluate the effectiveness
and value of the course. This is commonly done in Continuing Medical
Education courses for physicians as it enables the educators and
the manufacturers to continuously update and refine their courses
in order to be as relevant as possible. I have participated in
hundreds of courses internationally on every component of cataract
surgery, and these were the best evaluations that I have ever seen.
Without exception, each of the participants rated it as an excellent
course, and many indicated it was the best Continuing Medical Education
course in which they had participated, and almost all indicated they
planned to return to their own clinics and start performing this
We are now making plans for
continuous work with AMO and other manufacturers in producing more
of these courses in order to help doctors provide a better surgical
procedure for their patients. Once again, Drs. Fine, Hoffman and
Packer, are happy to be at the leading edge of the art and science
of cataract surgery. [ top ]
Dr. Hoffman has been promoted to the position of Clinical Associate
Professor at Oregon Health & Science University, where he has
served as a Clinical Instructor in the School of Medicine’s
Department of Ophthalmology for the past 7 years. Dr. Hoffman is
the only fellowship-trained corneal specialist in Lane County. He
has extensive experience in corneal transplantation and excimer laser
refractive surgery, and has conducted research in corneal disease,
wound healing, ocular oncology and other topics.
Dr. Packer was also
recently honored by being selected to participate in the American
Academy of Ophthalmology Leadership Development Program for 2003-2004.
As a member of the Leadership Development Program, he will be spearheading
projects in such areas as communication, public service, public relations
and training of physicians.
Finally, in June, Dr. Fine was honored
to give his eleventh named lectureship, in honor of Marvin Kwitko,
a well-known Canadian ophthalmologist. His presentation entitled, “Refractive
was very well received. We are very proud of our doctors! [ top ]
|Mark Packer, M.D
We are excited to announce that Carl Zeiss
has chosen our practice as one of only four sites in the United
States to investigate exciting new technology for vision correction
and make it available during clinical research monitored by the
Food and Drug Administration. The principles of this new technology
stem from ideas that first took root in the science of astronomy.
astronomers want an accurate image of a distant planet or galaxy
they employ fascinating technology known as wavefront science.
The term wavefront refers to the wave of light as it travels
from the object to form the image. The problem is that light
coming from a far away star is scattered and distorted or aberrated
as it travels through earth’s atmosphere. These aberrations
produce a blurry image. However, astronomers have now learned
how to compensate for the aberrations and sharpen the image by
using adaptive optics.
Adaptive optics relies on a lens which
can adapt to and eliminate the aberrations in a wave of light,
producing a faithful image of any object. The detailed, awe-inspiring
pictures of planets and stars we see today have been enhanced
through wavefront science and adaptive optics.
We now have the tools to measure the wavefront
aberrations of the human eye, and we will soon begin investigation,
here in our office in Eugene, of the Carl Zeiss MEL - 80, an
excimer laser designed to eliminate optical aberrations, as well
as to correct near-sightedness, far-sightedness and astigmatism.
If you are interested in learning more about wavefront-guided
LASIK surgery or finding out if you may be a candidate for inclusion
in the study, please contact Tony Reynolds today at 541-687-2110. [ top ]
Recent FDA approval of the eye
drop Restasis™ has given ophthalmologists a new effective
tool for treating the dry eye condition. Dry eyes can result
from aging, menopause, allergies, environmental stresses, ocular
surgery, and oral medications. Current accepted treatments
for dry eye include lubrication with artificial tears, tear
conservation with punctal occlusion (plugs or surgery), or
lifestyle changes by moving to an environment with more moisture
or eliminating certain oral medications.
| Richard S. Hoffman,
Restasis is a unique medication for dry
eye in that it treats the underlying problem contributing to
the dry eye condition – ocular
surface inflammation. Reduction of ocular surface inflammation
has been demonstrated in many patients to result in increased
tear production and improved ocular comfort and ocular surface
Restasis consists of the immunosuppressant
cyclosporine 0.05% within an oil emulsion that aids in its
absorption into the ocular surface. The medication is used
only twice a day and will usually start to have its beneficial
effect in 1-2 months. Side effects of the medication include
localized stinging and burning in some individuals. None of
the medication has been found to be absorbed into the bloodstream
so it has no effects other than those on the eye. Recent studies
have demonstrated improvements in baseline tear secretion scores
in 59% of treated patients with 15% of treated patients having
profound improvements in their tear production.
the medication is expensive and can cost $50-100 per month
depending on the method of instillation. Fortunately, we understand,
it is on most insurance pharmacy plans. Most patients who have
benefited from Restasis have found it to be well worth the
expense since they can decrease or eliminate the artificial
tears that they were previously using every 1-2 hours. The medication
does need to be used indefinitely since discontinuation will
ultimately result in return of the ocular surface inflammation
and an associated decrease in tear production.
The best candidates
for Restasis are patients with moderate to severe dry eyes
who are requiring artificial tears more than four times a day
in order to achieve ocular comfort. If you believe you might
benefit from this new medication, call for an appointment or
mention Restasis at your next routine eye exam. [ top ]
| Marcos Fandino
We are very proud of our technicians and are pleased to share
their latest accomplishments in certification. Marcos Fandino
was awarded the Certified Ophthalmic Assistant credential after
successfully passing his written exam.
Established in 1969,
the Joint Commission on Allied Health Personnel in Ophthalmology
(JCAHPO), is an international nonprofit corporation that certifies
and provides continuing educational opportunities to ophthalmic
allied health professionals. JCAHPO is accredited by the National
Commission for Certifying Agencies (NCCA). Their mission is to “Enhance
the quality and availability of ophthalmic patient care by promoting
the value of qualified allied health personnel and by providing
certification and continuing education.”
Congratulations, Marcos! We are proud of you! [ top ]
| Michael Potter and Son
I went to Dr. Fine for a second opinion regarding a difficult and challenging
cataract surgery. Previous eye surgery done elsewhere years ago had
left unpleasant memories, so I went in with a healthy dose of skepticism
and anxiety. I asked a lot of questions and discovered differences
in the approach contemplated by Dr. Fine. This resulted in many hours
of research, not only of the various differences but also of Dr. Fine.
The more research I did, the more impressed I became. After weeks of
researching and asking follow-up questions, I finally decided on Dr.
Fine for the surgery.
The surgery was performed under topical anesthesia
and was due to the complicated nature. As it turned out, the surgery
and recovery were much easier than all the research and debate over
who would perform the surgery warranted. There was virtually no discomfort
from the time the surgery started through the recovery period. I
even went on my first mountain bike ride 4 days after surgery with
So how did it turn out? The improvement is not
just good, it is spectacular! For the first time ever I can see my
5 year old son out of that eye and see him with nearly 20/20 vision.
I want to thank not only Dr. Fine (who knocked the ball out of the
park), but the entire staff for their patience (I asked a lot of
questions!), professionalism, and obvious dedication to upholding the
highest standards. What started out with anxiety has turned out to
be one of the most wonderful experiences I have ever had. [ top ]